乳腺癌肝转移外科治疗进展
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[1. 中国人民解放军海军军医大学第三附属医院(东方肝胆外科医院) 肝胆外科,上海 200438;2. 中国人民解放军海军军医 大学第一附属医院(长海医院) 甲乳外科,上海 200433]

作者简介:

李恒宇,中国人民解放军海军军医大学第一附属医院(长海医院)副主任医师,主要从事乳腺癌肝转移方面的研究。

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Advances in surgical treatment of breast cancer liver metastases
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[1. Department of Hepatobiliary Surgery, Third Affiliated Hospital (Eastern Hepatobiliary Surgery Hospital) of Naval Medical University, Shanghai 200438, China; 2. Department of Thyroid and Breast Surgery, First Affiliated Hospital (Changhai Hospital) of Naval Medical University, Shanghai 200433, China]

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    摘要:

    乳腺癌是全球女性最常见的恶性肿瘤,其中肝转移是导致高病死率的主要原因。随着外科技术的进步,特别是腹腔镜手术和微创技术的发展,外科治疗已成为乳腺癌肝转移(BCLM)综合治疗策略中的重要组成部分。但通过对国内外研究成果进行纵向和横向比较分析发现,不同地区在BCLM外科治疗实践中存在差异。国际上的研究多聚焦于技术创新和治疗效果的提升,而国内研究则更侧重于手术方法的优化、新兴治疗技术的探索,以及中西医结合治疗的可能性。这些研究的差异反映了不同地区在医疗资源、技术水平和治疗理念上的多样性。既往BCLM的外科治疗研究主要依赖于回顾性分析,这些研究往往质量参差不齐,加之研究结果间的显著差异,其可信度遭受限制。鉴于此,近年来国际与国内的研究领域已开始积极转向实施前瞻性研究,这一变革象征着BCLM外科治疗研究正朝着更高的质量标准和更广泛的影响力发展。我国在这一领域的研究规模仍显不足,亟需扩大研究范围并与国际研究水平同步,以确保获得更加可靠和具有代表性的研究成果。未来,研究焦点应集中在深入理解BCLM的生物学机制,进一步开展液体活检、分子分型和基因检测等技术的应用,为BCLM患者提供更精准的个性化治疗方案。此外,提高手术精准度和安全性以及通过网络和远程医疗提升手术治疗的可获得性,是未来发展的关键方向。尽管BCLM外科治疗面临诸多挑战,但随着科技进步和多学科合作的深入,外科治疗有望为BCLM患者带来更好的生存率和生活质量。未来研究需要继续探索新的治疗方法,以进一步提高BCLM患者的治疗效果和预后。

    Abstract:

    Breast cancer is the most common malignant tumor among women worldwide, with liver metastasis being a major cause of high mortality rate. With advancements in surgical techniques, particularly laparoscopic and minimally invasive surgeries, surgical treatment has become an important component of the comprehensive treatment strategy for breast cancer liver metastasis (BCLM). However, a longitudinal and cross-sectional analysis of domestic and international research reveals differences in surgical treatment practices for BCLM across regions. International studies tend to focus on technological innovations and improvements in therapeutic efficacy, while domestic research emphasizes optimizing surgical methods, exploring emerging treatment technologies, and the potential of integrating traditional Chinese and Western medicine. These differences reflect the diversity in medical resources, technological levels, and treatment philosophies across regions. Past studies on the surgical treatment of BCLM mainly relied on retrospective analyses, which often varied in quality and had significant discrepancies in results, thus limiting their credibility. In light of this, recent years have seen a shift towards prospective studies in both international and domestic research, signaling a move towards higher quality standards and broader impact in BCLM surgical treatment research. In China, the scale of research in this field remains insufficient, necessitating an expansion of research scope to synchronize with international standards and ensure more reliable and representative outcomes. Future research should focus on a deeper understanding of the biological mechanisms of BCLM and further application of technologies such as liquid biopsy, molecular typing, and genetic testing to provide more precise and personalized treatment plans for BCLM patients. Additionally, improving surgical precision and safety, as well as enhancing the accessibility of surgical treatment through networks and telemedicine, are key directions for future development. Despite the numerous challenges in the surgical treatment of BCLM, advancements in technology and multidisciplinary collaboration are expected to bring better survival rates and quality of life for BCLM patients. Continued exploration of new treatment methods is essential to further improve the treatment efficacy and prognosis for BCLM patients.

    表 1 2014—2024年国际BCLM外科治疗研究概览Table 1 Overview of international research on surgical treatment for BCLM from 2014 to 2024
    表 3 2014—2024年国内BCLM外科治疗研究概览Table 3 Overview of domestic research on surgical treatment for BCLM from 2014 to 2024
    表 2 2014—2024年国际BCLM外科治疗研究概览(续)Table 2 Overview of international research on surgical treatment for BCLM from 2014 to 2024 (continued)
    图1 BCLM外科治疗的历史发展Fig.1 Historical development of surgical treatment for BCLM
    图2 2014—2024年BCLM外科治疗研究数量分布图 A:地区分布图;B:时间分布图Fig.2 Distribution of research on surgical treatment for BCLM from 2014 to 2024 A: Regional distribution; B: Temporal distribution
    图3 2014—2024年HR与RFA在BCLM治疗中的应用及其效果分析 A:不同外科治疗方法的比例分布;B:治疗效果比较;C:HR有利预后因素的支持研究数量;D:RFA有利预后因素的支持研究数量Fig.3 Application and efficacy analysis of HR and RFA in the treatment of BCLM from 2014 to 2024 A: Proportional distribution of different surgical treatment methods; B: Comparison of treatment outcomes; C: Number of supporting studies on favorable prognostic factors for HR; D: Number of supporting studies on favorable prognostic factors for RFA
    图1 BCLM外科治疗的历史发展Fig.1 Historical development of surgical treatment for BCLM
    图2 2014—2024年BCLM外科治疗研究数量分布图 A:地区分布图;B:时间分布图Fig.2 Distribution of research on surgical treatment for BCLM from 2014 to 2024 A: Regional distribution; B: Temporal distribution
    图3 2014—2024年HR与RFA在BCLM治疗中的应用及其效果分析 A:不同外科治疗方法的比例分布;B:治疗效果比较;C:HR有利预后因素的支持研究数量;D:RFA有利预后因素的支持研究数量Fig.3 Application and efficacy analysis of HR and RFA in the treatment of BCLM from 2014 to 2024 A: Proportional distribution of different surgical treatment methods; B: Comparison of treatment outcomes; C: Number of supporting studies on favorable prognostic factors for HR; D: Number of supporting studies on favorable prognostic factors for RFA
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江庆良,李恒宇.乳腺癌肝转移外科治疗进展[J].中国普通外科杂志,2024,33(5):683-696.
DOI:10.7659/j. issn.1005-6947.2024.05.002

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  • 收稿日期:2024-03-15
  • 最后修改日期:2024-05-20
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  • 在线发布日期: 2024-06-06