乳腺癌保乳术中利用邻近皮瓣转移即刻修复乳房缺损的临床效果分析

目的评价乳腺癌保乳术中使用邻近腹壁脂肪瓣修复乳房广泛切除后缺损的疗效。方法对16例乳腺癌患者施行乳腺癌保乳术,术中切口设计、手术步骤、美学评价、皮瓣选择、皮肤缝合等综合修补乳房缺损。结果使用邻近皮瓣修复乳房广泛切除后的缺损,保证更充分地切除癌旁组织,同时还可以获得良好的乳房外形。美学评价:14例优秀,2例良好,无外形差的病例,乳房外观优良率88.9%。术后患者满意度调查显示,16例患者均对自己的乳房形态感到满意,患者主观评价满意度为100.0%。结论下皱襞切口即可达到隐蔽效果,又可不增加新手术切口使暴露显著,隐蔽效果更佳。乳腺癌保乳术利用邻近腹壁脂肪瓣修复乳房广泛切除后的缺损,保证更充分地切除癌旁组织,同时使一部分失去保乳手术机会的妇女接受保乳手术治疗,重建一个完美的乳房,从而弥补保乳手术所带来的美容缺陷。     

乳房成形术在乳腺癌保乳术后缺损修复中的应用

目的 对比分析乳腺癌不同保乳手术治疗中乳房缺损修复的方法,分析其各自的特点.方法 收集昆明医科大学第三附属医院乳腺科2011年10月至2014年3月期间,采用双环法＋腺体修复成形术,带蒂背阔肌肌皮瓣和邻近皮瓣修复保乳术后乳房缺损等方法,进行保乳手术治疗中乳房缺损修复的乳腺癌病例,术后随访3 ～ 24个月,采用体检测量和满意度调查的方式评价手术后乳房的美容效果.结果 共收集到乳腺癌保乳术后缺损修复病例124例,其中保乳手术时采用双环法＋腺体修复成形术对乳房缺损进行修复50例,采用带蒂背阔肌肌皮瓣修复48例,采用邻近皮瓣修复26例,手术均获得成功;术后3 ～ 24个月随访,3种方法乳房美容效果评分为21及以上者分别为36例（72.0％）、26例（54.2％）和18例（69.2％）,经卡方检验分析得出,采用双环法＋腺体修复成形术修复保乳术后乳房缺陷的效果优于另外2种方法,P＜0.05;3种方法患者满意度分别为：94.0％、87.5％和92.3％,双环法＋腺体修复成形术满意率高于另外2种方法,差异有统计学意义,P＜0.05.结论 乳腺癌早期患者,采用双环法＋腺体修复成形术对保乳术后乳房缺损进行修复,术后乳房美容效果更好,患者满意度高,是值得推荐的一种手术方式.     

背阔肌肌瓣在乳腺癌保乳术后局部缺损修复中的应用

目的探讨利用背阔肌肌瓣转移修复乳腺癌保乳术后局部缺损的手术方法和美容效果。方法 28名患者,肿瘤最大直径2.0~6.5 cm。乳腺癌保乳术后局部缺损采取背阔肌肌瓣转移修复,术后常规化疗—放疗—内分泌治疗。结果全组28名患者背阔肌肌瓣均成活,放疗结束后,背阔肌未受显著影响。术后定期复查,乳房外形评分,25例为优,3例为良。结论采用背阔肌肌瓣转移修复乳腺癌保乳术后局部缺损给一些乳房较小而肿瘤相对偏大的乳腺癌患者带来福音,可以更广泛地切除乳腺组织,赋予患者最佳的乳房美容效果。     

扩张皮瓣联合游离植皮在局部晚期乳腺癌手术中的应用

目的探讨扩张皮瓣联合游离植皮修复局部晚期乳腺癌手术后巨大软组织缺损的应用价值。方法对11例局部晚期乳腺癌行4个疗程化疗,化疗前先以亚甲蓝在肿瘤的体表轮廓纹身标记,并在患侧乳房下方腹壁皮下埋植扩张器,化疗期间逐渐注水扩张皮瓣,在完成乳腺癌改良根治术后即时取出水囊,利用扩张皮瓣和下腹壁游离皮瓣修复胸壁巨大软组织缺损。结果化疗过程顺利,11例患者皮瓣扩张良好,手术顺利,扩张皮瓣及游离植皮有效覆盖手术创面并实现Ⅰ期愈合,患者放疗耐受性好,短期随访未发现肿瘤胸壁复发。结论应用邻近扩张皮瓣联合游离植皮修复乳癌术后胸壁巨大软组织缺损的效果良好。     

邻近皮瓣修复颌面部软组织缺损34例的临床应用

目的评价应用邻近皮瓣修复颌面部软组织缺损的临床效果。方法对34例颌面部软组织缺损创面术后分别采用推进皮瓣、旋转皮瓣等多种方法转移修复。结果34例患者术后创面均I期修复,术后外形满意。结论邻近皮瓣设计灵活,采用适当的方法修复颌面部软组织缺损可以取得良好效果。     

乳腺癌保乳术行背阔肌皮瓣即刻乳房缺损修补6例

目的 探讨乳腺癌保乳术行背阔肌肌皮瓣修补乳房缺损的方法及疗效.方法 乳腺癌患者6例施行乳腺癌保乳术,术中切口设计、手术步骤、美学评价、皮瓣选择、皮肤缝合等综合修补乳房缺损.结果 乳房下皱襞不增加新的手术切口瘢痕且术野暴露充分,隐蔽效果较佳.按照Harris标准评价术后乳房美容效果,优秀3 例,良好2 例,尚可1例,无外形差的病例.术后患者满意度调查显示,6例患者均对自己的乳房形态感到满意.结论 "J"形切口,既达到隐蔽的效果,又不增加新的手术切口,隐蔽效果更佳,不会在后背另留手术瘢痕.乳腺癌保乳术行背阔肌肌皮瓣修补乳房缺损增加了保乳术的适应证,重建一个完美的乳房,从而弥补了保乳手术所带来的美容缺陷.     

周围腺体组织瓣在乳腺癌保乳术中局部缺损修复中的应用

目的：研究周围腺体组织瓣在乳腺癌保乳术中局部缺损修复中的应用效果。方法选取行乳腺癌保乳术患者72例,分为A组和B组,各36例,A组进行皮肤直接缝合,B组进行周围腺体组织瓣转位整形,比较2组美容效果以及术后并发症情况。结果 A组进行皮肤直接缝合,不满意8例,不满意率为22.22%,显著高于于B组行周围腺体组织瓣转位整形的1例及2.78%,差异具有统计学意义（χ2=4.57,P<0.05）;B组进行周围腺体组织瓣转位整形方法美容效果优于A组进行皮肤直接缝合（χ2=4.57,P<0.05）。结论周围腺体组织瓣在乳腺癌保乳术中局部缺损修复中的应用效果良好,患者满意度高,具有更好的美容效果。     

皮瓣Ⅰ期修复乳腺癌术后胸壁巨大缺损的疗效分析

目的探讨局部晚期乳腺癌术胸壁巨大缺损的修复方法。方法 4例局部晚期乳腺癌病例均为T4期患者,累及皮肤面积较大,局部切除后出现巨大胸壁缺损,2例行邻位皮瓣旋转修复,1例行背阔肌岛状瓣修复,1例行下腹部横型腹直肌皮瓣(TRAM)修复。结果行邻位皮瓣旋转修复病例出现小面积坏死,经清创换药后行胸锁乳突肌岛状瓣修复后愈合;余3例全部Ⅰ期愈合。结论对于可接受手术治疗的巨大晚期乳腺癌的患者,应用皮瓣修复其术后胸壁皮肤大面积缺损,使得胸壁创面得到完整的皮肤覆盖,明显改善患者的生活质量,有利于综合治疗的顺利进行。     

前锯肌肌瓣修补保乳手术后乳房局部缺损的应用

传统的乳腺癌手术在治疗的同时破坏了女性优美的性征和曲线,给患者造成极大的心理创伤,严重影响患者术后生存质量。早期乳腺癌治疗手段已经由传统的根治手术发展到现在的保乳术,应用前锯肌肌瓣修复保乳术后局部的缺损,可明显改善美容效果。其不仅可以缓解患者因失去乳房而导致的心理压力和情绪障碍,恢复患者的自信与社会参与意识,而且可以极大地提高乳腺癌患者术后的生活质量。     

皮肤软组织扩张术在乳腺癌术后缺损修复重建中的应用

目的：评价皮肤软组织扩张术修复重建乳腺癌术后缺损的效果10例。方法回顾性分析采用皮肤软组织扩张技术完成的18例乳腺癌重建、修复手术患者的临床资料,其中重建组10例乳腺癌术后即时植入皮肤软组织扩张器持续扩张皮瓣,延期植入假体进行乳房重建;皮瓣修复组8例化疗2周期后植入皮肤软组织扩张器扩张邻近皮瓣,术后即时进行皮瓣修复,分析皮肤软组织扩张技术应用的手术方法、并发症以及效果。结果重建组1例皮瓣出现2 cm ×1 cm 坏死,2例假体位置稍高于对侧,优良率为90%,患者主观评价满意度为100%;皮瓣修复组1例1个扩张器出现2 cm ×3 cm 区域皮瓣感染、坏死,伤口裂开,给予取出扩张器,患者主观评价满意度为88%。术后随访9～48个月,重建组手术效果满意,无一例复发转移;皮瓣修复组1例出现局部复发,2例出现骨转移,1例出现肺转移,1例出现肝转移。结论采用皮肤软组织扩张术修复重建乳癌术后缺损可以获得满意的修复重建效果。     

Breast

<正>209026 Relationship between breast cancer-related lymphoedema and VEGF-C and VGGFR-3/He Jianye (贺建业,DeptGen Surg,Anzhen Hosp,Cap Univ Med Sci, Beijing 100029)…∥Chin J Gen Surg. -2009,24(11). -900～903 Objective To study the distributionand clinicopath-ological characteristics between VEGF-C and peritumoral lymph vessels density (PlND) in breast cancer tissue,and to investigate the development and the mechanism of breast cancer-related lymphoedema(BCRL).     

Breast

Effect of PTEN on the cell growth and P13K/ AKT signal pathway in Tamoxifen-resistant breast cancer cell-line LCC2;Pacilitaxel in association with gemcitabine for anthracycine-resistant advanced breast cancer;Effect of uroacitides on the cell cycle progression and the expression of Cyclin D1 of breast cancer cells ; Relationship between expression of focal adhesion kinase, tumor suppressor gene PTEN-encoding protein and biological behaviors in breast carcinoma;……     

Breast

Significance of multidisplinary surgery in chest wall resection and reconstruction for selected patients with breast cancer, Relation between c-erbBl,c-erbB2,MAPK expression and resistance to tamoxifen in breast cancer cells in vitro, Observation and clinical significance of adjuvant chemotherapy-induced amenorrhea in premenopausal breast cancer patients,Effects of Syk （L） nuclear translocation on breast cancer cell invasion,     

Breast

<正>210378 Expression and significance of stromal CD10 and Ezrin inductal carcinoma in situ and invasive ductal carcinoma of breast/Zhang Rongju(张荣菊,Breast Cancer Research Key Lab Educat Minis Nation,Oncol Key Lab Tianjin,Tianjin Cancer Inst Cancer Hosp,Tianjin Med Univ,Tianjin 300060)…Chin J Exp Surg.-2010,27(6).-705～707     

乳腺癌术后的乳房重建

乳房重建能纠正乳房切除术后的形体畸变和减少负面情绪影响,并且不影响乳腺癌的预后及监测。是否进行重建和重建策略的制订需要个体化,必须考虑患者的形体特点、全身情况、乳腺癌治疗计划和个人喜好。乳房重建大体分为假体重建和自体组织重建。假体重建中使用盐水或硅胶假体同样安全有效;自体组织重建通常使用腹部皮瓣,其中腹部游离皮瓣技术能有效保留腹部肌肉,减少术后腹部并发症。无论是假体重建或自体组织重建都有其优缺点,都需考虑后续放疗的影响。     

Breast

<正>209169 Analysis of the treatment and prognosis of recurrent breast phyllodes tumor/Fang Yi(Dept Abdomin Surg,Oncol Cancer Hosp(Institute),Chin Acad Med Sci,Beijing 100021)…∥Chin J Oncol.-2009,31(1).-72~74Objective To explore the methods of diagnosis,treatment and prognosis for patients with recurrent breast phyllodes tumor.Methods Clinicopathological data of 26 patients with pathologically proven recurrent phyllodes tumors treated from March 1972 to June 2006 were retrospectively analyzed.Results The mean age of the 26 cases was 45 years,and the median follow-up duration was 83 months.The mean overall survival time of this series was 96 months.The primary breast phyllodes tumor was ≥5 cm in 10 cases with a recurrence rate of 60.0%(6/10 cases);<5 cm in 16 cases with a recurrence rate of 31.3% 5/16(cases).After surgical removal of the breast primary tumor,the recurrent tumor was ≥5 cm in 14 cases with a re-recurrence rate of 35.7%(5/14 cases);<5 cm was in 12 cases with a re-recurrence rate of 50.0% (6/12 cases).There was no statistically significant relationship between the(primary and reccurent)tumor size and recurrence rate(P=0.094,P=0.383)or prognosis,(P=0.142,P=0.486).The benign or malignant nature of the breast phyllodes tumor was singificantly correlated with the rate of local re-recurrence(P=0.046)and prognosis(P=0.028).     

Breast

Technique investigation of endoscopic axillary lymph node dissection by liposuction , The study on sentinel lymphatic channels by us. ing methylene blue in breast cancer patients , A study of the combination of vinorelbine and epirubicin as ncoadjuvant chemotherapy regimen in the treatment of locally advanced breast cancer , Epidermal growth factor receptor signaling pathway in tamoxifen-resistant breast cancer cells     

Breast

A retrospective study of 129 cases with immediate breast reconstruction after skin-sparing mastectomy for breast cancer; Expression of imprinted tmnor suppressor gene SLC22A18 in breast cancer; WWOX gene expression and aberrant CpG island hypermethylation of WWOX gene in breast cancer; Are there other axillary lymph node metastasis than positive sentinel lymph nodes containing micrometasrases and isolated tumor cells in patients with breast cancer.     

Breast

<正>209325 Clinical characteristics and survival in the operable breast cancer patients with different molecular subtypes/Zhang Huiming(张慧明,Dept Abdom Surg Oncol,Cancer Hosp(Inst),Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Oncol.-2009,31(6).-447～451Objective According to the immunohistochemical (IHC)test of ER,PR and HER-2,breast cancer can be divided into 4 different molecular subtypes:Luminal A subtype (ER or PR positive and HER-2 negative),Luminal B subtype (ER or PR positive and HER-2 positive),HER-2 sutype (ER and PR negative,HER-2 positive) and Basal-like subtype (ER,PR and HER-2 negative).This study was to analyze the clinical features of different breast cancer subtypes,and try to find the evidence of combined and individualized treatment for patients with breast cancer.Methods The data of 408 surgically treated breast cancer patients in the Cancer Hospital of Chinese Academy of Medical Sciences from January 1,2002 to December 31,2002 were collected and retrospectively analyzed.The clinicopathological features and recurrence,metastasis as well as survival of these four subtypes were compared.Results Of the 408 cases,Luminal A subtype accounted for 60.8% (248/408),Luminal Bsubtype 7.8% (32/408),HER-2 subtype 12.5%(51/408),and Basal-like subtype 18.9%(77/408).Basal-like subtype had less lymph mode metastases than other subtypes(P<0.05).HER-2 subtypes consisted of less patients aged 45 years or younger than other subtypes(P<0.05).Luminal B subtype contained less advanced cases than other subtypes(P<0.01).By August 2008,the median time of follow-up was 64 months (range,3-79 months).Fifty-eight cases presented local recurrence or metastasis,and 51 of them died of the disease.The 5-year overall survival rates (OS) for patients with Luminal A,Luminal B,Basal-like and HER-2 subtype were 89.83%,86.15%,79.85% and 86.70%,respectively.The 5-year disease-free survival (DFS) rates of the four subtypes were 83.52%,68.88% and 75.83%,respectively.The rate of local recur