乳腺MRI在乳腺癌保留乳头乳晕复合体Ⅰ期乳房重建中的应用

目的：探究乳腺磁共振成像（magnetic resonance imaging,MRI）在乳腺癌保留乳头乳晕复合体（nipple-areola complex,NAC）Ⅰ期乳房重建中的应用价值。方法：选取惠州市第三人民医院75例乳腺癌患者,均行保留NACⅠ期乳房重建。术前采用乳腺MRI评估乳房内肿瘤边缘与皮肤的距离、肿瘤边缘与NAC的距离,依据术前MRI测量数据评估皮下腺体切除的范围,计算计划切除组织体积,指导假体大小选择。并于术中测量乳房肿瘤边缘与皮肤的距离、肿瘤边缘与NAC的距离,测量术中实际切除组织体积、植入假体体积,比较MRI与术中测量数据,采用Pearson相关系数分析两组数据的线性关系,统计术后并发症发生情况、乳房重建美容效果。结果：乳腺MRI测量乳房内肿瘤边缘与皮肤的距离与术中测量比较,差异无统计学意义（P>0.05）,两者呈正相关（r=0.747,P<0.05）;乳腺MRI测量肿瘤边缘与NAC的距离与术中测量比较,差异无统计学意义（P>0.05）,两者呈正相关（r=0.752,P<0.05）;乳腺MRI测量计划切除组织体积与实际切除组织体积、植入...     

硅胶假体植入乳房重建在乳腺癌改良根治术中的应用

乳腺癌是女性最常见的恶性肿瘤之一,其发生呈逐年上升趋势。乳腺癌改良根治术是根治乳腺癌的常规手术,而此术式造成乳房缺如,使女性形体美遭到破坏,且乳腺癌患者术后产生极大心理压力,随着社会发展女性愈来愈注重形体美,因此乳腺癌术后乳房重建愈来愈受重视。本院近年来开展了保留皮肤的乳腺癌改良根治术（skin sparing modified mastectomy）,配合即时硅胶假体乳房重建,效果良好,现介绍如下。     

保留乳头乳癌改良根治术评价

目的评价保留乳头乳癌改良根治术应用于乳腺癌的术后美容效果和近期疗效。方法对符合入选条件的早期乳癌患者按乳房大小分为两组,组一施行保留乳头乳癌根治术或一期行扩大背阔肌带蒂肌瓣再造乳房,组二施行保留乳房手术 放疗,比较术后美容效果的优良率,随访复发转移情况。结果两组间患者年龄、病理性质、临床分期相似,术后优良率无统计学差异,无复发生存差别有统计学意义。结论体积小的乳房适合做保留乳头改良根治术,术后Ⅰ期行扩大背阔肌带蒂肌瓣再造乳房效果满意;体积较大的乳房适合于保留乳房手术。保留乳头改良根治术可作为ⅠⅡ期乳癌手术的可供选择的术式。     

新辅助化疗对乳腺癌改良根治术后即刻自体乳房重建结局影响

目的探讨新辅助化疗对乳腺癌改良根治术后即刻乳房重建结局的影响。方法回顾性分析2010年3月至2015年2月辽宁省肿瘤医院乳腺外科行新辅助化疗和未行新辅助化疗乳腺癌改良根治术后即刻乳房重建患者的术后并发症的发生率以及对术后辅助治疗的影响。结果新辅助化疗组和对照组术后并发症发生率相当,但新辅助化疗组术后放化疗时间较对照组延长。结论新辅助化疗可延长乳腺癌改良根治术后即刻乳房重建患者的术后辅助治疗的时间,但并不增加术后并发症的发生率。     

保留乳头乳晕复合体皮下腺体全切术在早期乳腺癌中应用

目的探讨保留乳头乳晕复合体(NAC)皮下腺体全切术(NSM)在早期乳腺癌(EBC)中的应用。方法选取自2012年2月至2017年12月首都医科大学附属北京天坛医院收治的94例EBC患者为研究对象。采用随机数字表法将其分为A、B两组,每组各47例。A组患者接受Auchincloss式改良根治术,B组患者接受NSM术。比较两组患者的美观度、术后并发症发生情况、术后5年内随访情况。结果 B组患者乳腺外观程度明显优于A组,差异有统计学意义(P<0.05);两组患者术后并发症发生率、5年存活率与无复发转移存活率比较,差异均无统计学意义(P>0.05)。结论与传统的Auchincloss式改良根治术比较,NSM可以改善乳腺癌患者术后外观情况,并且术后安全性较高,是治疗早期乳腺癌安全有效的手术方式。     

自体脂肪注射联合硅胶假体置入在聚丙烯酰胺水凝胶隆乳术后取出修复中应用

目的探讨自体脂肪注射联合硅胶假体置入在修复聚丙烯酰胺水凝胶取出术后乳房继发畸形中的方法和疗效。方法选取中国医科大学附属盛京医院自2010年6月至2016年3月收治的聚丙烯酰胺水凝胶注射隆乳术后乳房畸形患者68例,所有患者术前均完善乳腺三维彩超及增强磁共振影像检查,明确注射物所在层次、面积及容量。全身麻醉下采取乳晕下半圆形切开,在保证安全前提下,尽量清除可见注射物,以及被侵蚀后变性坏死的组织。术后半年,行硅胶假体隆乳术;同期,于腹壁抽吸脂肪,离心提纯后,将脂肪注射于外形不饱满处。结果本组68例患者,122侧乳房采用脂肪注射联合硅胶假体置入的方法进行修复,随访12~24个月,乳房外形佳,无严重并发症。结论脂肪注射联合硅胶假体置入,弥补了以往单纯硅胶假体置入修复乳房外形的不足,是聚丙烯酰胺水凝胶隆乳术后畸形矫正的理想修复方法。     

乳腺癌根治和乳房重建术体位摆放及护理

目的：探讨乳腺癌根治和乳房重建术体位摆放及术中护理问题。方法：2008-01~2009-12间,本院收治的45例乳腺癌根治和乳房重建的患者,术中均先平卧位做乳房根治术,然后侧卧位消毒铺巾,取背阔肌代皮瓣做乳房重建。结果：经根治术和重建术,结合术后保持引流导管畅通和供、受瓣区护理,再造乳房全部成活,供受区切口均Ⅰ期愈合。随访至今,再造乳房外观自然,重建的腋前皱襞与健侧基本对称,腋顶及腋前皱襞凹陷畸形基本纠正。结论：乳腺癌根治乳房重建术是修复根治术后较严重缺损的较好方法,正确摆放手术体位,能有效地预防并发症的发生。术中合理、妥善的护理能有效提高手术的成功率与再造乳房的成活率。     

胸肌肌膜瓣包裹法乳房悬吊术

目的探索一种持久有效的乳房松弛悬吊术式。方法对于乳头位置低于乳房下皱襞的乳房下垂患者,采用乳晕周边"双环"切口加垂直切口,胸肌肌膜瓣包裹乳腺的方法进行校正。结果自2008年9月—2011年4月,共16例乳头位置低于下皱襞水平乳房松弛患者采用该法手术,术后均无皮瓣血运障碍,切口愈合良好,乳头乳晕无坏死、感觉障碍等并发症。1例患者术后并发血肿,清除后预后良好。随访6个月到2年,效果良好,乳头乳晕复合体位于乳房最高点,两侧乳房位置对称。患者均满意。结论乳晕周边"双环"切口加垂直切口,胸肌肌膜瓣包裹法矫正乳房松弛下垂为一种持久有效的乳房松弛悬吊术式。     

整形外科技术在复发性乳晕下脓肿治疗中的应用

 目的 探讨整形外科技术在复发性乳晕下脓肿手术中的临床应用。方法 回顾性分析接受手术治疗的乳晕下脓肿39例的临床资料。通过应用整形外科技术,联合切除瘘管及边缘皮肤、受累大导管及其周围腺体,腺体重塑的同时纠正内翻乳头、重建乳头、乳晕复合体,并观察长期疗效及美学评价结果。结果 39例手术成功,疗效满意,术后美容效果优良。随访11～37个月(平均23.6个月),无复发。结论 结合整形外科技术手术治疗乳晕下脓肿,方法简单、可行,疗效满意,不必考虑瘘管与乳头-乳晕复合体的位置关系,非常适合治疗单发的慢性瘘管性乳晕下脓肿。     

高压氧综合治疗对保留乳头乳晕的乳房切除术后乳头存活的疗效观察

乳腺癌是女性最常见的恶性肿瘤之一,发病率逐年增长,且发病年龄有年轻化趋势,中国城乡女性乳腺癌的发病均呈逐年上升趋势。手术是治疗乳腺癌的重要手段,为提高患者生活质量,改善心理状态,手术方式也由单一的乳腺癌改良根治术逐渐侧重于保证肿瘤完整切除前提下的乳腺重建整形术,其中保留乳头乳晕的乳房切除术(nipple sparing mastectomy,NSM)也逐渐受到施术者及患者的青睐。本研究回顾性分析2014年6月至2018年6月烟台山医院乳腺外科行NSM手术后联合高压氧(hyperbraic oxygen,HBO)治疗的30例乳腺癌患者的临床疗效。现报告如下。     

乳腺癌两种手术方式对女性婚姻质量的影响

 目的 比较乳腺癌保乳手术和改良根治术对女性婚姻质量的影响.方法 同期选取接受保乳手术和改良根治术的乳腺癌患者各28例,在手术后6个月,采用自编凋查问卷和Olson婚姻质量问卷(ENRICH)进行调查.结果 两种乳腺癌手术患者的婚姻质量在婚姻满意度、夫妻交流、性生活3个方面得分低于常模(P<0.01);保乳手术患者在婚姻质量的3个维度得分均高于改良根治术患者(P<0.01).结论 乳腺癌手术后患者婚姻质量下降.保乳手术患者婚姻质量优于改良根治术患者,保乳手术对于保障乳腺癌女性婚娟质量有一定作用.     

Hyperbaric oxygen treatment for skin flap necrosis after a mastectomy: a case study

The rate of complications in immediate breast reconstruction is in 15% to 20% due to partial loss of the mastectomy skin flaps. In the case of skin necrosis or ischemia, a therapy that reduces skin loss could be of additional benefit. Hyperbaric oxygen has been used to treat compromised flaps and grafts, an indication recognized and reimbursed according to the Undersea and Hyperbaric Medical Society (UHMS). So far, hyperbaric oxygen has not been previously reported as therapy for full-thickness breast skin flap necrosis on patients with a direct reconstruction with silicone implants after a skin-sparing mastectomy. This report presents such a case, in which a 52-year-old woman carrier of the BRCA2 mutation gene was successfully treated with hyperbaric oxygen therapy.     

湿润烧伤膏联合龙血竭防治乳腺癌改良根治术后放射性皮肤损伤疗效观察

目的对比分析湿润烧伤膏联合龙血竭防治乳腺癌改良根治术后放射性皮肤损伤的临床疗效。方法将2015年8月至2018年8月临沂市第三人民医院收治的120例乳腺癌改良根治术后行放射治疗的患者按照治疗方法分为观察组(60例)、对照1组(30例)与对照2组(30例),观察组患者放射治疗后照射区域皮肤均匀涂抹湿润烧伤膏,出现Ⅱ~Ⅳ级放射性皮肤损伤时加用龙血竭粉末外敷;对照1组患者放射治疗后照射区域皮肤均匀涂抹湿润烧伤膏,出现Ⅱ~Ⅳ级放射性皮肤损伤时继续应用湿润烧伤膏换药治疗;对照2组患者放射治疗后照射区域皮肤不采取防护措施,出现Ⅱ~Ⅳ级放射性皮肤损伤时予以碘伏常规换药治疗。对比观察3组患者放射性皮肤损伤发生情况、放射治疗中断情况及临床疗效结果放射治疗20 Gy、40 Gy及结束后,3组患者皮肤损伤发生情况对比,χ~2=59.417、94.876、29.072,P均=0.000,差异具有统计学意义,且对照2组患者皮肤损伤发生情况较观察组及对照1组严重(放射治疗20Gy后:χ~2=41.918、23.721,P均=0.000;放射治疗40 Gy后:χ~2=74.118、47.368,P均=0.000;放射治疗结束后:χ~2=61.606、30.610,P均=0.000),而观察组与对照1组患者皮肤损伤发生情况无明显差异(P均>0.05)。放射治疗过程中,对照2组中有7例患者因放射性皮肤损伤中断治疗,明显高于观察组与对照1组均无患者中断治疗(χ~2=15.181、7.925,P=0.000、0.005)。放射治疗结束后2周,观察组患者的临床疗效明显优于对照1组及对照2组(χ~2=6.923、24.761,P=0.009、0.000),而对照1组患者的临床疗效明显优于对照2组(χ~2=8.324,P=0.016)。结论湿润烧伤膏联合龙血竭可有效防治乳腺癌改良根治术后放射性皮肤损伤,促进放射性皮肤损伤创面愈合,避免放射治疗中断,且操作简便,值得临床推广应用。     

Local Recurrence of Invasive Secretory Breast Carcinoma in a Gravid Patient Post-Mastectomy

This is a case of locally recurrent invasive secretory carcinoma of the breast during pregnancy, detected as a palpable mass in the reconstructed right breast of a 32-year-old female at 24 weeks gestation. The patient was initially diagnosed with secretory carcinoma 8 years prior, for which she underwent nipple sparing mastectomy followed by adjuvant chemotherapy and endocrine therapy. Due to pregnancy, the recurrence was treated initially with conservative excision alone, followed by definitive management postpartum which included wide local excision, sentinel lymph node biopsy and adjuvant chest wall radiation. Secretory carcinoma of the breast is a rare cancer with a predilection for young age and indolent course. This case report describes an unusual case of recurrent secretory carcinoma, of interest due to both its diagnosis during pregnancy, and its recurrence after nipple sparing mastectomy.     

Breast MRI findings after modified radical mastectomy and transverse rectus abdominis myocutaneous flap in patients with breast cancer

PURPOSE: To evaluate the MRI findings in breast cancer patients who had undergone a modified radical mastectomy (MRM) and a transverse rectus abdominis myocutaneous (TRAM) flap. MATERIALS AND METHODS: MRI was performed on 20 patients who had been diagnosed with breast cancer and had undergone an MRM and TRAM flap. The results were examined in terms of MRI's ability to detect the flap and assess possible postoperative changes and recurrence. In addition, MRI images of the opposite breast were analyzed. Follow-up examinations were carried out on 11 patients, and all changes were assessed. RESULTS: The flap was clearly visualized by MRI in all of the patients. The signal intensity of the flap was equivalent to that of fat. The contact zone between the TRAM flap and the mastectomy site was enhanced after contrast infusion. Postoperative changes, such as skin thickening (n=20), edema (n=2), fluid collection (n=3), hematoma (n=1), and fat necrosis (n=3), were detected. In two patients, artificially inserted fat tissue was identified. On the MRI of the opposite breast, enhancing lesions were detected in seven patients. In one patient with this finding, ductal carcinoma in situ was diagnosed. On the follow-up MRI, a decrease in skin thickening, fat necrosis, and hematoma was detected. CONCLUSION: MRI is an effective method for lesion detection and evaluation of postoperative changes after MRM and TRAM flap, as well as for evaluation of the opposite breast.     

ACE-star模式实施功能康复对乳腺癌改良根治术后患者恢复的影响

 目的 探讨ACE-star模式实施功能康复对乳腺癌改良根治术后患者恢复的影响。方法 选择2017年1－12月在北京协和医院行乳腺癌改良根治术治疗的乳腺癌患者。采用方便抽样选择1－6月份行乳癌改良根治术的92例为对照组,7－12月份行乳癌改良根治术的92例为试验组。相同的乳腺癌改良根治手术后,对照组患者仅接受常规护理,试验组接受常规护理+ACE-star模型循证护理干预。对比两组患者术后并发症发生情况,统计患者对护理的满意度,评价手术前后患者心理状态。结果 试验组患者术后皮下积液、淋巴水肿发生率低于对照组(2.2% vs 16.3%,1.1% vs 13.0%),差异有统计学意义( P<0.05)。试验组患者对护理工作的满意度高于对照组(97.83% vs 82.61%, P<0.05)。试验组患者在躯体化、敌对性和恐怖方面的得分均低于对照组[(2.2±0.3) vs. (1.5±0.5);(2.3±0.5) vs. (1.7±0.6);(1.9±0.7) vs. (1.2±0.5), P<0.05)]。结论 ACE-star模式护理干预可降低乳腺癌患者术后并发症的发生率,提高患者满意度和生存质量,值得临床推广。     

Ruptured breast implant: computed tomographic and mammographic findings

We report the computed tomographic and mammographic findings in a patient with a ruptured breast implant. The diagnosis was made by recognition of alteration in prosthesis contour, collapse of the prosthesis envelope, and the presence of free silicone in the breast and axillary region.     

皮瓣多点缝合防治乳腺癌术后并发症的临床研究

目的探讨在乳腺癌改良根治术中加用腋窝及胸壁与皮瓣缝合减少皮下积液的临床效果。方法将96例行乳腺癌改良根治术患者随机分为两组,治疗组行腋窝、胸壁与皮瓣缝合,对照组采用传统缝合方法。对比观察两组术后每天的引流量、皮下积液发生率、皮瓣坏死率等指标。结果术后两组引流量、皮下积液发生率的差异有统计学意义（P〈0.05）;术后两组皮瓣坏死率差异无统计学意义（P〉0.05）。结论乳腺癌改良根治术中采用皮瓣多点缝合可明显减少术后引流量及皮下积液发生率。     

Treatment results in males with breast cancer

Because cancer of the male breast is rare knowledge about its biology and behavior is essentially due to a compilation of pooled experiences. Hence, a continued report of cases appears to be important. Therefore a retrospective review of patients suffering from male breast cancer was carried out. Twenty-four evaluable cases were analyzed. Eight patients (1 patient with bilateral Stage I carcinoma was included) were in Stage I, 7 in Stage II, 2 in Stage IIIa, 4 in Stage IIIb, and 3 in Stage IV. Of 23 patients who were treated with mastectomy, 22 had modified radical mastectomy and postoperative irradiation to the chest wall as well as to the peripheral lymphatic areas in most cases. One patient underwent radical mastectomy. Another patient had an excision biopsy only, followed by irradiation. One of 24 patients received tamoxifen; another received cyclophosphamide, methotrexate, 5-fluorouracil, predisone (CMF) regimen in an adjuvant setting. Local recurrence developed in one of 23 (4%) patients treated with mastectomy and radiation therapy to the chest wall and peripheral lymphatics. Four (17%) patients developed distant metastases. The 5-year overall survival (Kaplan-Maier) was 90% for the entire group, 100% for patients in Stage I–III disease, and 60% in Stage IV disease (P = <0.005). As observed in former reports the stage of disease at initial presentation seems to be a parameter that significantly contributes to survival in male breast cancer patients. To what extent improved local control by adequate local therapy, such as surgery and postoperative radiotherapy, may improve overall survival remains to be discussed. Correspondnce to: B. Pakisch