Breast cancer in young women: Imaging and clinical course

The purpose of this study was to characterize presenting imaging findings in women younger than 40 diagnosed with invasive breast cancer in the context of pathology and clinical course. Retrospective chart and imaging reviews were performed in patients under 40 diagnosed with breast cancer between July 1, 2004, and December 31, 2013. Patient demographic, imaging, pathology, and clinical data were collected. Overall and recurrence-free survival were estimated using the Kaplan-Meier method. Univariate Cox proportional hazards models were performed to identify factors associated with recurrence-free survival. Our study cohort consisted of 110 patients with invasive mammary carcinoma. One hundred one (91.8%) presented with a palpable mass. The mean size of all lesions on imaging was 3.5 cm ± 2.9 cm. Malignant calcifications were present in 54 (49.1%) cases. Imaging demonstrated multifocal or multicentric disease in 45 (40.9%) cases. Seventy four (67.3%) cancers were high grade. Luminal genomic subtypes were the most common (n = 61, 55.5%). At presentation, 4 (3.6%) patients had bilateral malignancy and 8 (7.3%) patients had distant metastatic disease. Ninety seven (88.2%) underwent neoadjuvant chemotherapy and 67 (60.9%) underwent radiation therapy. Seventy five (68.2%) of the patients underwent mastectomy. The restricted mean time to recurrence was 9.01 years (standard error 3.162 months). ER positivity was associated with compromised recurrence-free survival. The overall survival rate was 0.962 at 10 years. Young patients diagnosed with breast cancer typically present with advanced breast imaging findings and undergo aggressive treatment. Recurrence often occurs >5 years from diagnosis, and ER positive subtypes are at increased risk for recurrence.     

新辅助治疗行胃癌根治术患者术后并发症及其对预后的影响因素分析

目的探讨新辅助治疗后行胃癌根治术的患者术后并发症发生情况及其预后的影响因素。方法采用回顾性病例队列研究方法。病例纳入标准:(1)组织病理学证实为胃腺癌;(2)术前影像学检查无远处转移或腹膜种植转移;(3)行新辅助治疗后接受胃癌根治术加D2淋巴结清扫术;(4)临床病理及随访资料完整。根据以上标准,回顾性收集2008年1月至2018年12月期间,于中国医学科学院北京协和医学院肿瘤医院行胃癌根治术的490例胃癌患者的临床资料,其中男性358例,女性132例,年龄(55.0±10.6)岁。新辅助治疗方案包括SOX(替吉奥+奥沙利铂)151例,XELOX(希罗达+奥沙利铂)105例,FLOT(多西他赛+奥沙利铂+氟尿嘧啶)66例以及DOS(多西他赛+奥沙利铂+替吉奥)68例;术前行同步放化疗患者100例,采用SOX方案2-4周期诱导化疗加同步放化疗(三维适形调强放疗+替吉奥)。术后并发症指术后出现的手术相关并发症,主要包括术后出血、吻合口漏、术后梗阻、术后狭窄、肺部感染、腹腔感染等。根据Clavien-Dindo法评定术后并发症分级。采用log-rank检验进行预后单因素分析,采用Cox回归模型进行预后模型的多因素分析。结果全组患者术后总并发症的发生率为17.8%(87/490,总计101例次),其中发生严重并发症者(Clavien-Dindo Ⅲ-Ⅴ级)29例,非严重并发症者(Clavien-Dindo Ⅰ-Ⅱ级)58例。多因素分析结果显示,年龄>65岁(HR=3.077,95% CI:1.827-5.184,P<0.001)和胃切除范围(HR=1.735,95% CI:1.069-2.814,P=0.026)是新辅助治疗胃癌根治术患者术后并发症发生的独立危险因素(均P<0.05)。全组患者随访时间0.7-131.8(中位数21.5)个月,5年生存率为47.4%。并发症组(87例)与无并发症组(403例)5年总体生存率分别为33.2%和50.9%(P=0.001)。多因素分析结果显示,年龄(HR=1.906,95% CI:1.248-2.913,P=0.003)、ypTNMⅡ-Ⅲ期(Ⅱ期:HR=5.853,95% CI:1.778-19.260,P=0.004;Ⅲ期:HR=10.800,95% CI:3.411-34.189,P<0.001)、手术时间>3.5 h(HR=1.492,95% CI:1.095-2.033,P=0.011)、全胃切除(HR=1.657,95% CI:1.216-2.257,P=0.001)以及术后并发症(HR=1.614,95% CI:1.125-2.315,P=0.009)是影响本组患者预后的独立危险因素,术后行辅助治疗(HR=0.578,95% CI:0.421-0.794,P=0.001)是本组患者预后的独立保护因素。结论新辅助治疗行胃癌根治术患者并发症的发生与患者年龄和手术切除范围密切相关,重视减少并发症的损害及加强辅助治疗,有利于改善新辅助治疗胃癌根治术患者的预后。     

Assessment of changes in penile sensation by electrophysiological study after radical prostatectomy: A pilot study

Background:To evaluate the changes in penile sensation by electrophysiological tests in patients who underwent radical prostatectomy (RP) and to demonstrate the role of dorsal penile nerve injury in postoperative erectile dysfunction.Materials and methods:Twenty-six volunteer patients who were eligible for RP were included in the study. Preoperative penile sensory electromyography and the International Index of Erectile Function-5 (IIEF-5) questionnaire were done for each patient. Erectile function assessment and electrophysiological evaluation of penile sensation were repeated at postoperative 3rd and 6th months.Results:Postoperative IIEF-5 scores and electromyography values were significantly lower than preoperative findings (p < 0.05). The IIEF-5 scores in the nerve sparing-RP (NS-RP) group were significantly higher than the non-nerve sparing-RP (NNS-RP) group in the postoperative period. Nerve conduction velocity values in the NS-RP group were also higher than the NNS-RP group at the postoperative 3rd and 6th months. However, these changes were not statistically significant (p > 0.05).Conclusions:Patients who underwent RP have decreased penile sensation due to cavernous nerve damage and a possible dorsal penile nerve injury. The decrease of penile sensation may be associated with postoperative erectile dysfunction.     

海德堡三角清扫在胰腺癌根治术中的应用价值

目的探讨海德堡三角清扫在胰腺癌根治术中的应用价值。方法采用回顾性描述性研究方法。收集2020年3―7月南京医科大学第一附属医院收治的30例行海德堡三角清扫胰腺癌病人的临床病理资料;男12例,女18例;中位年龄为65岁,年龄范围为41~79岁。病人完成肿瘤可切除性评估和肝十二指肠韧带廓清后,显露肠系膜上动脉、腹腔干、肝总动脉、门静脉及肠系膜上静脉,根据肿瘤部位行胰十二指肠切除术、胰体尾切除术或者全胰腺切除术,并完成海德堡三角区域内神经纤维及淋巴结组织清扫。胰十二指肠切除术至少完成肠系膜上动脉和腹腔干右半周骨骼化,胰体尾切除术时至少完成肠系膜上动脉和腹腔干左半周骨骼化,全胰腺切除术时原则上需完成肠系膜上动脉和腹腔干全周骨骼化,手术均彻底清除肠系膜上动脉和腹腔干夹角处的神经纤维及淋巴结组织。观察指标:(1)手术情况与术后组织病理学检查。(2)术后恢复情况。(3)随访情况。采用电话或门诊方式进行定期随访,了解病人肿瘤复发转移情况,随访时间截至2021年1月。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示,组间比较采用Fisher确切概率法。结果(1)手术情况与术后组织病理学检查:30例病人均行开腹手术,其中21例行胰十二指肠切除术,6例行胰体尾切除术,2例行全胰腺切除术,1例行保留中段的胰腺切除术;16例病人联合门静脉-肠系膜上静脉切除术;3例联合左侧肾上腺切除术。30例病人中,5例术中肠系膜上动脉-腹腔干周围组织清扫范围为1.00周,8例为1.25周,8例为1.50周,9例为1.75~2.00周。16例病人离断胃左静脉,14例保留胃左静脉。30例病人手术时间为287 min(165~495 min),术中出血量为275 mL(50~800 mL)。9例病人术中输注红细胞或冰冻血浆。术后组织病理学检查结果示肿瘤长径为3.4 cm(1.2~7.3 cm),淋巴结检出数目为20枚(9~35枚),阳性淋巴结数目为2枚(0~19枚)。30例病人中,20例肿瘤分化程度为中分化,10例为低分化。9例病人环周切缘为R0切除,17例为切缘1 mm R1切除,4例为R1切除。术后病理学T分期:30例病人中,3例为T1期,18例为T2期,5例为T3期,4例为T4期。术后病理学N分期:30例病人中,9例为N0期,13例为N1期,8例为N2期。术后病理学TNM分期:30例病人中,2例为Ⅰa期,2例为Ⅰb期,3例为Ⅱa期,11例为Ⅱb期,12例为Ⅲ期。(2)术后恢复情况:30例病人中,20例发生术后并发症,其中Clavien-DindoⅠ级并发症6例,Ⅱ级并发症9例,Ⅲa级并发症3例,Ⅴ级并发症2例。术中肠系膜上动脉-腹腔干周围组织清扫1.00周的病人术后腹泻发生情况为0,清扫1.25周的病人术后腹泻发生情况为1/8,清扫1.50周的病人术后腹泻发生情况为4/8,清扫1.75~2.00周的病人术后腹泻发生情况为9/9,4者比较,差异有统计学意义(P<0.05)。术中离断胃左静脉病人术后胃排空延迟发生情况为5/16,保留胃左静脉病人术后胃排空延迟发生情况为1/14,两者比较,差异无统计学意义(P>0.05)。30例病人中,19例行术后辅助化疗;28例顺利出院,术后住院时间为15 d(8~68 d);2例病人死亡。3例病人术后90 d内非计划性再入院。(3)随访情况:28例出院病人均获得随访,随访时间为1.0~9.0个月,中位随访时间为6.5个月。随访期间,1例局部进展期病人发生局部复发,9例病人发生肝转移(4例可切除胰腺癌、4例边界可切除胰腺癌、1例局部进展期胰腺癌),1例边界可切除胰腺癌病人发生腹膜转移。17例病人无瘤生存。结论海德堡三角清扫应用于胰腺癌根治术肿瘤根治程度较高,术后局部复发率较低,术后并发症发生率及病死率稍高,其远期疗效需进一步评估,建议对选择性病例行新辅助治疗后在高流量胰腺外科中心进行。     

保留左结肠动脉的腹腔镜直肠癌D3根治术对中晚期直肠癌患者的临床效果分析

目的探讨保留左结肠动脉的腹腔镜直肠癌D3根治术(Dixon)对中晚期直肠癌患者的临床效果分析。方法选取2015年12月至2018年1月60例中晚期直肠癌患者资料,根据术式不同分为保留组和未保留组,其中保留组(n=32)采用保留左结肠动脉的Dixon术,未保留组(n=28)采用高位结扎的Dixon术。采用SPSS 22.00软件对数据资料进行处理,围术期各项指标用(x±s)表示,采用独立t检验;术后并发症发生率、淋巴结清扫情况采用χ^2或Fisher检验,P<0.05表示差异有统计学意义。结果保留组肛门排气时间、边缘动脉弓压力显著少于未保留组(P<0.05),其余围术期指标比较均无统计学意义(P>0.05);两组清扫淋巴总数、转移淋巴结数及阳性淋巴结总数差异均无统计学意义(P>0.05),但保留组清扫第253组淋巴结数目显著大于未保留组(P<0.05);保留组吻合口漏发生率3.1%(1/32)显著少于未保留组10.7%(3/28),(P<0.05);两组患者术后1年肿瘤复发、转移发生率差异无统计学意义(P<0.05)。结论相比于高位结扎的Dixon术,保留左结肠动脉不增加术后肿瘤复发转移概率,并且可有效降低吻合口漏的发生率,具有良好的应用前景。     

乳癌保留乳房手术的探讨

①目的 探讨乳癌保留乳房手术的可行性。②方法 将９０例Ⅰ,Ⅱ期乳癌病人随机分为两组,保留乳房手术组４２例,采用乳腺区段切除加腋窝淋巴结清扫术;改良根治术组４８例,采用乳腺全切加腋窝淋巴结清扫术,术后两组均行放疗、化疗和内分泌治疗。比较两组治疗效果及并发症发生情况。③结果 乳癌保留乳房手术组３年生存率为９５．２％,５年生存率为９１．７％,发生并发症４例,改良根治术组３年生存率为９５．８％,５年生存率     

长引流管在乳癌根治术中的应用

目的：探讨乳癌根治术后放置长引流管对促进术后伤口愈合、预防和减少继发感染的效果;方法：共观察７２例乳癌根治术病例,每例病人在术后均放置前端多侧孔长度９０ｃｍ乳胶引流管,以负压吸引对创曲渗液进行引流;结果：本组病例中没有发生一起与放置长引流管有关的皮瓣感染,仅有２例出现术后切口轻度感染;结论：长引流管的应用能有效促进创面愈合、减少感染。     

乳腺癌（改良）根治术住院流程与平均住院日

参照业务流程重组的理论与方法研究了乳腺癌根治术的住院流程。结果显示,该病种住院流程存在的主要问题有：诊疗服务的随意性过大,等待诊疗服务的时间过长,患者入院标准的掌握过松,对该病种往院注程进行重组,将在不影响医疗服务质量的前提下有效缩短平均住院日。     

残胃癌的外科治疗

目的：分析和总结残胃癌外科治疗结果。方法：回顾分析１９８６年至１９９７年间我院收治的１９例残胃癌的临床表现、治疗及生存结果。结果：残胃癌缺乏相对特异的症状。５３８％患者术前有不同程度的贫血。手术切除率及根治切除率分别为７８９％和６８４％。手术并发症率为２６３％。该组总５年生存比率及１３例根治手术后的５年生存比率分别为２３５％和３６４％。该组４例Ⅰ期、Ⅱ期病例术后均得到长期生存;９例Ⅲ期、Ⅳ期病例根治术后１年、２年、５年生存比率分别为７７８％、４４４％、２２２％。５例行姑息或探查术病例,其术后生存均不到１年。结论：积极外科手术尤其是根治手术是残胃癌有效治疗手段,对于早期病变,术后有良好的预后;对于中晚期病例,可延长生命,部分病例仍可能得到长期生存。早期诊断是提高预后的关键。残胃手术并发症相对较多。改善患者术前营养状况是降低并发症的重要方面     

Long-term results in the surgical treatment of lymphedema

Summary In the irreversible stage of lymphedema corrective surgery is often mandatory. A choice has to be made between two different basic selective procedures. As no totally satisfactory surgical method has as yet been established surgical management is difficult and implies considerable personal responsibility. This is a report on the long-term results of operations carried out on 16 patients between 1958 and 1979 using the so called Charles procedure. It concludes that this radical operation gives an acceptable long-term result in long-standing, elephantiastic primary lymphedema of the lower extremity.