保留肋间臂神经在乳腺癌术中的应用

目的: 探讨乳腺癌改良根治术中保留肋间臂神经的作用。方法:选择100例Ⅰ，Ⅱ期乳腺癌患者术中保留肋间臂神经，术后进行观察并随访。结果:91例术后无上肢感觉异常，9例出现上臂内侧感觉异常。结论:保留肋间臂神经可以明显减少术后患侧上肢感觉异常的发生率，提高术后的生活质量。     

乳腺癌改良根治术中保留肋间臂神经的临床意义

目的探讨乳腺癌改良根治术中保留肋间臂神经（ICBN）的可行性及临床意义。方法分析105例Ⅰ、Ⅱ期乳腺癌患者,分为2组：实验组56例,行乳腺癌改良根治术时保留ICBN,对照组49例,行常规乳腺癌改良根治术,术中不保留ICBN,随访观察术后患者腋窝、上臂内侧感觉功能。结果实验组患者上臂感觉障碍发生率10.7%,而对照组为69%,差异有统计学意义（P〈0.01）,全部病例随访3 a无局部复发。结论Ⅰ、Ⅱ期乳腺癌行改良根治术时保留ICBN可明显减少术后患侧腋窝上臂内侧感觉障碍和疼痛,提高生活质量,而且不增加复发风险。     

乳腺癌改良根治术后上肢淋巴水肿与腋窝淋巴结阳性率的相关性分析

目的探讨分析乳腺癌改良根治术后上肢淋巴水肿与腋窝淋巴结阳性率的相关性。 方法对2014年11月至2016年11月进行改良根治术治疗的112例乳腺癌患者进行回顾性研究,依据周径测量法对患者淋巴水肿状况进行测量,将未出现水肿患者作为对照组,出现水肿患者列入水肿组,应用SPSS18.0进行分析,对两组患者上肢淋巴水肿与腋窝淋巴结阳性率进行Logistic单因素与多因素分析,两组患者术后上肢淋巴水肿症状对比采用χ²检验,P<0.05差异有统计学意义。 结果经单因素分析结果显示,患者体质指数、淋巴结转移、术后并发症、瘤体大小、放射治疗与上肢淋巴水肿、腋窝淋巴结阳性率有关(P<0.05);经多因素分析上肢淋巴水肿的独立危险因素为：体质指数、年龄、放射治疗(P<0.05);通过对比,水肿组上肢肿胀感与沉重感发生率显著高于对照组(P<0.05)。 结论导致乳腺癌患者术后出现上肢淋巴水肿的独立危险因素诸多,应当对出现的危险因素给予高度重视,采取相应措施来降低上肢淋巴水肿的发生率。     

Lymphedema of the arm and breast in irradiated breast cancer patients: risks in an era of dramatically changing axillary surgery

The purpose of this study was to assess risk for lymphedema of the breast and arm in radiotherapy patients in an era of less extensive axillary surgery. Breast cancer patients treated for cure were reviewed, with a minimum follow-up of 1.5 years from the end of treatment. Clinical, surgical, and radiation-related variables were tested for statistical association with arm and breast lymphedema using regression analyses, t-tests, and chi-squared analyses. Between January 1998 and June 2001, 240 women received radiation for localized breast cancer in our center. The incidence of lymphedema of the ipsilateral breast, arm, and combined (breast and arm) was 9.6%, 7.6%, and 1.8%, respectively, with a median follow-up of 27 months. For breast edema, t-test and multivariate analysis showed body mass index (BMI) to be significant (p = 0.043, p = 0.0038), as was chi-squared and multivariate testing for site of tumor in the breast (p = 0.0043, p = 0.0035). For arm edema, t-test and multivariate analyses showed the number of nodes removed to be significant (p = 0.0040, p = 0.0458); the size of the tumor was also significant by multivariate analyses (p = 0.0027). Tumor size appeared significant because a number of very large cancers failed locally and caused cancer-related obstructive lymphedema. In our center, even modern, limited level 1-2 axillary dissection and tangential irradiation carries the risk of arm lymphedema that would argue in favor of sentinel node biopsy. For breast edema, disruption of draining lymphatics by surgery and radiation with boost to the upper outer quadrant increased risk, especially for the obese. Fortunately both breast and arm edema benefited from manual lymphatic drainage.     

乳腺癌改良根治术保留肩胛下肌群筋膜的腋窝淋巴结清扫对腋窝积液的影响

目的 探讨乳腺癌改良根治术腋窝淋巴结清扫保留肩胛下肌群筋膜的方法对腋窝积液的影响.方法 将我院2010年1月～2010年12月确诊乳腺癌并需行乳腺癌改良根治术的患者共178例随机分为保留肩胛下肌群筋膜腋窝淋巴结清扫组（治疗组,n＝98）及切除全部肩胛下肌群筋膜腋淋巴结清扫组（对照组,n＝80）,比较两组在切除淋巴结平均数目、拔引流管时间,腋窝皮下积液发生率及患侧上肢水肿发生率的情况.结果 治疗组切除腋窝淋巴结平均数、腋窝皮下积液例数（发生率）、拔管时间、拔管时间超过14天例数及发生患侧上肢水肿例数依次为：15.1个/例,6例（6.1%）、7±0.5天、4例及3例,对照组为14.8个/例、9例（11.3%）、9±0.5天、12例及7例.两组均未发生严重水肿.治疗组与对照组在切除淋巴结平均数目无显著差异,但前者拔管时间较后者短,腋窝皮下积液发生率及患侧上肢水肿发生率均较对照组低,两组差异具有统计学意义.结论 保留肩胛下肌群筋膜腋窝淋巴结清扫的方法较常规方法损伤更小,发生腋窝皮下积液及患侧上肢水肿的几率低,不影响肿瘤分期.     

乳腺癌改良根治术后皮下积液、皮瓣坏死、患肢淋巴水肿的原因分析与预防对策

目的分析乳癌改良根治术后皮下积液、皮瓣坏死及患肢淋巴水肿的原因,并探讨其防治方法。方法对比改进组225例和对照组176例乳腺癌病人用不同的皮瓣游离法、不同的腋窝引流法和伤口包扎法所发生皮瓣下积液、皮瓣坏死及患肢水肿的区别。结果改进组及对照组术后出现皮下积液分别为13例(5.8%)及71例(40.3%),出现皮瓣坏死分别为5例(2.2%)及54例(30.7%),出现患肢水肿分别为0及42例(23.9%),三种并发症发生率均有统计学差异(P<0.01)。改进组和对照组术后腋窝引流量和引流时间分别为(350±50)ml vs.(430±70)ml,(5.7±0.7)d vs.(7.3±1.5)d,均有统计学差异(P<0.01)。结论通过改进皮瓣游离方法、腋窝引流的方法及伤口包扎方法,可明显降低术后皮下积液、皮瓣坏死及患肢水肿的发生率,减轻患者痛苦。     

Improvement of upper extremity lymphedema after delayed breast reconstruction with an extended latissimus dorsi myocutaneous flap

Lymphedema is a common complication after mastectomy in breast cancer patients. Many treatment options are available, but no treatment results in a complete cure. We report a case of lymphedema that occurred after modified radical mastectomy in a breast cancer patient who showed objective improvement after delayed breast reconstruction with an latissimus dorsi myocutaneous flap. A 41-year-old female patient with left breast cancer had undergone modified radical mastectomy with axillary lymph node dissection and postoperative radiotherapy 12 years previously. Four years after surgery, lymphedema developed and increased in aggravation despite conservative treatment. Eight years after the first operation, the patient underwent delayed breast reconstruction using the extended latissimus dorsi myocutaneous flap method. After reconstruction, the patient's lymphedema symptoms showed dramatic improvement by subjective measures including tissue softness and feeling of lightness, and by objective measures of about 7 mL per a week, resulting in near normal ranges of volume. At a postoperative follow-up after 3 years, no recurrence was observed. Delayed breast reconstruction with extended latissimus dorsi myocutaneous flaps may be helpful to patients with lymphedema after mastectomy. This may be a good option for patients who are worried about the possibility of the occurrence or aggravation of secondary lymphedema.     

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。     

胸大肌肌瓣转移术预防乳腺癌术后上肢淋巴水肿的临床研究

目的 探讨胸大肌肌瓣转移术对乳腺癌改良根治术后患侧上肢淋巴水肿的预防效果。方法 自2013年9月至2014年6月,将68例乳腺癌患者分成2组,35例行乳腺癌改良根治术+胸大肌肌瓣转移术(干预组),33例单纯行乳腺癌改良根治术(对照组),术后随访观察,分别在术后2周、1个月、3个月、6个月和9个月测量双侧臂围,判断有无上肢淋巴水肿的发生及程度。结果 随访结果表明,干预组和对照组相比,术后患侧上肢淋巴水肿发生率明显减少,差异具有统计学意义(P<0.05)。结论 乳腺癌改良根治术后行胸大肌肌瓣转移术,可显著减少乳腺癌术后患侧上肢淋巴水肿的发生率,提高患者的生活质量。     

Trend towards conservative surgery for intraductal carcinomas of the breast. (Retrospective study of 165 cases)]

One hundred and sixty-five intraductal, non invasive breast carcinomas in 162 patients were reviewed. The mean follow-up was 75 months. Recurrence rates seem to be influenced by the therapeutic approach: 4.8% following mastectomy (4 cases out of 83); 16% following breast conserving surgery associated with radiotherapy (4 cases of 25); 22.8% following subcutaneous mastectomy (8 cases out of 35); 50% following breast conserving surgery alone (11 cases out of 35). When considering the clinical and radiological sizes of the tumor in the group of tumor excision and breast irradiation, additional information is gained. When the size is less than 25 mm the recurrence rate drops to 6.6% (1 case out of 15). When the lesions are extensive a subcutaneous mastectomy followed by irradiation (with or without a breast implant) might be an interesting alternative to modified radical mastectomy.     

乳腺癌术后预防上肢淋巴水肿专用软枕的研制与应用

目的预防乳腺癌术后病人患侧上肢淋巴水肿的发生.方法选择临床诊断(经病理证实)为乳腺癌行乳腺癌改良根治术后病人70例,随机分为观察组和对照组,各35例.观察组术后给予自制专用软枕,抬高患侧上肢;对照组按常规方法抬高患肢.比较两组病人术后患侧上肢淋巴水肿发生率.结果观察组病人术后患侧上肢淋巴水肿11例(占31.43%),对照组20例(占57.14%),两组比较,差异有显著性意义(P＜0.05).结论乳腺癌术后病人使用自制专用软枕,能降低术后患侧上肢淋巴水肿发生率,病人感觉舒适,易接受.     

A role of interpectoral (Rotter's) lymph node dissection in modified radical mastectomy for breast cancer]

To study the influence of interpectoral lymph node (IPN) dissection on the prognosis of patients who underwent modified radical mastectomy, IPN was carefully dissected and studied pathologically on 168 cases of our breast cancer patients operated with modified radical mastectomy. There were 1.2 lymph nodes on an average in the interpectoral region, and they were almost 1-2mm in diameter. IPN metastases were found in 10 cases. (Tis: 0%, Stage I: 4.9%, Stage II: 5.7%, Stage III: 13%). Tumors located in outer quadrant in almost all these cases. Positive IPN were found in 6 (16%) of n1 alpha group, 1 (10%) of n1 beta group, and in 3 (50%) of n2 group. All these 3 cases of n2 died of distant metastasis and local recurrence. Two (1.7%) of axillary node (1a, 1b) negative patients had microinvolvement of cancer only in IPN, and are currently disease-free. These data suggest that IPN metastasis may occur even in the early breast cancer patients, and that may be controllable by lymph node excision. Therefore, routine and careful dissection of IPN through wide opening of sulcus interpectoralis is necessary for modified radical mastectomy and even for breast preserving operation.     

保留乳头乳晕的改良根治术联合假体置入术对乳腺癌早期患者的影响观察

目的探讨保留乳头乳晕的改良根治术联合假体置入术对乳腺癌早期患者应对方式及美观效果的影响。 方法选取2017年3月至2019年3月长安医院收治的乳腺癌早期患者140例,根据手术方案分为研究组与对照组,各70例。研究组采取保留乳头乳晕的改良根治术联合假体置入术,对照组采取乳腺癌改良根治术。统计两组手术情况（手术时间、淋巴结清扫数目、术后引流量、住院时间）、并发症（皮下气肿、感染、皮肤坏死、皮下积液、上肢水肿）、美观效果,对比手术前后免疫功能（CD3⁺、CD4⁺、CD4⁺/CD8⁺）、应对方式。 结果研究组术后引流量少于对照组,住院时间短于对照组（t=13.584、8.423,P<0.001、<0.001）。术后1 d研究组CD3⁺、CD4⁺、CD4⁺/CD8⁺高于对照组（t=6.612、7.057、5.170,均P<0.001）。术后1个月研究组依靠自我、姑息、宿命、逃避评分低于对照组,情感宣泄、寻求支持、乐观、面对评分高于对照组（t=10.821、11.010、7.854、5.952、8.563、9.657、9.223、11.596,均P<0.001）。研究组并发症发生率（5.72%）低于对照组（20.00%）（χ²=6.375,P=0.012）,美观效果优良率（92.86%）高于对照组（81.43%）（χ²=4.080,P=0.043）。 结论保留乳头乳晕的改良根治术联合假体置入术治疗乳腺癌早期患者,可减少并发症,改善应对方式,提高美观效果,且对免疫功能影响较小。     

Surgical outcomes after breast cancer surgery: measuring acute lymphedema

BACKGROUND: Studies of lymphedema have used inconsistent measures and criteria. The purpose of this pilot study was to measure the onset and incidence of acute lymphedema in breast cancer survivors using strict criteria for limb evaluation. MATERIALS AND METHODS: Eligible women were those undergoing breast cancer surgery that included axillary staging and/or radiation therapy of the breast. Arm volume, strength, and flexibility were measured preoperatively and quarterly. Lymphedema was defined as a greater than 10% increase in limb volume. Additional strength and flexibility assessments were done at these times. RESULTS: In 30 evaluable patients, half underwent modified radical mastectomy and half lumpectomy, with half of the lumpectomy patients undergoing axillary node staging. Of the 30 patients 27% were Stage 0; the rest were Stage I (27%), IIA (13%), IIB (23%), and IIIA (7%). One subject was IIIB postoperatively. There were 2 women with a 10% or greater change in limb volume; the change was detected in one woman at 3 months (5% incidence) and in the second woman at 6 months (11% incidence). Both had undergone mastectomy and axillary dissection and one of these two women had symptoms of tingling and numbness in the affected arm that began at 3 months. Overall, 35% of the sample experienced symptoms by 3 months, which included numbness, aching, and tingling of the entire upper extremity, but without volume changes. The relationship between undergoing modified radical mastectomy and experiencing symptoms in the affected limb at 3 months was significant (P = 0.05). CONCLUSIONS: In this interim report strict methods of measurement and limb volume comparisons detected acute lymphedema at 3 months in 5% of the sample, and at 6 months in 11% of the sample. Furthermore, symptoms were detected in 35% without volume changes at 3 months postoperatively, which may warn of lymphedema occurrence within the next 3 months. This may assist clinical evaluation of symptoms in the postoperative period and support early referral to lymphedema experts.     

保留胸前神经和肋间臂神经的横切口乳腺癌改良根治术(附40例临床分析)

目的：探讨在乳腺癌改良根治术中采用横切口，并保留胸前神经和肋问臂神经，对术后皮瓣成活、胸大小肌功能、患侧上臂感觉功能的影响。方法：40例乳腺癌均采用横切口乳腺癌改良根治术，清扫时注意保留胸前神经及肋问臂神经。术后检查胸大小肌萎缩情况和患侧上臂内侧的感觉、运动功能变化。结果：术后发生切口皮瓣坏死3例，胸大小肌无明显萎缩，28例保留肋问臂神经患侧上臂内侧皮肤感觉良好，活动自如。结论：保留胸前神经，肋间臂神经的横切口乳腺癌改良根治术减少了术后并发症的发生率，改善了生存质量。     

保留胸大、小肌改良乳腺癌根治术214例

目的探讨保留胸大、小肌改良乳腺癌根治术的临床疗效。方法回顾性分析214例乳腺癌(Ⅰ期66例,Ⅱ期141例,Ⅲ期7例)施行保留胸大、小肌改良乳腺癌根治术的治疗结果。结果214例患者中术后发生皮下积液12例(5．6％),皮缘坏死16例(7．4％),上肢淋巴性水肿8例(3．7％),胸肌挛缩伴同侧上臂运动障碍11例(5．1％)。3年生存率为82．3％,5年生存率为63．4％,其中Ⅰ期5年生存率为79．6％,Ⅱ期5年生存率为56．3％。结论重视保护胸外侧支神经可避免胸肌挛缩导致的上臂运动障碍,重视术后早期化疗能有效地预防复发和转移,重视创面综合处理可减少皮下积液,重视加强术后综合治疗可提高远期疗效。     

保留乳头乳晕复合体乳腺癌改良根治术后主要并发症的防治

目的 探讨保留乳头乳晕复合体(nipple-areola complex, NAC)乳腺癌改良根治术后主要并发症的防治.方法 对手术治疗124例NAC乳腺癌改良根治术临床资料行回顾性总结,分析发生并发症的原因,提出预防和处理方法.结果 124例术后发生乳头坏死18例(14.52%),皮瓣感染、坏死9例(7.26%),皮下积液7例(5.65%),上肢淋巴水肿5例(4.03%),胸肌挛缩伴同侧上臂运动障碍3例(2.42%),术腔继发性出血2例(1.61%).结论 精细的手术操作能有效降低保留NAC乳腺癌改良根治术并发症的发生率;保留NAC术后出现的并发症进行积极处理能明显改善患者预后.     

乳腺癌改良根治术保留肋间臂神经文献分析

目的探讨保留肋间臂神经与切除肋间臂神经在乳腺癌改良根治术中的临床意义,为制定临床合理的个体化手术方案提供证据.方法： 制定原始文献的纳入标准、排除标准及检索策略,搜索关于保留肋间臂神经在乳腺癌改良根治术中的价值和意义方面的临床随机对照试验.检索日期由2000年1月—2012年2月.按cochrane系统评价方法,评价所纳入研究的文献质量,并提取有效数据后采用RevMan5.0软件进行Meta分析.结果纳入12项研究,共计1146例患者.结果： 保留肋间神经可以明显减轻患者上臂内侧感觉功能（随访1个月,3个月,12个月OR1=0.15,95%CI：0.10～0.21;OR3=0.06,95%CI：0.03～0.10; OR12=0.07,95%CI：0.03～0.16））,保留肋间臂神经手术时间较切除肋间臂神经在乳腺癌改良根治所用的时间略延长（MD=6.75,95%CI：3.88～9.26）;随访1～3年乳腺癌局部复发率两种术式术中出血量、清除淋巴结数、术后肩关节运动障碍及皮下积液切除ICBN与保留ICBN均没有明显的差异.结论： 保留肋间臂神经可以明显减轻乳腺癌改良根治术后患侧上臂内侧感觉功能障碍、延长手术时间但对乳腺癌复发率没有明显影响.     

保留乳头乳晕的改良根治术联合假体即刻置入术治疗早期乳腺癌的临床研究

目的观察保留乳头乳晕的改良根治术联合假体即刻置入术治疗早期乳腺癌的临床价值。 方法回顾性分析93例乳腺癌患者的临床资料,根据患者手术方案不同分为假体置入组(采取改良根治术联合假体置入术,n＝48)与传统手术组(行传统改良根治术,n＝45)。应用统计学软件SPSS19.0处理数据,两组年龄、肿瘤直径、体重指数采用( ±s)表示,行独立样本t检验;TNM分期、乳房外观优良率、术后心理状况及生活质量、并发症总发生率采取χ²检验,P<0.05为差异有统计学意义。 结果假体置入组与传统手术组并发症总发生率分别为25.0%与20.0%(P>0.05)。假体置入组术后3个月的乳房外观优良率为93.8%,显著高于传统手术组77.8%(P<0.05)。假体置入组术后6个月的焦虑、抑郁、恐惧、人际敏感、自我形象紊乱发生率分别为25%、16.7%、31.3%、20.8%、14.6%,显著低于传统手术组的46.7%、35.6%、53.3%、40%、33.3%(P<0.05)。两组2年无瘤生存率、随访期间复发率、转移率、死亡率均无统计学意义(P>0.05)。 结论保留乳头乳晕的改良根治术联合假体置入术治疗早期乳腺癌可满足患者乳房重建的需求,不影响根治效果且提高了患者乳房外形美观度,患者术后心理与生活质量得到改善,值得推广。     

保留乳房的乳腺癌切除术与改良根治术治疗绝经前乳腺癌患者的效果比较

目的探讨保留乳房的乳腺癌切除术与改良根治术治疗绝经前乳腺癌患者的效果比较。 方法选取2009年10月至2012年10月住院治疗的绝经前乳腺癌患者160例进行前瞻性研究,根据手术术式的不同应用随机数字法分为保乳组(80例)和根治组(80例),其中保乳组采用保留乳房的乳腺癌切除术,根治组采用改良根治术进行治疗。应用SPSS 20.0统计学软件进行统计学处理,术中相关指标及乳腺癌治疗功能评价系统以( ±s)表示,采用独立t检验;生存率、局部复发率及远处转移率采用卡方检验,以P<0.05表示差异具有统计学意义。 结果与根治组相比,保乳组患者的术中出血量显著降低(P<0.05),手术时间和住院时间显著缩短(P<0.05);两组患者的2年生存率均为100%,保乳组患者的5年生存率、5年局部复发率和5年远处转移率分别为80例(100.0%)、3例(3.8%)和1例(1.3%),根治组分别为78例(96.3%)、5例(6.3%)和3例(3.8%),两组相比,差异均无统计学意义(χ²＝3.057, 0.526, 1.026, P>0.05);与根治组相比,保乳组患者的FACT－B和生理状况均显著提高(P<0.05);而两组患者的社会/家庭状况、功能状况、功能状况、情感状况和乳腺癌附加关注相比差异均无统计学意义(P>0.05)。 结论保留乳房的乳腺癌切除术治疗绝经前乳腺癌患者的临床效果较好,且可显著提高患者的生活质量。