乳腺癌保留乳房治疗后乳房美容效果的影响因素探讨

目的回顾性分析早期乳腺癌患者保留乳房治疗后影响美容效果的相关因素。方法本院于1999年11月至2008年12月对162例临床0、Ⅰ、ⅡA期的乳腺癌患者实施保留乳房治疗,将乳头横向移位距离、乳头纵向移位距离、体表凹陷程度、乳房质地与弹性及皮肤色泽作为保留乳房治疗后的评判指标,于放射治疗后6个月综合评分判断美容效果。良好率差异比较采用卡方检验。结果共实施保留乳房手术162例,占同期乳腺癌手术患者的12．8％（162／1266）,术后病理分期为0期32例,Ⅰ期83例,ⅡA期47例。全部病例获随访,复发率为9．9％（16／162）。保留乳房治疗后美容效果良好占61．1％（99／162）,一般占35．2％（57／162）,差占3．7％（6／162）。采用双切口、保留皮肤、肿瘤广泛切除及适形放射治疗等技术者美容效果良好率显著高于单切口、切除皮肤、象限切除及非适形放射治疗组（P〈0．01）,而肿瘤分期和术后放射治疗开始时间是否早于12周对美容效果无影响（P〉0．05）。结论乳腺癌患者保留乳房治疗后美容效果良好,采用双切口、保留皮肤和肿瘤广泛切除等手术技巧以及适形放射治疗可提高保留乳房治疗的美容效果。     

乳腺癌保留乳房治疗远期疗效的研究

目的探讨临床Ⅰ、Ⅱ期乳腺癌选择性行乳腺癌保留乳房治疗（BCT）的远期生存、同侧乳腺复发（IBR）、美容效果及其相关因素。方法对1985年10月至2000年12月收治的270例Ⅰ、Ⅱ期乳腺癌患者进行BCT远期疗效的临床研究。乳腺癌保乳手术先后采用乳腺象限／区段切除术及肿瘤扩大切除术，联合全腋窝淋巴结清扫术。术后放射治疗先后采用^60Co及加速器全乳放射治疗及瘤床缩野照射。结果在10年的中位随访时间内，270例BCT患者10年总生存率83．7％、IBR8．5％、远处转移率23．7％。患者年龄、肿瘤大小、病理组织学类型、腋窝淋巴结转移状况等临床病理因素对BCT后IBR无显著性影响（均P〉0．05），切缘阳性、术后未行全乳照射的患者IBR显著升高（均P=0．000）。在确保切缘阴性的前提下，不同切除范围的手术方式对IBR无显著性影响（P=0．799），但切除范围较大的区段／象限切除术对BCT后乳房美容效果有显著不良影响（优秀P=0．043，优秀＋良好P=0．005）。结论①临床Ⅰ、Ⅱ期乳腺癌选择性行BCT有较高的远期疗效、较好的美容效果和较低的IBR，可以安全地替代乳房切除性手术。②确保切缘阴性及接受术后全乳放射治疗仍是现阶段乳腺癌BCT的金标准。③在确保切缘阴性的前提下，切除范围较小的肿瘤扩大切除术有较好的美容效果和相同的治疗效果。     

极限肿瘤整形技术:乳腺癌保留乳房肿瘤整形技术新挑战

目前,中国乳腺癌的发病率呈逐年上升趋势。对于早期乳腺癌患者,保留乳房手术是重要的外科治疗手段之一,可在切除病灶的同时保留乳房的外形,提高患者的生活质量。近年来,对于部分以往推荐接受全乳切除的乳腺癌患者,特别是保留乳房相对禁忌的患者,可以通过极限肿瘤整形技术,保留部分乳腺组织,并最大化的保留乳房外形。笔者通过介绍极限肿瘤整形技术,对其常见整形方式的选择与影响因素进行综述,以期在保留乳房手术切缘及肿瘤整形美容效果之间寻求最佳平衡点,在不影响乳腺癌常规外科治疗的基础上,修复乳房缺损,进一步提高患者的生活质量。     

早期乳腺癌保留乳房术后放射治疗临床研究

目的 观察早期乳腺癌保留乳房术后放射治疗的疗效、乳房美容效果及并发症.方法 随访2001年1月至2008年9月治疗的78例早期乳腺癌患者,其中Ⅰ期36例,Ⅱ期42例.术后全乳切线照射50 Gy,瘤床追加电子线照射10 Gy.淋巴结阳性者,患侧锁骨上X线和电子线混合照射50 Gy.结果 随访6～98个月,局部复发率4.9%,3年总体生存率96.6%,5年总体生存率92.7%,乳房美容满意率94.9%,治疗后并发症主要有皮肤急性反应及上肢水肿.结论 乳房保留手术加术后根治性放射治疗早期乳腺癌可获得满意的生存率及美容效果,提高了患者的存活质量.     

乳腺癌保留乳房术后放射治疗并发症与美容效果

目的 介绍乳腺癌保留乳房治疗的手术模式、放射治疗技术、放疗并发症及美容效果。方法 １９８５年９月至１９９６年６月共６５例女性乳腺癌病人接受了保留乳房术后根治性放疗，其中，Ⅰ期２９例，Ⅱ期３４例，Ⅲ期２便，肿瘤位于外上象限者５２例，其他２象限者１３例。手术模式为乳房肿瘤扩大切除术加腋淋巴结清扫术。全部病人均于术后２个月内接受根治性放疗，各野的中位剂量为内乳ＤＴ５３．２Ｇｙ，锁上ＤＴ５５．４Ｇｙ、全乳     

放射治疗对乳腺癌术后乳房重建的影响

放射治疗在乳腺癌术后的治疗中扮演着重要的角色,乳房重建在乳腺癌术后的治疗中也逐渐被患者接受,放射治疗对乳房重建的影响成为放疗科、乳腺外科和整形外科医生共同关注的问题.本文介绍乳腺癌患者乳房重建的技术和时机选择,以及放射治疗对重建乳房美容效果的影响,同时分析乳房重建对放射治疗技术设计的要求以及在不同放射治疗背景下最合适的乳房重建术.     

乳腺癌保留乳房术后放射治疗并发症与美容效果(附65例报告)

目的介绍乳腺癌保留乳房治疗的手术模式、放射治疗技术、放疗并发症及美容效果。方法１９８５年８月至１９９６年６月共６５例女性乳腺癌病人接受了保留乳房术加术后根治性放疗，其中，Ⅰ期２９例，Ⅱ期３４例，Ⅲ期２例，肿瘤位于外上象限者５２例，其他象限者１３例。手术模式为乳房肿瘤扩大切除术加腋淋巴结清扫术。全部病人均于术后２个月内接受根治性放疗，各野的中位剂量分别为内乳ＤＴ５３．２Ｇｙ、锁上ＤＴ５５．４Ｇｙ、全乳切线ＤＴ４９．２Ｇｙ、瘤床追加ＤＴ１４．６Ｇｙ。结果病人的３年和５年生存率分别为９３．６％、９１．７％；出现急性放射反应者１３例，占２０％；出现放射性肺炎／肺纤维化者４例，发生率６％；出现乳房／胸壁纤维化者２例。治疗后美容效果医患均满意者占９２．３％。结论早期乳腺癌保留乳房加术后根治性放疗与根治性手术疗效相同，只要选择病例恰当并掌握好手术模式和放疗技术，其手术和放射并发症的发生率是可以接受的，而且具有良好的美容效果。     

倒T形切口缩乳术在乳房肥大或合并乳腺癌患者中的应用

目的探讨倒T形切口缩乳术在乳房肥大患者，特别是合并乳腺癌的患者手术中的应用及其临床意义。 方法本回顾性研究共纳入2007年10月到2017年10月分别在同济大学附属东方医院及附属同济医院乳腺外科行缩乳术的39例乳房肥大女性患者，均采用倒T形切口(内侧蒂25例，垂直蒂5例，外侧蒂9例)。其中，包括18例符合保留乳房手术指征的乳腺癌患者(内侧蒂10例，垂直蒂4例，外侧蒂4例)。术后6、12个月评价美容效果(乳腺癌患者待放射治疗结束后进行评价)。评估患者的术后并发症、满意度以及复发转移情况。 结果39例患者术后乳房外形自然、对称，明显缩小上提，乳头、乳晕血供和感觉良好，瘢痕不明显，患者满意度高。1例术后2周出现一侧乳房的乳头乳晕区坏死，经过清创换药后愈合。5例术后双侧乳头乳晕感觉减退，其中4例在术后6个月左右恢复正常感觉，1例在术后12个月恢复。5例出现术后局部乳房组织硬结，其中3例为接受过放射治疗的乳腺癌患者，二次手术切除硬结后无再次发生。3例出现瘢痕处猫耳畸形，再次局部麻醉手术修整后效果良好，3例瘢痕增粗，其余患者瘢痕正常。乳腺癌患者中有3例出现放射治疗后患侧乳房皮肤水肿，术后12个月消退。术后6个月进行了美容效果评价，极好25例，良好10例，中等4例，差0例(18例乳腺癌患者中，极好9例，良好6例，中等3例，差0例)。术后12个月的美容效果评价显示：极好25例，良好13例，中等1例，差0例(18例乳腺癌患者中，极好9例，良好8例，中等1例，差0例)。随访时间最长的1例患者(双侧乳房单纯性重度肥大)术后观察了10年，乳房外形无明显变化。全部患者术后随访15～120个月，中位随访61个月，18例乳腺癌患者均无局部复发转移。 结论对于乳房肥大，特别是合并乳腺癌的患者，采用倒T形切口缩乳术，既可切除病变，又可缩小并悬吊乳房。     

乳腺癌保留乳房肿瘤整形术合并同期健侧乳房对称性整形手术10例分析

保留乳房手术已成为早期乳腺癌的标准治疗方法。保留乳房手术加放射治疗可获得与乳房全切同样的局部复发率及生存率[1-2]。但是,若肿瘤扩大切除组织超过乳腺体积的20%[3],或肿瘤位于内下象限等美容敏感区域,常常出现难以接受的乳房畸形,比如局部凹陷、乳头偏斜等,严重影响保留乳房手术的效果。近年来,为减少局部复发及术后乳房畸形,乳房整形技术在保留乳房手术中得到应用,使切除组织增加的同时并能较好的维持乳房形     

乳腺癌保留乳房术后放射治疗58例

介绍早期乳腺癌保留乳房术后放疗的方法、疗效和美容效果。材料与方法１９８５年８月－１９９５年６月共５８例乳腺癌病人接受保留乳房术后放射治疗，Ⅰ期２５例，Ⅱ期３１例，Ⅲ期２例。位于乳房外上象限者４８例，其它象限者１０例，符合保留乳房手术条件者５４例，２例为未婚的Ⅲ期病人，２例为肺、乳腺重复癌。５６例行乳房肿瘤扩大切除术，２例行肿瘤单纯切除术。全部病例均于术后３个月内接受根治性放疗，设野包括内乳─锁骨上野、切线野、局部追加野，部分病人给腋后野；切线野采用等中心照射，各野的中位照射剂量分别为ＤＴ５３．２Ｇｙ、５５．４Ｇｙ、４９．２Ｇｙ和１４．６Ｇｙ。结果随访满３年者４７例，满５年者３６例，３年和５年生存率分别为９５．７％和９４．４％。出现放射性肺炎／肺纤维化者４例，发生率为６．９％，出现乳房胸壁纤维化者２例，放疗后美容效果医患均满意者占９６．６％。结论早期乳腺癌保留乳房术后放疗生存率与根治术相同而且美容效果好，半束照射并发症低。符合条件的Ⅰ、Ⅱ期病人应给予保留乳房治疗。     

Preoperative breast MRI in early-stage breast cancer

Rapid uptake of new imaging technology is a major contributor to rising healthcare costs. Preoperative breast magnetic resonance imaging (MRI) for patients with early-stage breast cancer has dramatically increased in use without the evidence of improved outcomes compared to standard assessment and is associated with higher rates of mastectomy. A decision analytic model was developed to evaluate the impact of adding breast MRI to the preoperative evaluation of women with early-stage breast cancer who were candidates for breast-conserving therapy on patient outcomes measured in quality-adjusted life years (QALYs). Model inputs, including survival, recurrence rates, and health utilities, were obtained from a comprehensive literature review. One-way sensitivity analyses were performed to estimate threshold values for key parameters at which adding MRI would become the optimal imaging strategy over standard assessment. Preoperative MRI resulted in 17.77 QALYs compared to 17.86 QALYs with standard assessment, a decrease of 0.09 QALYs or 34?days. In sensitivity analyses, standard assessment was associated with better patient outcomes than preoperative breast MRI across all plausible probabilities for mastectomy, local recurrence, and health utilities. For routine preoperative breast MRI to become the optimal strategy, the conversion rate to mastectomy after preoperative MRI would need to be <1?% (versus the range of 3.6-33?% reported in the literature). Routine preoperative breast MRI appears to confer no advantage over the standard diagnostic evaluations for early-stage breast cancer and may lead to worse patient outcomes.     

Glycolytic enzymes in breast cancer, benign breast disease and normal breast tissue

The activities of hexokinase, phosphofructokinase, aldolase, enolase and pyruvate kinase were studied in breast cancer tissues, in comparison to benign breast disease and normal breast tissues. The enzyme activities in breast cancer were significantly increased compared to normal and benign breast tissues (p less than 0.001). Also the increase in activity in benign disease compared to normal was statistically significant (p less than 0.001). Within the group of benign diseases, fibroadenomas could be distinguished from fibrocystic disease, the former generally showing higher activities compared to the latter (p less than or equal to 0.05). Carcinoma subgroups, classified according to their histology, could not be recognized enzymologically. In addition, isozyme composition of pyruvate kinase and enolase was studied. We did not find a significant shift towards K type pyruvate kinase expression in benign disease compared to normal breast tissues. Also fibroadenomas did not differ from fibrocystic disease. However, the amount of K type pyruvate kinase in carcinomas proved to be significantly higher in comparison to benign disease and normal breast tissues (p less than 0.001). Expression of alpha gamma-enolase in normal breast tissue was virtually absent. In benign disease only a minority of specimens did show the hybrid alpha gamma-enolase. Nearly all carcinomas had alpha gamma-enolase expression and in 20% of the carcinomas gamma gamma-enolase could be detected (so-called neuron-specific enolase). By discriminant analysis, the function giving the best discrimination compared to the histological data was based on natural logarithm aldolase and the total of gamma-enolase subunits. Contrary to expectation, the regulator enzymes of glycolysis; i.e., hexokinase, phosphofructokinase and pyruvate kinase were not included in this discriminant function. The best fit produced a 90% correct classification in both benign and malignant disease. If these findings are confirmed to a larger series, the discrimination is sufficiently strong to form the basis of a clinically useful tool.     

保乳术和延迟即刻再造术对乳腺癌患者生活质量的影响

目的探讨保乳术和延迟即刻再造术对乳腺癌患者手术后生活质量(QOL)的影响。方法选取2010年1月至2015年6月北京协和医院行保乳术和延迟即刻再造术后于2016年3月至2016年4月在医院乳腺外科门诊随访的64例患者,其中保乳手术30例(保乳组),延迟即刻再造术34例(乳房再造组)。应用肿瘤治疗功能评价系统(FACT-B)量表对两组患者进行生活质量测评比较。结果两组患者生理状况、社会/家庭状况、情感状况、功能状况、总体生活质量评价FACT-G和FACT-B条目状况比较,差异无统计学意义(P>0.05);乳房再造组患者附加关注(乳腺癌特异模块)方面QOL优于保乳术组,差异有统计学意义(29.37±2.72vs 24.05±7.01,P<0.05)。结论乳腺癌保乳术和延迟即刻再造术后患者生活质量无明显差异。     

早期乳腺癌保乳手术后加速部分乳腺照射与全乳照射剂量学的比较

目的比较早期乳腺癌患者保乳手术后加速部分乳腺照射(APBI)与全乳照射(WBI)剂量学的差异。方法选取2013年1月至2013年12月间收治的26例保乳术后采用APBI治疗的乳腺癌患者作为观察组,另选取同期保乳术后采用WBI治疗的28例乳腺癌患者作为对照组。采用剂量体积直方图(DVH)比较两组患者剂量学差异,总结两组患者的短期疗效;比较观察组患者在有无图像指导下的位移差异。结果观察组患者的平均剂量(Dmean)、照射体积百分比(V103、V105、V110)和靶区剂量不均匀指数(IHI)均显著低于对照组,各项危及器官(OARS)照射剂量均显著低于对照组,且心脏和肺的照射体积也显著低于对照组,差异均有统计学意义(均P<0.05)。观察组患者美容满意率为96.2%(25/26),对照组患者为67.9%(19/28),两组间差异有统计学意义(P<0.05)。观察组患者在有无图像引导下的位移差异均有统计学意义(均P<0.05)。结论早期乳腺癌患者保乳手术后APBI照射剂量低于WBI,改善靶区剂量分布,降低心肺等组织高剂量受照体积,结合图像引导,可以增加准确性。     

Delayed breast cellulitis following breast conserving operation.

A complication of breast conservation, which has been increasingly reported in the literature, is 'delayed cellulitis' in the treated breast. This is to be distinguished from wound infection in the breast following lumpectomy. This study reports 16 cases diagnosed with delayed cellulitis following breast conserving surgery, unresponsive to antibiotic therapy. Diagnostic criteria included: pain, erythema and edema in the operated breast. Symptoms appeared up to 10 months after surgery and time to resolution was seven and a half months. No patients had positive cytology and bacteriology tests were negative. Thirteen patients were observed, and three patients were treated with antibiotics with no apparent immediate effect. The appearance of breast cellulitis after surgery poses a problematic diagnostic and management dilemma. It is important to distinguish between this entity and infection, or inflammatory carcinoma. The picture may be attributed to impairment or occlusion of the lymphatic circulation in the breast. This seems to be a newly defined complication with an incidence of 3-5%.     

Controversies in breast conservation treatment for breast cancer

Breast conservation treatment has become the standard treatment for early breast cancer patients, after the equivalence of mastectomy and breast conservation treatment was demonstrated in prospective, randomized trials and large retrospective studies. New questions, such as the feasibility of neoadjuvant chemotherapy in improving breast conserving rate, the appropriateness of breast conservation treatment in ductal carcinoma in situ, the effectiveness of radiation therapy in patients treated by breast conservation, and patient selection for breast conservation without radiation, are now being raised. Future work that needs to be done to answer these questions is discussed in this review.     

保留乳房天然结构的乳腺癌改良根治术后即刻乳房成形术的临床应用

目的探讨保留乳房天然结构的乳腺癌改良根治术后即刻自体组织乳房成形术在临床中的运用价值。方法乳腺癌患者12例,其中DCIS 6例,浸润性导管癌3例,小管癌1例,髓样癌1例,黏液癌1例;保留乳房皮肤的乳腺癌改良根治术9例,保留乳头乳晕复合体的乳腺癌改良根治术3例。全组均保留或重建乳房下皱襞,切除乳腺组织和腋窝淋巴结,应用下腹部横行腹直肌肌皮瓣或背阔肌肌皮瓣即刻乳房成形。结果横行腹直肌肌皮瓣乳房成形术3例,背阔肌肌皮瓣乳房成形术9例,术后皮瓣均存活,皮瓣血管通畅,成形乳房外观良好。结论对早期乳腺癌患者行保留乳房天然结构的乳腺癌改良根治术后即刻自体组织乳房成形,切口隐蔽,成形乳房形态效果良好,可以获得较好的美容效果。     

Prostate specific antigen in breast cancer,benign breast disease and normal breast tissue

Prostate specific antigen (PSA) is a tumor marker used widely for the diagnosis and monitoring of prostatic adenocarcinoma. Recently, we provided evidence that PSA may also be produced by breast tumors. In this report we examined quantitatively the PSA levels in 199 breast tumors, 48 tissues with benign breast disease (BBD, 34 fibroadenomas), and 36 normal breast tissues. Significant amounts of PSA (≥ 0.030 ng of PSA per mg of total protein) were found in 28% of breast tumors, 65% of BBD tissues, and 33% of normal breast tissues. PSA positivity in breast tumors was highest in stage I disease (34%) and decreased with disease stage (24% in stage II and 18% in stage III–IV). Using polymerase chain reaction amplification we have shown PSA mRNA presence in patients with PSA protein-positive tissues (benign and malignant) but not in patients with PSA protein-negative tissues. Our data suggest that PSA is expressed frequently by normal breast tissue, by tissue of benign breast diseases, and by breast cancer tissue. Highest expression is seen in benign breast disease and lowest expression in advanced stage cancerous tissue. As PSA production is mediated by steroid hormones and their receptors, we propose that PSA may be a new marker of steroid hormone action in the normal or diseased female breast. The role of this enzyme in the development of breast diseases including breast cancer is currently unknown.