目的:分析保乳手术切缘阳性率及影响因素，探讨采用彩超引导切除病灶及周边1 cm 组织范围的
可行性。方法: 2013－04～ 2018－02 期间，本单位进行保乳手术的病例为研究对象，彩超引导切除病灶及周边1
cm 组织，采用墨汁染色法检查切缘情况，回顾分析病灶切缘阳性率及其影响因素。结果: 共89 例保乳手术纳入
研究，平均年龄42．41岁，病灶切缘阳性率为15．7%( 14 /89 例) ，浸润性癌较导管内癌和浸润性癌伴导管内癌的切
缘阳性率低( 7．3% vs 22．9%，P= 0．044) ，组织学高级别较低、中级别切缘阳性率高( 63．6% vs 9．0%，P ＜0．001) ;
切缘阳性与年龄、病灶大小、肿块是否可触及、是否合并可疑恶性钙化、病灶边界、新辅助化疗、淋巴结转移、雌激
素受体状况等无关。结论:保乳术中应用彩超引导确定病灶周边1 cm 切除范围是可行的，但对于组织学高级
别、穿刺病理为导管内癌或浸润性癌伴导管内癌病例，可适当增加切除范围。

Objective: To analyze the surgical margin positive rate of breast － conserving surgery
( BCS) and its influencing factors，and to explore the feasibility of ultrasound guidance resection of the
lesion and surrounding 1 cm tissue． Methods: From April 2013 to February 2018，the patients
received BCS in the university of HongKong Shenzhen hospital were recruited，ultrasound guidance resection
of lesion and surrounding 1 cm tissue，positive margin defined as ink on invasive carcinoma or
ductal carcinoma in situ ( DCIS) ，positive margin rate and its influencing factors were reviewed．
Ｒesults: A total of 89 cases included in this study，average age was 42．41 years，the overall margin
positive rate was 15．7% ( 14 /89) ，the positive margin rate of invasive carcinoma was lower than DCIS
and invasive carcinoma combined with DCIS ( 7．3% VS 22．9%，P = 0．044) ，the positive margin rate of
high grade tumor was higher than low grade and middle grade ( 63．6% VS 9．0%，P＜0．001) ． The age，
lesion size，palpation，mass with suspicious calcification，lesions border，neoadjuvant chemotherapy，
lymph node metastasis and estrogen receptor did not affected with margin positive ． Conclusion: Ultrasound
guidance resection of the lesion and surrounding 1 cm tissue in BCS was feasible，but the histo-
logical high grade tumor，DCIS and invasive carcinoma combined with DCIS should be increased resection
surrounding tissue．

Ｒ445．1

 收稿日期: 2018－03－15; 修回日期: 2018－07－12
基金项目:广东省医学科学技术研究基金项目( B2016137)
作者简介:郑爱秋( 1970－) ，女，香港大学深圳医院乳腺外科副主任医师，医学硕士。
通讯作者:许晓华，主任医师，E－mail: XH160@ 163．com 香港大学深圳医院影像科，518053