早期乳腺癌保乳手术探讨

目的 探讨早期乳腺癌保乳手术加放疗治疗效果.方法 分析近6年76例保乳术后加放疗的乳腺癌病人临床资料.结果 76例患者3,5年生存率分别为96.05%,94.8%;3,5年局部复发率分别为5.3%,6.6%;术后3,5年乳房保留率分别为96.05%,93.3%;仅1例胸壁复发,无死亡病例.该复发病例25岁,未婚,保乳愿望强烈,复发后再次行乳房切除及化疗,现健在.术后形体美容效果满意度80.5%.结论 早期乳腺癌采用保乳手术及放射治疗可取得满意结果,规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.     

乳腺癌保乳整复手术

保乳整复手术是乳腺癌治疗中的一个基本组成部分。这种治疗方式可以切除大量的乳腺组织,提高美容效果,在使患者满意的同时保持良好的肿瘤学切除原则,减少再切除术和乳腺切除率,并有助于辅助放射治疗计划。 我们复习了近年来各种不同保乳整复手术,并描述了在切除乳腺内不同位置肿瘤的技术应用以及选择不同技术时所考虑患者相关的具体因素。最后,对于这种外科手术类型的肿瘤学安全性的证据及并发症进行了讨论。     

早期乳腺癌保乳手术术中放疗59例

目的 研究早期乳腺癌保乳手术术中放疗的可行性,评价术后并发症、乳房美容效果及肿瘤复发事件.方法 2007年6月至2010年12月,115例患者做保乳手术,59例(研究组)做术中放疗,同期有56例(对照组)术后做全乳放疗,在术后1个月评估切口愈合状况及并发症;术后1年比较两组乳房美容效果;术后随访肿瘤复发及死亡事件.结果 研究组切口愈合天数为13 ～22d,对照组为9 ～14d.研究组2例出现切口脂肪液化,16例有切口水肿,对照组未见切口脂肪液化、水肿;两组均未出现术后切口感染或血肿.术后1年乳房美容评价:研究组41例中优秀或好的有36例、一般或差的5例;对照组37例中优秀或好的有25例、一般或差的有12例(P=0.031).随访3～42个月(中位24个月),研究组局部复发2例(3.39％),其中1例(1.7％)死亡;对照组局部复发1例(1.8％),无死亡.结论 早期乳腺癌保乳手术术中放疗安全可靠、美容效果好、局部控制满意.     

早期乳腺癌的保乳手术治疗25例分析

目的：对早期乳腺癌采用保瘤乳房的手术治疗配以术后放疗，以探讨其手术适应证和疗效。方法：对25例早期乳腺癌进行保乳手术并与传统根治术进行比较，保乳手术指征包括：肿瘤直径小于3cm，腋窝淋巴结N0或N1a肿瘤距乳头距离大于3cm，手术前乳腺照相排除多发癌灶，手术时肿瘤周围边界至少2cm(冰冻切片证实），腋窝淋纠结解剖到第2站，术后2周内做放疗，从生存质量（Quality of life,QOL)的观点出发，分析保乳手术的适应证及存在的问题。结果：两组术后均获随访，平均随访时间64．1个月，保乳手术和传统根治术在5年生存率和复发率的比较差异无显著意义（P＞05），结论：早期乳腺癌采用保乳手术治疗效果满意。     

保乳手术加综合治疗治疗乳腺癌的临床研究

目的　探讨保乳手术加综合治疗乳腺癌的手术适应证、治疗方法和疗效。方法　对 46例I～IIb 期乳腺癌施行保乳手术加术后放疗、化疗及内分泌治疗等综合治疗 (保乳组 ) ;并与同期施行改良根治术加综合治疗的 5 0例I～IIb 期乳腺癌 (对照组 )进行对比。两组患者术后均随访 0 .5～ 14年 ,平均 4年。结果　保乳组 46例双侧乳房乳头基本对称、外形丰满 ,外观优良。保乳组、对照组的平均手术时间分别为 (14 3 .7± 2 1.6)min ,(181.9± 16.0 )min ;术中平均出血量分别为 (2 42± 73 )ml ,(3 76± 5 6)ml ,手术并发症率分别为 15 .2 %,3 4.0 %;保乳组均优于对照组 (均P <0 .0 5 )。保乳组 3 ,5 ,10年期生存率分别是 96.8%,88.9%,85 .7%,总局部复发率是 6.5 %;对照组 3 ,5 ,10年期生存率分别是 97.1%,89.5 %,87.5 %,总局部复发率是 4.0 %。两组生存率和复发率比较差异无显著性(均P >0 .0 5 )。结论　临床早期乳腺癌采用保乳手术加综合治疗可以取得满意的临床疗效 ,可作为早期乳腺癌的首选治疗方法。     

早期乳腺癌保乳手术175例回顾性分析

目的探讨影响乳腺癌保乳手术后局部复发的预后因素。方法对中国医学科学院肿瘤医院腹部外科2001年1月至2004年12月间收治的175例早期乳腺癌保乳手术资料进行回顾性研究,对年龄、分期、切缘、肿瘤大小、淋巴结情况等指标做单因素和多因素分析。结果中位随访时间57（18~94）个月。全组5年的总存活率和无病存活率分别为964%和911%,局部复发率17%。单因素分析显示保乳手术后局部复发危险因素包括肿瘤直径＞3cm、切缘＜2mm以及TNM分期。结论早期乳腺癌行保乳治疗是安全的,但要掌握保乳手术指征,保证术后综合治疗。     

老年乳腺癌的保乳治疗

老年患者是否适合行保乳手术，国内报道甚少。近年来，我们对部分60岁以上的老年乳腺癌患者开展了此项手术，现报道如下。     

乳腺癌保乳治疗43例诊治体会

探讨乳腺癌保乳治疗的诊治体会及相关问题。行保乳手术治疗的乳腺癌患者43例,采用肿瘤局部扩大切除或象限切除,以及腋淋巴结清除,术后辅以放疗、化疗或术前新辅助治疗等。无复发、无淋巴结转移、无远处转移、无死亡病例;乳腺皮肤微小变化,形状与健侧乳腺相似,手感好;少数因局部放疗后皮肤手感及弹性欠佳。保乳手术和传统手术相比,保乳手术既可以在生存中获益,同时又能保持完美的体态,术后并发症少,无伤口感染,无皮瓣坏死、皮下积液,患者心理状态良好,生存质量较高。     

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。     

乳腺癌保乳治疗的临床研究

目的探讨早期乳腺癌保乳综合治疗的疗效及可行性。方法将189例Ⅰ、Ⅱa期乳癌患者前瞻性非随机分为两组：（1）保乳组：92例行乳腺区段切除加腋窝淋巴结清扫术;（2）对照组：97例行乳癌改良根治术。两组术后均给予相同方案的放疗、化疗和内分泌治疗,术后进行定期随访,并进行美容评估。结果本组178例得到随访,随访率94.2%,中位随访时间为78个月。局部复发：保乳组3例,对照组1例。保乳组3年存活率97.7%,5年存活率94.1%,远处转移率7.9%。对照组3年存活率97.8%,5年存活率90.8%,远处转移率7.9%,两组局部复发和远处转移差异均没有统计学意义,两组3、5年生存率差异应用log-rank检验无统计学意义（P〉0.05）。COX比例风险模型分析发现年龄、ER、PR情况不是影响生存的风险因素,TNM分期与生存率有关。85.5%患者对保乳手术的美容效果满意。结论对早期乳癌使用保乳综合治疗可达到传统根治术相当的治疗效果,应作为早期乳癌的首选治疗方法。     

95例高龄大肠癌的手术治疗

目的：探讨高龄大肠癌的外科治疗方法。方法：对95例高龄大肠癌的临床资料进行回顾性分析。本组平均年龄74．5(70—87)岁，伴肠梗阻38例，行急诊手术20例。肿瘤部位：直肠40例，乙状结肠25例，结肠肝曲7例，横结肠10例，回盲部7例，升结肠3例，结肠脾曲2例，降结肠1例。高中分化腺癌80例(84．2％)，低分化肿瘤15例(15．8％)。行Dixon术18例，Miles术10例、乙状结肠切除13例，余行左、右半结肠切除、横结肠切除、乙状结肠造瘘术等。结果：随访3年，生存3年以上65例(68．4％)，生存2年以上15例(15．80%)，2年内死亡15例(15．8％)。结论：高龄大肠癌治疗以手术为主，手术的目的是切除肿瘤，防止梗阻，提高生活质量。     

Selection of Patients for Breast Cancer Conservation Therapy

Abstract: Modified radical mastectomy and lumpectomy axillary node dissection with postoperative radiation therapy are both good surgical options for the treatment of early stage breast cancer. A number of parameters should be considered when evaluating a breast cancer patient for mastectomy versus breast conservation therapy. These parameters include size of the lesion and its biological characteristics as well as patient age and preference. Progress in breast cancer screening and treatment, including BRCA-1 testing and sentinel node biopsy, may also affect these decisions.     

Breast Conservation: Evolution of Surgical Strategies

Abstract:   The surgical strategy for breast cancer has changed considerably over the last decade. Breast-conserving therapy (BCT) is now standard treatment. Today, at least three out of four breast cancer patients are, in principle, eligible for BCT. However, several specific factors must be considered to choose the correct surgical strategy. This review provides a scientific overview of the history, surgical methodology, and specific aspects of BCT.      

Patterns of Surgical Treatment for Women with Breast Cancer in Relation to Age

Abstract: Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged ≤40 years (OR = 1.140; 95% CI: 1.004–1.293) compared to women aged 51–70 years (reference group). BCS was lowest in women aged >70 years (OR = 0.498, 95% CI: 0.455–0.545). Significantly more women aged ≤50 years underwent more than one operation for breast conservation (20.4–24.8%) compared with women aged >50 years (11.4–17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0–1.3% in all other age groups (≤40, 41–50 51–70 years). There is an association between patient age and the type of breast cancer surgery for women in Australia and New Zealand. Women age ≤40 years are more likely to undergo BCS despite having adverse histologic features and have more than one procedure to achieve breast conservation. Older women (>70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment.     

老年胃癌患者的外科治疗

目的探讨老年胃癌患者的外科手术治疗方法及其治疗效果。方法回顾性分析我院1999年6月至2003年6月226例65岁以上老年胃癌患者行手术治疗的临床资料。胃癌根治性切除122例(D157例,D232例,D333例),姑息性切除56例,行远端胃切除术107例,近端胃切除术51例,全胃切除术15例,联合器官(脾、胰尾、横结肠)切除5例,未切除41例。结果围手术期死亡率为3.1%,手术并发症发生率为17.3%。随访207例,平均随访时间37(12~60)个月。总体中位生存时间32.5个月;根治性切除组平均为37个月,姑息性切除组为19个月,未切除组为8个月;5年生存率根治性切除组为28.0%,姑息性切除组为2.1%,未切除组为0。根治性切除者的术后生存时间明显长于姑息性切除者,差异有显著意义(P<0.01)。结论老年胃癌术后并发症发生率高。对老年胃癌患者积极行根治性切除术,能延长生存期,改善患者生活质量,但应做好围手术期处理。     

HER-2阳性乳腺癌保乳术后局部复发的多因素研究

目的研究人类表皮生长因子受体2(HER-2)阳性乳腺癌保乳治疗后影响局部复发的风险因素。方法收集我院2002年6月～2012年6月间收治的82例HER-2阳性乳腺癌保乳治疗后的随访资料,分析年龄、HER-2状态、雌激素受体(ER)/孕激素受体(PR)状态、淋巴结转移状态、肿瘤大小、抗HER-2治疗对局部复发的影响。结果 82例中位随访52(8～118)个月,同侧乳房局部复发9例(10.97%),远位转移11例(13.4%),5年无病生存率82.9%,5年无远处转移生存率93.9%,5年总体生存率98.7%。单因素分析显示,淋巴结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;多因素分析显示淋巴结状态及HER-2状态是局部复发的独立影响因素。82例病人中,接受曲妥珠单抗治疗35例,112个月出现1例局部复发,复发率2.86%(1/35);未接受者47例,11～108个月出现局部复发8例,复发率17.02%(8/47)。差异有显著性统计学意义(P<0.001)。结论保乳治疗后出现两个局部复发高峰时间段,淋巴结状态和HER-2表达状态是局部复发的独立影响因素,抗HER-2治疗可降低局部复发和远处转移。对于具有高危因素的患者更需积极治疗。     

Surgical Treatment for Women with Breast Cancer in Relation to Socioeconomic and Insurance Status

Based on the National Breast Cancer Audit of the Royal Australasian College of Surgeons an association between patient age and type of breast cancer surgery received has already been demonstrated. The aim of this study is to assess the patterns of surgical treatment for women with early breast cancer in relation to socioeconomic and insurance status. Data on patient demographics, diagnostic, and surgical procedures and cancer characteristics in 115,872 episodes of early breast cancer reported to the National Breast Cancer Audit between 1998 and 2012 is used for this study. Tumor size, histologic grade, number of tumors, lymph node positivity, and lymphovascular invasion are the major prognostic factors adjusted for. Reconstruction following mastectomy is the most likely surgical procedure for the higher socioeconomic and privately insured patients. Mastectomy alone is the most likely surgical procedure for the lower socioeconomic and for public patients. No surgery is the most likely surgical outcome for the lower socioeconomic and the least likely for the higher socioeconomic population. Open biopsy is the most likely diagnostic procedure for the lower socioeconomic and fine needle aspiration for the higher socioeconomic population. Socioeconomic and insurance status, are both independently associated with the types of treatment and diagnostic procedure for women with breast cancer. Opportunities present to investigate an association of these factors with morbidity and survival outcomes.     

Efficacy of Breast Conservation Therapy in Early Stage Bilateral Breast Cancer

The purpose of this study was to evaluate the outcome of patients with bilateral breast cancer as compared to unilateral breast cancer treated with breast conservation therapy. Sixty patients with bilateral breast cancer (BBC) and 1,080 unilateral breast cancer (UBC) patients treated with breast conservation therapy from 1977 to 1994 were analyzed for outcome. Of the 60 bilateral patients, 44 were metachronous bilateral breast cancer patients (MBBC) and 16 were synchronous bilateral breast cancer patients (SBBC). The majority of patients received lumpectomy, axillary node dissection, and localized radiation therapy. Median tumor size was 1.4 cm for BBC and 1.5 cm for UBC patients. Median total dose to the tumor bed was 60 Gy for both unilateral and bilateral patients. Of the 44 MBBC patients, 14 received breast conservation for both the first and second lesions, while 30 received breast conservation for only the second metachronous lesion. Thus 58 lesions in 44 patients were treated with breast conservation therapy. Of the SBBC patients, 13 of 16 patients received breast-conserving therapy for both breasts, while 3 received a mastectomy for the second synchronous primary. Median follow-up was 50 months for SBBC patients, 45 months for MBBC patients, and 52 months for UBC patients. Local control and survival were analyzed in patients with SBBC, MBBC, and UBC. The interval to development of local recurrence and survival were calculated from the time of development of the second breast lesion in patients with MBBC. No differences were found for survival and failure-free survival in patients with SBBC, MBBC, or UBC. Five-year overall survival by lifetable analysis was 76% for SBBC, 78% for MBBC, and 87% for UBC patients (p = 0.32 by log-rank analysis). The 5-year failure-free survival was 79% for SBBC, 73% for MBBC, and 85% for UBC patients (p = 0.28 by log-rank analysis). No significant differences were seen for median age, tumor size, pathologic node status, tamoxifen use, chemotherapy use, or median total radiation dose for SBBC, MBBC, or UBC patients. A significant difference was found in the incidence of family history of breast cancer in patients with unilateral versus bilateral breast cancer (p = 0.028 by chi-square analysis). However, there was no difference in outcome of patients by family history of breast cancer. The local control was identical in both BBC and UBC patients, with a local failure rate of 3%. Therefore, breast conservation therapy in local-regional, early stage breast cancer is a rational and efficacious treatment modality for patients with SBBC, MBBC, and UBC.