保留皮肤乳腺癌改良根治术后即刻乳房重建的效果评价

目的总结乳腺癌患者行保留皮肤的改良根治术后即刻背阔肌（或扩大背阔肌）肌皮瓣乳房重建的效果。方法自2010-06—2012-10,对5例女性乳腺癌患者行保留皮肤的乳腺癌改良根治术,术后即刻乳房重建,重建方式为应用背阔肌肌皮瓣联合假体或扩大背阔肌肌皮瓣。术后评价其再造效果。结果5例患者手术成功,恢复良好,术后3例皮下积液,局部处理后愈合。患者均获随访,随访时间6～34个月,肿瘤均无局部复发。结论乳腺癌切除术后应用同侧背阔肌肌皮瓣联合假体或扩大背阔肌肌皮瓣即刻乳房再造可获得良好乳房形态。     

老年乳腺癌改良根治术后即刻乳房重建对患者生存的影响

目的探讨老年乳腺癌改良根治术后即刻乳房重建对患者生存的影响。方法选取老年乳腺癌患者98例,根据患者意愿将其分为对照组和试验组,各49例。对照组采用乳腺癌改良根治术,试验组采用乳腺癌改良根治术+即刻乳房重建,术后随访1年,比较两组生活质量评分、生活满意度、复发率、转移率、生存率、美容效果及并发症。结果术后1年,试验组社会及家庭状况评分(20.39±2.41)分、生理状况评分(17.09±2.30)分、附加关注状况评分(27.54±2.33)分、功能状况评分(19.68±3.02)分、情感状况评分(19.28±2.63)分均高于对照组[(15.22±2.47)分、(14.52±2.51)分、(21.35±2.06)分、(15.82±2.16)分、(16.02±2.50)分],差异有统计学意义(P<0.05);试验组术后生活总满意度(95.92%)较对照组(51.02%)增高,差异有统计学意义(P<0.05);试验组术后美容优良率(81.63%)较对照组(20.41%)增高,差异具有统计学意义(P<0.05);试验组疾病复发率(2.04%)、远处转移率(10.20%)、无瘤生存率(87.76%)、总生存率(91.84%)、并发症发生率(14.29%)与对照组(6.12%、4.08%、89.80%、93.88%、10.20%)相比差异无统计学意义(P>0.05)。结论老年乳腺癌患者采用乳腺癌改良根治术后即刻乳房重建术治疗可提升患者生活满意度,提升乳房美观效果,改善患者生活质量,不增加疾病复发率、远处转移率,且对患者生存率无明显影响。     

腔镜乳腺癌根治乳房重建的现状及努力方向

［摘要］　社会的进步促进了患者对提高乳腺癌手术后生活质量的要求。微创理念在乳腺外科领域的不断提升,使以腔镜技术为代表的微创手术得到了广泛的应用并日趋成熟。在不改变乳腺癌外科治疗原则的基础上,相较于传统开放手术,微创手术具有独特的微创及美学优势,尤其是在乳腺癌根治即刻乳房重建手术中,腋窝淋巴结切除、乳房腺体切除及获取自体组织行乳房重建等术式的灵活搭配组合,使重建后的乳房表面皮肤不再留下瘢痕,代表着乳腺癌的外科治疗步入了新的阶段。该文根据笔者的经验,就乳腺癌根治乳房重建的腔镜技术在纵深及腔镜术式整合方面进行探讨,为致力于乳腺腔镜技术的专家学者在临床治疗中提供一些参考。     

腔镜乳腺癌保乳根治术后一期带蒂大网膜乳房重建术的临床效果探讨

目的 探讨腔镜乳腺癌保乳根治术后一期带蒂大网膜乳房重建术的临床效果及术后并发症发生的预防。方法 回顾性分析2017年5月至2023年3月南方医科大学珠江医院收治的32例早期乳腺癌患者的临床资料,均在腹腔镜下获取带蒂大网膜行乳房重建术。总结分析其基线资料、手术结果、术后并发症、复发及转移情况等。结果 所有患者在腔镜辅助下成功获取大网膜,无中途转为开放手术的病例。术后随访时间为4～71个月,平均21.34个月。术后发生腹壁切口疝1例(3.13%),切口感染2例(6.25%),总并发症发生率为9.38%(3/32)。切口感染患者在采取抗感染、规律换药后均得到改善。对腹壁切口疝患者行切口疝修补术,后续无复发。结论 腔镜辅助下获取带蒂大网膜行乳房重建术能获得良好重建效果,但亦可发生相应的并发症,改善术中操作步骤,术后及时采取特定的措施可减少并发症的发生,获得良好的手术效果。     

分层充气法腔镜下胸肌筋膜联合假体一期乳房重建术的技术创新（附2例病例报告）

［摘要］　目的　探讨免补片经单切口分层充气法腔镜下乳房切除术后一期假体植入联合胸肌筋膜乳房重建的手术方法和临床应用价值。方法　回顾性分析2例早期乳腺癌患者的临床资料,分别经侧胸壁切口、腋窝切口入路在腔镜下完成乳房皮下腺体切除术后,完成全腔镜下胸肌筋膜联合假体植入的乳房重建术。观察其手术并发症发生情况,并运用BREAST-Q量表调查患者术前术后满意度。结果　2例患者均顺利完成手术,无术后感染、乳头乳晕或皮瓣缺血坏死、假体外露或取出、术后运动畸形、术后胸壁疼痛、包膜挛缩、“波纹”征等并发症。BREAST-Q量表调查结果显示患者均对术后乳房感到满意,除了偶有牵拉感,未报告其他胸壁不适,社会心理状态和性健康状态较术前无明显下降。结论　分层充气法腔镜下乳房切除术后胸肌筋膜联合假体植入一期乳房重建可为无条件使用补片的患者提供一种新的技术选择,该方法实现腔镜下分离解剖胸肌筋膜的技术要点,对于部分合适的人群值得进一步探索研究。     

乳腺癌乳房全切术后局部区域复发和远处转移的相关危险因素

目的探讨乳腺癌乳房全切术后局部区域复发(LRR)和远处转移的相关危险因素。方法收集并分析接受乳房全切术治疗的原发性乳腺癌患者178例,随访7~120个月,随访率97.2%(173/178)。结果 LRR 18例,3年复发率9.5%(14/148),3年生存率91.9%(136/148);远处转移30例,5年转移率21.8%(22/101),5年生存率84.2%(85/101)。术后无放疗组3年复发率显著高于术后放疗组(P<0.01);且切缘阳性术后放疗者复发率明显高于切缘阴性术后放疗者(P<0.05);腋窝淋巴结阳性术后未化疗组5年远处转移率显著高于术后化疗组(P<0.05);肿块>5 cm、切缘阳性与LRR有关(P<0.05),年龄<45岁、腋窝淋巴结阳性、组织学分级G3与远处转移有关(P<0.05)。结论乳腺癌乳房全切术后应放疗,且切缘阳性者应再切除至切缘阴性,腋窝淋巴结阳性者术后应化疗,肿块大小、年龄和组织学分级均是术后不良事件发生的危险因素。     

淮安地区乳腺癌患者术后乳房再造需求情况调查

目的 了解乳腺癌根治术后患者乳房再造的需求.方法 对淮安地区500例乳腺癌根治术后患者进行资料收集和问卷调查,把不同年龄、教育、临床病理(肿瘤大小、淋巴结转移、激素受体状态等)和重建需求情况进行比较.结果 多数患者对义乳佩戴效果满意.在乳房再造需求中,年龄越轻(＜45岁)需求比例越高,并受病理及术后并发症等影响.结论 应根据不同患者需求,制定合适的术后乳房缺失补救措施.     

乳腺癌施行保留乳房术式前辅以动脉灌注化疗32例临床观察

1996年 1月～ 1999年 10月 ,我院共收治乳腺癌患者 12 7例。随机选择 32例乳腺癌患者术前辅以动脉灌注化疗 ,对化疗后肿瘤直径 <2 cm的患者选用保留乳房的乳癌根治术( BCT) ,近期效果良好 ,现报告如下。临床资料 :1病例选择 :32例均是经临床、乳腺 X线钼靶摄片及穿刺细胞学确诊的女性乳腺癌患者 ,年龄 32～ 6 0岁 ,平均 42 .5岁。肿瘤均位于乳房外上象限 ,距乳晕 3.0 cm以上。根据国际抗癌联盟 ( U ICC)的 TNM分期 ,32例患者中 期 8例 , 期 2 4例 ,病变位于右侧 14例 ,左侧 18例。 32例均于术前动脉化疗灌注 2次。灌注前测量肿瘤大小…     

乳腺癌患者术后康复治疗的研究进展

［摘要］　乳腺癌是女性中发病率最高的恶性肿瘤,目前以外科切除为主进行综合治疗。对于乳腺癌术后的多种并发症,需要早期介入康复。该文就乳腺癌患者术后康复治疗的研究进展进行综述。     

Impairment of echocardiographic acoustic window caused by breast implants.

Cosmetic breast implants are increasing in popularity. The presence of a breast implant overlying the anterior mediastinal space as a cause of impairment of the echocardiographic acoustic window has not been described previously. Here, we report three cases with significant impairment of echocardiographic acoustic window caused by breast implants. Clinicians should be aware of this interference and women should be informed of this dilemma before considering this cosmetic surgery.     

Ropivacaine continuous wound infusion after mastectomy with immediate autologous breast reconstruction: A retrospective observational study

Continuous wound infusion usually provides postoperative analgesia as a multimodal analgesia with systemic opioid use. When continuous wound infusion of local anesthetics (LA) supports successful postoperative analgesia without systemic opioid use, the side effects of opioid can be reduced. Nevertheless, continuous wound infusion after mastectomy with immediate autologous breast reconstruction leads to concerns about wound healing. This study evaluated analgesic effects and wound healing conditions of continuous wound infusion of LA compared with opioid-based, intravenous patient-controlled analgesia (IV PCA) in mastectomy with immediate autologous breast reconstruction.This retrospective observational study included females, aged between 33 and 67 years, who underwent mastectomy with immediate autologous breast reconstruction. Sixty-five patients were enrolled. The eligible patients were placed into 2 groups for managing postoperative pain, one used continuous wound infusion with 0.5% ropivacaine (ON-Q, n = 32) and the other used a fentanyl-based IV PCA (IV PCA, n = 33). Using the electronic medical record system, the postoperative recovery profiles were examined over 5 days using a visual analogue scale (VAS), incidence of postoperative nausea and vomiting (PONV), incidence of sleep disturbance, frequency of rescue analgesic use, analgesia-related adverse events, length of hospital stay, and degree of patient satisfaction. The condition of the surgical wound was observed for 1 year after surgery.The primary endpoint was the intensity of pain at 6 hours after surgery. The VAS was comparable between the groups (P > .05). Although recovery profiles and the degree of patient satisfaction were similar between the groups, the incidence of PONV was significantly lower in the ON-Q group than in the IV PCA group on the day of surgery and postoperative day 1. No patients had severe wound complications. The satisfaction score of analgesia in the ON-Q group was comparable with that of the patients in the IV PCA group.This study demonstrates that single use of continuous wound infusion showed comparable analgesia with fentanyl-based IV PCA in patients who underwent mastectomy with immediate autologous breast reconstruction. Furthermore, the continuous infusion of LA directly on the surgical site did not significantly affect wound healing.     

保乳术与改良根治术治疗乳腺癌的临床疗效比较

目的比较保乳术与改良根治术治疗乳腺癌的临床疗效和应用价值。方法选取2011-06~2014-05该院收治的147例女性乳腺癌患者,按手术方式分为两组,其中保乳术(观察组)78例,改良根治术(对照组)69例,于术后结合患者实际情况给予辅助性治疗及术后定期随访,分别记录两组癌症患者的术中情况、乳房美观效果等,对两种手术方式进行多方面比较分析。结果观察组的手术时间、出血量及术后住院时间明显少于对照组,差异有统计学意义(P0.05);观察组的乳房美观效果明显优于对照组,差异有统计学意义(P0.05);两组的并发症、局部复发率、转移率差异无统计学意义(P0.05)。结论保乳术治疗女性乳腺癌患者的临床疗效显著,与传统的改良根治术相比,手术损伤小、恢复快、乳房美观效果好,具有临床应用价值。     

乳腺癌35例的超声表现分析

目的探讨乳腺癌的超声表现。方法对35例手术和病理证实为乳腺癌患者术前超声检查资料进行分析。结果 35例乳腺癌中超声显示为形态不规则30例,低回声不均匀31例,低回声均匀3例,混合回声1例,内部出现钙化5例,后方回声衰减23例,肿块内血流信号密度分级Ⅱ～Ⅲ级15例,阻力指数0.7以上10例。结论二维灰阶声像图结合彩色血流成像检查乳腺癌具有较高的灵敏度和特异度,且超声检查经济、简便、患者无痛苦、无放射损害,值得临床推广。     

Immediate breast reconstruction using latissimus dorsi muscular flap: A retrospective study of Chinese patients with breast cancer

Reconstruction of breast defects of patients who underwent mastectomy can be challenging. This study was designed to review a series of 43 breast cancer patients who underwent immediate breast reconstruction (IBR) using the latissimus dorsi myocutaneous flap with/without implants. The demographic characteristics, clinical application feasibility, and the satisfaction rates of the patients were retrospectively collected and evaluated.A total of 43 breast cancer patients who underwent mastectomy between August 2015 and February 2020 were included in the retrospective study. The included patients were subjected to IBR using latissimus dorsi muscular flap (LDMF) with/without implants. The clinical application feasibility and the satisfaction rates of the patients were evaluated.Among these patients, 35 patients underwent nipple-sparing mastectomy and 8 patients underwent skin-sparing mastectomy. Twenty-nine patients underwent IBR using LDMF with implants, and 14 patients underwent IBR using LDMF without implants. Among these patients, 2 patients had partial LDMF necrosis and atrophy, and showed significant shrink of the reconstructed breast. One patient developed seromas, and seromas were improved by active dressing change and sucking out the fluid via the skin using a syringe. Two patients had local skin flap necrosis on the chest, 1 patient had preserved areola and local necrosis of the nipple, and this was healed after dressing change. Based on the Harris method, 27, 9, 5, and 2 cases were evaluated as “excellent,” “good,” “fair,” and “poor,” respectively.In the present study, the reconstructed breast has natural shape, good symmetry, and hidden postoperative scars. The aesthetic effect is relatively good, and the use of LDMF may represent an acceptable and valid option for IBR. The success of this procedure depends on the design of the incision, the skill and proficiency of the operation, as well as the correct treatment after surgery.     

Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: a population-based study

Purpose  Breast-conserving therapy (BCT) was developed to improve quality of life (QOL) in early stage breast cancer patients. Except for differences in body image, literature comparing the psychosocial sequelae of BCT with mastectomy is ambiguous and shows a lack of substantial benefits. However, knowledge regarding long term effects of treatment on QOL in breast cancer is very limited as most of the pertinent studies have been performed in the early post-operative period. Therefore we compared QOL in women with breast cancer undergoing BCT versus women undergoing mastectomy over a 5-year period following primary surgery. Methods  QOL was assessed at 1, 3, and 5 years after diagnosis in a population based cohort of 315 women with early stage breast cancer (UICC stage I-II) from Saarland (Germany) using the EORTC QLQ-C30 questionnaire and the breast cancer specific module BR23. Results  Breast-conserving therapy was performed in 226 women (72%). After control for potential confounding, women with BCT reported better physical and role functioning, were sexually more active and more satisfied with their body image already at 1 year after diagnosis (all P values < 0.05). Differences in overall QOL and social functioning were gradually increasing over time and became statistically significant only at 5 years. Conclusions  Whereas some, very specific benefits of BCT, such as a better body image, are already visible very timely after completion of therapy, benefits in broader measures such as psychosocial well-being and overall quality of life gradually increase over time and become fully apparent only in the long run.     

Uncut Roux-en-Y reconstruction after distal gastrectomy for gastric cancer

Introduction: Uncut Roux-en-Y gastrojejunostomy is a modification of the Billroth II procedure with Braun anastomosis, in which a jejunal occlusion is fashioned to avoid the Roux Stasis Syndrome. This review aimed to summarize the current knowledge about the uncut Roux-en-Y anastomosis operation, so that surgeons may be able to make informed decisions about its clinical application. Additionally, we hope that our findings will guide future research on this topic.

Areas covered: The original uncut technique was associated with dehiscence or recanalization of the jejunal occlusion, and was therefore not widely applied. However, with recent improvements in the method of jejunal occlusion, the uncut Roux-en-Y reconstruction may be an appropriate alternative for digestive tract reconstruction after distal gastrectomy. This review summarizes the basic research on and clinical applications of uncut Roux-en-Y gastrojejunostomy from the following several aspects: origin of the uncut reconstruction technique, rationale for uncut reconstruction based on data from animal experiments, clinical results of the uncut reconstruction, recanalization and its countermeasures, and so on.

Expert commentary: The uncut Roux-en-Y gastrojejunostomy is a controversial yet promising method of gastrointestinal reconstruction after distal gastrectomy. Prospective randomized controlled trials and long-term follow-up outcomes are required to support the modified technique in the future.     

BCRP基因在乳腺癌组织中的表达及意义

目的　研究乳腺癌耐药蛋白 (BCRP)基因在乳腺癌组织中的表达水平 ,探讨其与肿瘤病理分期、淋巴结转移的关系。方法　采用实时荧光定量 RT- PCR检测 5 1例乳腺癌患者癌组织和癌旁组织中 BCRP基因表达。结果　 BCRP基因在乳腺癌组织中的阳性表达率、表达水平均显著高于癌旁组织 (P<0 .0 1、<0 .0 5 ) ;BCRP基因在 、 、 期乳腺癌组织中的表达水平无显著性差异 (P>0 .0 5 ) ;有淋巴结转移者的 BCRP基因表达水平显著高于无淋巴结转移者 (P<0 .0 5 )。结论　 BCRP基因表达水平与肿瘤病理分期无关 ,与淋巴结转移有关 ,BCRP基因过表达可能在乳腺癌的多药耐药中起较重要的作用。     

Mitochondrial DNA content in paired normal and cancerous breast tissue samples from patients with breast cancer

Introduction  We develop a multiplex quantitative real-time PCR for synchronized analysis of mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) to investigate relative mtDNA abundance in paired normal and cancerous breast tissues. Materials and methods  The amounts of nDNA and mtDNA in 102 tissue samples were quantified for both glyceraldehype-3-phosphodehydrogenase (GAPDH) gene and mtDNA encoded ATPase (MTATP) 8 gene. The average threshold cycle (Ct) number values of the nDNA and mtDNA were used to calculate relative mtDNA content in breast tissues. Results  The median delta Ct (ΔCt) and the median mtDNA content for normal and cancerous breast tissues were 6.73 and 2.54, as well as 106.50 and 5.80 (P = 0.000, respectively). The mtDNA content was decreased in 82% of cancerous breast tissues compared with the normal ones. The changes were associated with hormone receptor status. Conclusion  Our finding suggests that decreased mtDNA content in breast cancer may have diagnostic and prognostic value for the disease.