肿瘤大小对保留乳房手术后美容效果的影响

目的探讨肿瘤大小对保乳术后美容效果的影响。方法对1999年9月至2005年9月，肿瘤大小明确的170例保乳患者美容效果进行评价。结果术后患者美容效果满意率为84％（143／170）。当肿瘤直径大小〉3cm时，美容效果满意率为45．5％：肿瘤直径大小≤3cm时，满意率为86．8％。二者具有明显的统计学差异（P〈0．05）。结论肿瘤大小是影响术后美容效果的重要因素。     

乳腺癌保留乳房术后影响乳房形态的多因素分析

目的探讨乳腺癌保乳术后影响乳房形态的因素及提高保乳术后乳房美学效果的方法。方法由整形外科医师和患者分别对67例乳腺癌保乳术后的美学效果做出各自独立的评价，单因素分析采用Mann-Whitney U检验，而多因素分析则应用Logistic回归的方法。结果医师对保乳术后乳房形态的满意率为65．7％。单元素分析中，年龄（P=0．003）、体重指数（P=0．002）、绝经状况（P=0．002）、放疗剂量（P=0．022）、肿物位于外上象限时的切口数量（P=0．036）、切除次数（P=0．036）、纤维化（P=0．002）、手术方式（P=0．002）对保乳术后乳房形态具有明显的影响。多元素分析中，纤维化、手术方式、放疗剂量对术后乳房形态具有明显影响（P=0．009、0．001、0．019）。患者对保乳术后乳房形态的满意率为76．1％。单元素分析中，手术方式（P=0．001）和纤维化（P=0．045）对乳房形态影响明显，差异具有统计学意义。多元素分析中，手术方式对术后乳房形态影响明显（P=0．005）。结论患者和医师的满意率具有正相关性（R=0．701，P〈O．01）。在可能影响乳房美学的27项因素中，年龄、体重指数、绝经状况、放疗剂量、肿物位于外上象限时的切口数量、切除次数、纤维化、手术方式对术后乳房形态影响明显。     

Survival outcomes after breast-conserving therapy compared with mastectomy for patients with early-stage metaplastic breast cancer: a population-based study of 2412 patients

BackgroundPrevious studies revealed that patients with early-stage metaplastic breast cancer (MBC) underwent mastectomy more often than breast-conserving therapy (BCT) mainly due to the larger tumor size. This study was performed to compare the survival outcomes following BCT versus mastectomy for patients with early-stage MBC.MethodsSurveillance, Epidemiology, and End Results (SEER) database was used to identify women diagnosed with early-stage MBC (T1-3N0-3M0) between 2001 and 2016, who were treated with either BCT or mastectomy. We assessed overall survival (OS) and breast cancer-specific survival (BCSS) using the Kaplan-Meier method and hazard ratios using Cox proportional hazards models.ResultsA total of 2412 MBC patients were identified, 881 (36.5%) of whom underwent BCT and 1531(63.5%) underwent mastectomy. The median follow-up time was 73 months. Most of patients had older age (≥50 years old), larger tumor size, higher American Joint Committee on Cancer (AJCC) stage and hormone receptor negativity. After adjustment for confounding variables, patients who underwent BCT had significantly improved OS (5-year OS: 84.3% vs 62.5%; 10-year OS: 73.0% vs 52.1%; adjusted HR = 0.76, 95%CI: 0.59–0.97, p = 0.028) and BCSS (5-year BCSS: 89.1% vs 70.8%; 10-year BCSS: 83.9% vs 67.5%; adjusted HR = 0.72, 95%CI: 0.53–0.96, p = 0.026) than those who underwent mastectomy, and this improvement remained significant for all T and N stages of MBC except for N2-3 stage.ConclusionBCT conferred improved OS and BCSS compared with mastectomy for patients with early-stage MBC, and the improvement persisted in almost all of the subgroups of different T and N stages.     

乳腺癌门诊误切后保乳手术的选择

目的探讨乳腺癌在门诊作为良性肿瘤诊误切后保乳手术的可行性。方法对我院2003年1月～2006年1月乳腺癌门诊误切后施行保乳手术的14例病人进行总结分析。肿瘤直径在1～2cm,平均1.5cm。术前腋窝淋巴结均无扪及,术中哨兵淋巴结冰冻检查有3例转移。结果14例中施行保乳手术11例,术后均无发生并发症,平均7天出院,随访3～34个月无肿瘤复发。结论门诊误切后的乳腺癌多为早期患者,故保乳手术是其较佳的治疗选择。     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。     

乳腺癌保乳术中残存乳腺的处理方法

目的 探讨乳腺癌保乳手术中残存乳腺直接缝合法与美学重塑法的效果比较.方法 43例经穿刺活检确诊的Ⅰ、Ⅱ期乳腺癌患者,均行肿瘤扩大切除术及腋淋巴结清扫术.其中,直接缝合组22例,术中对乳腺体缺损不予缝合,直接缝合皮肤封闭创腔;乳腺美学重塑组21例,游离剩余乳腺组织瓣,转移修复乳腺腺体缺损,再缝合皮肤.术后均给予全乳三维放射治疗、规范化疗和内分泌治疗.术后3年,自拟美学评分标准,对两组患者乳房的美学效果进行回顾性分析.结果 直接缝合组美学评分4.3分,优良率40.9%（9/22）;乳腺美学重塑组美学评分4.8分,优良率71.4%（15/21,P＜0.01）,乳腺美学重塑组乳房美学效果优于直接缝合组.结论 乳腺癌保乳术中采用美学重塑技术,术后乳房美学效果更好.     

保乳手术治疗高龄乳腺癌患者的临床分析

目的:探讨保乳手术治疗早期高龄乳腺癌患者的临床效果。方法:筛选114例早期高龄(≥60岁)乳腺癌患者,随机分为乳腺癌局部扩大泛切除术组,即保乳手术组(57例)和传统乳腺癌根治术组(57例),分析比较两组的围手术期观察指标和临床疗效。结果:保乳手术围手术期的出血量和总引流量少,引流管拔除时间短,与传统手术组相比,差异有统计学意义(P<0.05);保乳手术组美容效果优良率为94.74%,远高于传统手术组(3.51%);保乳手术组与传统手术组在局部复发率、远处转移率和生存率等方面无统计学差异(P>0.05)。结论:保乳手术联合术后辅助治疗,对老年乳腺癌患者机体损伤小、恢复快,可满足患者的美学要求,因此,保乳手术联合术后辅助治疗的方案可在早期老年乳腺癌患者中推广。     

乳腺癌保乳手术切除范围的探讨

目的 探讨乳腺癌保乳手术的局部切除范围.方法 回顾性分析南京医科大学第一附属医院乳腺外科、镇江市人民医院乳腺外科和常州市中医医院行保乳手术的275例连续病例,所有患者均按统一的手术步骤操作,并采用相同的术后辅助治疗,定期随访患者局部和全身情况.结果 271例患者获得随访,随访率98.5％.随访时间1个月～9年9个月,中位随访34个月.2例局部复发,6例发生远处转移死亡.患者1年、3年、5年总生存率分别为99.5％、98.1％、95.7％.结论 切除肿瘤周围1 cm乳腺组织,冰冻切片证实边缘无肿瘤浸润,术后辅助化疗、内分泌治疗及放疗,手术是安全的,有益于提高患者生存质量.以钼靶片结合体检确定有无多中心、多灶性病变是安全、有效的.     

Aggressive therapy for locoregional recurrence after mastectomy in stage II and III breast cancer patients

Background: To determine if aggressive treatment of locoregional recurrence affects survival, we retrospectively analyzed the clinical outcome of 69 breast cancer patients who developed locoregional disease as their first episode of recurrence following mastectomy and adjuvant chemotherapy. Methods: Patients were identified from among 1,707 stage II and III breast cancer patients who enrolled in five different doxorubicin-based adjuvant chemotherapy protocols at The University of Texas M. D. Anderson Cancer Center from 1975 to 1986. Sixty-nine evaluable patients who had a locoregional recurrence as the first site of relapse after mastectomy formed the study group. Multifactorial analysis of clinical and histopathological characteristics of both the primary tumor and the subsequent recurrence was performed using a logistic regression method. Survival analysis was performed using an actuarial life-table method calculated from the date of registration into the adjuvant therapy protocols. Results: Median follow-up was 6.6 years. Two factors significantly affected survival: recurrence of disease during or after adjuvant treatment of the primary and whether the patient was rendered disease free after recurrence. Conclusions: Stage II and III breast cancer patients who have locoregional recurrence after adjuvant chemotherapy and can be rendered disease free may have a better survival rate. Aggressive treatment of locoregional recurrence including complete surgical excision should be considered in this subgroup of patients.     

早期乳腺癌保乳手术与改良根治术的对比研究

目的探讨保乳手术与改良根治术对早期乳腺癌的治疗效果。方法回顾性分析86例早期乳腺癌患者的临床资料,比较两组患者术后生存率、复发率、转移率及焦虑和对美容效果的满意度。结果改良根治术和保乳手术后患者的3、5、10年生存率、复发率和转移率差异无统计学意义,而保乳手术组患者术后1年的焦虑情况显著低于改良根治术组,美容效果显著优于改良根治术组。结论保乳手术能够取得与改良根治术相似的治疗效果和远期疗效,且能够满足女性形体美的要求,患者的满意度高,值得临床推广应用。     

Ⅰ期和Ⅱ期乳腺癌保乳手术与改良根治术临床疗效对比研究

目的：探讨保乳手术与改良根治术治疗Ⅰ、Ⅱ期乳腺癌的临床疗效差异。方法：系统回顾2000年1月—2009年1月我院肿瘤外科收治的45例接受保乳手术的乳腺癌患者的临床资料,将其与同时期接受改良根治术的120例乳腺癌患者进行对比,比较2组患者在术后早期并发症、生存率、术后局部复发及远处转移、术后美容效果和生活质量方面的差异。结果：乳腺癌患者术后早期并发症主要为皮下积液、皮瓣坏死和患侧上肢水肿,此方面2组患者差异无统计学意义;术后复发、远处转移率和生存期2组患者的差异亦无统计学意义;而保乳手术术后美容效果和生活质量显著优于改良根治术,二者差异有统计学意义（P〈0.05）。结论：保乳手术和改良根治术在Ⅰ、Ⅱ期乳腺癌患者的术后早期并发症、生存率、术后复发和远处转移方面无明显差异,而在术后美容效果和生活质量方面,保乳手术明显优于改良根治术。保乳手术是Ⅰ、Ⅱ期乳腺癌的最佳手术方式。     

Patient age and positive margins are predictive factors of residual tumor on mastectomy specimen after conservative treatment for breast cancer

AimsTo determine factors predictive of the presence of residual tumor on the specimen from mastectomy performed after conservative treatment for breast cancer in order to limit potentially unnecessary mastectomies (free of residual lesions).Materials and methods294 patients treated in 2 expert centers for breast cancer with breast-conserving therapy (BCT) followed by mastectomy, according to French recommendations, were investigated between January 1, 1998 and January 1, 2005. Patients with residual tumor on the mastectomy specimen were compared with patients whose mastectomy specimens did not reveal any residual tumor. All the clinical risk factors (age, previous history of breast cancer, tumor focality) and histological risk factors (tumor size, histological type, positive margins, estrogen and progesterone receptor expression, histological grade) for residual tumor after BCT were compared between the 2 patient groups.ResultsOf the 294 patients studied, 202 (68.71%) mastectomies had residual tumor and 92 (31.29%) were tumor-free. Four predictive factors for residual tumor were found in the univariate analysis: age under 45 years (p = 0.01), absence of estrogen receptor expression (p = 0.05), positive margins (p = 0.01), and presence of lymph node metastases (p = 0.05). The multivariate analysis revealed only 2 independent risk factors that were significantly associated with increased risk of residual tumor on the mastectomy specimen: age under 45 years (p = 0.05) and presence of positive margins on the lumpectomy specimen (p = 0.05).ConclusionYoung age of patients (under 45-years-old) and presence of positive margins on the operative specimen are independent risk factors of residual tumor after conservative treatment of breast cancer.     

The use of radiation therapy after breast-conserving surgery in hormonally treated breast cancer patients is dependent on patient age, geographic region, and surgeon specialty

BACKGROUND: The use of radiation therapy (RT) after breast-conserving surgery (BCS) is inconsistent in patients treated with hormonal therapy (HT). We sought to identify factors influencing the decision to use RT in this setting. METHODS: Patients in the North American Fareston vs. Tamoxifen Adjuvant (NAFTA) trial who had BCS were evaluated for factors influencing the use of RT using univariate and multivariate analyses. RESULTS: Of the 1,811 patients enrolled in the NAFTA trial, 1,222 (67.4%) had BCS. Of these, 241 (19.7%) did not have RT. There were no significant differences in tumor grade, lymphovascular invasion, estrogen receptor status, or nodal status between those who received RT and those who did not. On univariate analyses, patients who did not receive RT were more likely to be older (median 72 versus 66 years, P < .001), have larger tumors (median 1.35 versus 1.10 cm, P = .009), and be progesterone negative (18.3% versus 13.1%, P = .048). Surgeons in the West were most likely to omit RT, whereas those in the Midwest were least likely to omit it (26.7% versus 7.2%, P < .001). Surgical oncologists were more likely to omit RT after BCS than general surgeons (21.8% versus 13.7%, P < .001). Academic affiliation (P < .001), number of breast procedures performed per year (P = .017), and the percentage of breast practice (P = .019) also correlated with whether or not RT was used. On multivariate analysis, patient age (P < .001), geographic region (P = .006), and surgeon specialty (P = .027) remained significant. CONCLUSION: Patient age, geographic region, and surgeon training influence the decision to use RT after BCS in patients receiving HT.     

乳腺癌保乳治疗后局部复发的临床研究

目的 比较分析乳腺癌保乳治疗后局部复发病例与同期非复发病例资料,分析影响局部复发的风险因素.方法 密切随访2000年1月至2008年6月收治的1034例保乳治疗患者.患者年龄23～94岁,中位年龄48岁.分析年龄、雌激素受体(ER)/孕激素受体(PR)状态、人类表皮生长因子受体2(HER-2)状态、淋巴结转移状态、肿瘤大小、新辅助化疗、病理类型对局部复发的影响.结果 随访截至2010年6月,中位随访42个月(3～126个月),同侧乳房局部复发35例(3.3%),远位转移47例(4.5%),5年无病生存率87.7%,5年无远处转移生存率94.0%,5年总体生存率99.3%.单因素分析显示,淋巴结状态、年龄及HER-2表达状态是影响局部复发的风险因素;复发高峰时间为术后第2年至第3年,以及第5年至第6年;多因素分析显示HER-2状态是局部复发的独立影响因素.结论 保乳治疗后出现两个局部复发高峰时间段,HER-2表达状态是局部复发的独立影响因素,对于具有高危因素的患者需更积极治疗.     

乳腺癌切除术后乳房再造

目的 探讨乳腺癌切除术后乳房再造的方法及时间.方法 总结30例不符合保乳条件的乳腺癌病例,乳房切除术后假体置人乳房再造16例,下腹部横行腹直肌肌皮瓣(TRAM瓣)乳房再造10例,背阔肌肌皮瓣乳房再造4例.其中即刻乳房再造27例,延期乳房再造3例.结果 16例假体置入乳房再造术后外观评价均为良,未出现术后并发症.10例TRAM瓣乳房再造术后发生皮瓣部分坏死2例,腹壁疝1例,术后外观评价7例为良.2例为较好,1例为差.4例背阔肌肌皮瓣再造术后外观评价为良.结论 乳房再造术是乳腺癌综合治疗不可忽视一部分,对于有强烈的保乳愿望,而又不符合保乳条件的患者,乳房再造术是一种较好的选择.即刻乳房再造优于延迟乳房再造.乳房再造的方法选择要因人而异.局部晚期乳腺癌患者可以选择性进行即刻乳房再造术.     

保乳手术和改良根治术治疗早期乳腺癌的临床疗效分析

目的探讨和比较保乳手术和改良根治术治疗早期乳腺癌的临床疗效和安全性。方法回顾性分析2013年1月至2015年9月期间接受外科手术治疗的100例早期乳腺癌手术患者的临床资料,根据患者的手术方式进行分组,其中保乳手术组(保乳组)50例,改良根治术组(改良组)50例,采用SPSS 19.0统计分析,两组患者的手术时间、术中出血量、住院天数等用"均数±标准差"表示,组间比较采用t检验;术后并发症发生情况、乳房美容效果、术后肿瘤局部复发率、远处转移率、1年生存率等用"%"形式表示,组间比较采用χ2检验。P0.05差异有统计学意义。结果保乳组手术时间、术中出血量、住院时间及术后并发症发生率均少于改良组(P0.05),美容效果优良率高于改良组(P0.05)。两组患者术后肿瘤局部复发率、远处转移率、1年生存率差异均无统计学意义(P0.05)。结论保乳手术与改良根治术治疗早期乳腺癌疗效确切,但保乳手术对患者损伤小、出血量少、并发症少、美容效果好,值得推广应用。     

Immediate reconstruction after mastectomy for breast cancer does not prolong the time to starting adjuvant chemotherapy

BACKGROUND: Immediate breast reconstruction is often performed after mastectomy for breast cancer. There has been concern that this will result in a delay in initiating chemotherapy and, as a consequence, may adversely impact survival. In this study we sought to determine whether immediate breast reconstruction affects the interval between surgery and adjuvant chemotherapy. METHODS: A single institution retrospective analysis was made using the institutional tumor registry and chart reviews. RESULTS: Forty-nine patients were identified who had undergone mastectomy with immediate reconstruction followed by adjuvant chemotherapy. They were compared with 308 patients undergoing mastectomy without reconstruction. Patients who underwent reconstruction were overall younger (46 versus 55, P <0.001), and had more advanced disease. The time to chemotherapy was significantly longer in the group receiving no reconstruction: 53 versus 41 days (P = 0.039). The type of reconstruction did not affect the time to chemotherapy. CONCLUSIONS: Immediate reconstruction after mastectomy does not increase the time to chemotherapy compared with mastectomy alone.     

经乳晕保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌

目的探讨经乳晕或乳腔镜辅助保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌的效果. 方法 2001年8月～2003年11月,对19例直径<2 cm、距离乳头>2 cm的乳腺癌经乳晕或乳腔镜辅助行保乳手术,腋窝脂肪溶解抽吸后常规开放性腋窝淋巴结清扫. 结果 1例术中冰冻病理报告一侧切缘镜下癌残留,经扩大切除后转阴.术后2例乳房创面皮下积液,抽洗加压包扎消失.保留的乳房形态良好,伤口小而隐蔽,所有患者对手术效果满意.术后随访2～19个月,平均10.6月,未见乳腺和腋窝肿瘤复发. 结论经乳晕或乳腔镜辅助下,借助乳腔镜器械可以方便地完成乳腺癌保乳手术,联合常规腋窝淋巴结清扫,手术效果肯定.     

保乳手术与改良根治术对早期乳腺癌患者预后及生活质量的临床观察

目的 比较保乳手术与改良根治术对早期乳腺癌(临床I、Ⅱ期)患者的预后及生活质量的差别.方法 回顾我院诊治的180例早期乳腺癌,分为保乳组与改良组,各90例.2组术后均按适应证进行放疗、化疗及内分泌治疗,观察其预后及生活质量的差别.结果 患者均术后随访5年,2组的无病生存期差异无统计学意义,但保乳组的生活质量(总体健康、生理功能、生理职能、躯体疼痛、活力、社会功能、情感职能及精神健康)明显高于改良组.结论 对早期乳腺癌患者应用保乳手术治疗,效果理想,且能取得良好的美容效果,提高生活质量,临床可积极应用.