摘要目的:探讨真空辅助旋切（VAE）与开放手术对乳腺良性叶状肿瘤术后局部复发的影响。方法:回顾性分析广东省妇幼保健院2013年1月至2018年1月收治的128例乳腺良性叶状肿瘤患者的临床资料，均为女性，年龄为（37.7±9.1）岁（范围：16~56岁）。80例接受超声引导下VAE（微创组），48例接受开放手术（开放组）。采用 t检验、χ 2检验或Fisher确切概率法比较两组患者的临床资料，采用Logistic回归分析术后局部复发的预后因素。 结果:微创组肿瘤最大径小于开放组[（20.6±7.4）mm比（42.0±2.0）mm， t=-7.173， P=0.000]。随访时间为（36.4±1.8）个月（范围：12~71个月），7例发生局部复发，微创组和开放组局部复发率分别为5.0%（4/80）和6.3%（3/48）。多因素分析结果显示，肿瘤最大径≥25 mm是术后局部复发的独立预后因素（ OR=0.122，95 %CI：0.016~0.901， P=0.039），手术方式、年龄、绝经状态及同侧乳房曾患纤维腺瘤病史不是术后局部复发的独立预后因素。微创组肿瘤最大径<25 mm和≥25 mm患者的局部复发率分别为2.9%（2/69）和2/11。 结论:乳腺良性叶状肿瘤术后局部复发与肿瘤大小密切相关。对于肿瘤最大径<25 mm者，VAE术后局部复发率低，术中应保证切除范围以避免局部复发。

abstractsObjectives:To examine the effect of VAE and open surgery on the postoperativelocal recurrence of benign phyllodes tumors of breast and to investigate the clinical efficacy of VAE in the treatment of benign phyllodes tumors.Methods:The clinical data of 128 patients with benign phyllodes tumors of breast admitted to the Guangdong Women and Children Hospital from January 2013 to January 2018 were retrospectively analyzed. All patients were female, aged (37.7±9.1) years (range: 16 to 56 years). Eighty patients underwent ultrasound-guided VAE (minimally invasive group) and 48 patients underwent open surgery (open group). The t-test, χ 2 test or Fisher exact probability method were used to compare the clinical characteristics of the two groups of patients. Logistic regression was used to analyze the prognostic factors of postoperative local recurrence. Results:The maximum diameter of tumor in the minimally invasive group was smaller than that in the open group ((20.6±7.4) mm vs. (42.0±2.0) mm, t=-7.173, P=0.000). The follow-up time was (36.4±1.8) months (range: 12 to 71 months). There were 7 cases of local recurrences during the follow-up period. The local recurrence rates in the minimally invasive and open groups were 5.0% (4/80) and 6.3% (3/48). The results of multivariate analysis showed that the maximum tumor diameter of 25 mm was an independent prognosis factor for postoperativelocal recurrence ( OR=0.122, 95 %CI: 0.016 to 0.901, P=0.039). While surgical procedure, age, menopausal status and history of fibroadenomas in the ipsilateral breast is not an independent prognostic factor for postoperative local recurrence. In the minimally invasive surgery group, the local recurrence rates were 2.9% (2/69) and 2/11 in patients with tumor maximum diameters<25 mm and ≥25 mm, respectively. Conclusions:Local recurrence of breast benign phyllodes tumors is closely related to the tumor size. For patients with tumor diameter <25 mm, the postoperative local recurrence rate of VAE is low, which can be used in clinical practice. Intraoperative complete resection to achieve a negative surgical margin should be guaranteed to avoid local recurrence.