乳腺外科整复术在乳腺癌保乳根治术中的应用

目的:探讨乳腺外科整复术在乳腺癌保乳手术中的临床应用价值。方法:分析2010年1月至2011年6月期间应用乳腺外科整复术行保乳手术病例87例,术中根据肿瘤的大小和位置设计乳房切口。行局部扩大切除术,切缘距瘤缘的距离为1~2cm。乳房缺损部位的修复采用自身乳腺组织瓣修复法和乳腺以外的组织瓣修复法。术后1年对乳房美容效果进行客观评价和主观满意度调查。结果:年龄:29~66岁,中位年龄47岁。肿瘤大小:1~5cm,平均2.4cm。术式选择:蝙蝠翼整形11例,环乳晕整形8例,下蒂倒T整形18例,上蒂倒T整形12例,内侧整形8例,外侧整形13例,J整形2例,侧胸部带蒂脂肪筋膜组织瓣修复法9例,腹直肌鞘脂肪筋膜组织瓣修复法6例。切缘阳性率为8.0%。并发症发生率为1.6%。乳房美容效果:客观满意率为86.2%,主观满意率为88.5%。全部病例随访38~60个月,中位随访54个月,局部复发率为5.7%,5年总生存率为94.3%,5年无远处转移生存率为90.8%。结论:乳腺外科整复术术后美观效果好,患者满意度较高。     

乳腺癌患者保乳整复术应用现状

摘 要：随着医疗技术的发展,更多乳腺癌患者获得保乳机会。保乳整复手术的应用,实现了保乳手术安全性和美容性的统一。全文就保乳整复术的产生背景、手术简要操作过程、可能出现的并发症以及术后美观效果评价作一概述。     

乳房整形技术在乳腺癌保乳手术中的应用

目的总结乳房整形技术在乳腺癌保乳手术中的可行性及其对美容效果的影响。方法回顾性分析150例乳腺癌保乳手术患者的临床资料,根据保乳手术中应用乳房整形技术与否分为乳房整形技术保乳组(A组,70例)和传统手术保乳组(B组,80例),比较两组患者术后并发症、复发转移率、生存率及术后乳房美容效果,采用SPSS16.0软件对数据进行统计分析。结果平均随访时间为30.5个月(6~62个月),随访率为93.3%(140/150)。两组患者术后并发症、局部复发、远处转移、总生存和无病生存率均无统计学差异(P0.05)。A组主观满意率、乳房美容客观评分均优于B组。结论对早期乳腺癌患者采用乳房整形技术进行保乳手术治疗安全性好,而且术后乳房美容效果佳,是一项值得推荐的技术。     

我国乳腺肿瘤整形外科的临床研究进展

乳腺癌是我国女性发病率最高的恶性肿瘤。随着乳腺癌综合治疗技术的进步和患者生存期的延长,为提高乳腺癌患者的生存质量,乳腺肿瘤整形外科受到越来越多的重视。乳腺肿瘤整形外科主要包括保乳整形和乳房重建两个技术体系。相较于西方发达国家,我国乳腺肿瘤整形外科虽起步较晚,但发展迅速,在很多领域都取得长足的进步。本文将就植入物乳房重建、自体组织乳房重建、脂肪移植乳房成形、内窥镜辅助乳房重建、乳头乳晕重建、患者报告结局评价等亚专科领域,对我国乳腺肿瘤整形外科的研究进展、当前学科发展的不足之处,及未来发展方向进行综述。     

Needle-wire-guided breast tumor excision

Complete resection of large-size tumors can be easily approachable developing needle-guide tumour excision, in the context of Oncoplastic Conservative Breast Surgery. Needles are used as markers showing optimal excision margins, especially at conflicting points.     

Subaxillary Replacement Flap Compared with the Round Block Displacement Technique in Oncoplastic Breast Conserving Surgery: Functional Outcomes of a Feasible One Stage Reconstruction

Background: For selected women diagnosed with breast cancer (BC), partial reconstructive techniques involve displacement or replacement procedures to improve cosmesis without compromising oncological safety. This study aims to evaluate the surgical outcomes of the round block (RB) compared with the subaxillary flap (SF) technique for patients with upper outer tumor. Patients and Methods: Thirty-three patients treated with oncoplastic conserving surgery (15 RB and 18 SF) were enrolled in this retrospective study. After carrying out a comparison of baseline characteristics, all cases were recruited for postoperative evaluation of oncological and cosmetic parameters. Moreover, we investigated several scoring combinations to check whether they could discriminate surgeon and patient satisfaction according to different functional results. Results: Median age (p < 0.05), average tumor size (p > 0.05), estimated resection volume (p > 0.05), and nodal involvement (p > 0.05) were slightly higher in the SF group. A greater frequency of DCIS (p < 0.05) in the RB series correlated with reintervention for positive margins (p > 0.001). At a mean follow-up of 19 months, no locoregional recurrences were recorded and early and late complications were comparable (p > 0.05). The overall satisfaction with cosmesis was characterized by similar proportions of good results (p > 0.05), with some details more related to each procedure. Conclusion: The proposed techniques represent effective solutions for reshaping that follows upper outer wide excision, achieving comparable complication rates, low reinterventions, and good aesthetic results in relation to technical and social functioning evaluations. However, it is crucial to establish a careful patient selection in order to manage correct surgical planning while predicting any potential sequelae or complication.     

61例早期乳腺癌保留乳房手术疗效分析

[目的]探讨早期乳腺癌保乳手术的疗效及整形效果。[方法]自1993年4月-1998年7月共61例早期乳腺癌接受1/4乳房切除或肿瘤广泛切除加全腋淋巴结清扫术,其中56例行围手术期化疗（CMF）4-7周,48例术后全乳放疗,7例腋淋巴结阳性者接受区域放疗。[结果]1例失访,余患者随访2-7年,乳房保留率56/61,局部复发率3/61,远处转移率1/61,乳房整形满意率70%,[结论]早期乳腺保乳手术与根治术近期疗效相似。值得推广。     

New lumps in the breast following conservation treatment for early breast cancer

Summary A new lump in the breast following conservation treatment for early breast cancer may represent a recurrence of the disease or may be a benign lesion. Clinical evaluation of these lumps is often extremely difficult and, potentially, mammography would seem to be of great importance in the assessment. Between November 1981 and March 1986, 214 patients with operable breast cancers of 4 cm or less in diameter underwent conservative treatment. The conservation technique comprised synchronous excision of the primary tumour without a wide margin, axillary clearance, interstitial irradiation with iridium 192 (2000cGy), and subsequent external beam radiotherapy to the breast (4600cGy). After an average followup of 26 months, 17 patients developed a new lump in the treated breast necessitating further biopsy. Seven of these were malignant and 10 benign. In the latter category the most frequent finding was fat necrosis. Clinically, the lesions were indistinguishable from each other. The mammographic signs, which best predicted malignancy, were either of a mass or of a malignant type of microcalcification. This study illustrates the problems associated with deciding the nature of a new lump in the breast following conservation treatment. Mammography is complementary to physical examination, and a base-line mammogram six months after completion of therapy is helpful. Despite the use of mammography, biopsy is the only definitive way of excluding recurrence.     

Angiosarcoma of the breast after conservation therapy for invasive cancer, the incidence and outcome. An unforeseen sequela

Purpose. In the past 15 years breast conserving therapy (BCT) has become an important treatment option for primary breast cancer. Thirty three angiosarcomas (AS) after BCT have been described in a total of 20 published reports. Limited follow-up data and the lack of information on incidence of AS prompted the authors to review the comprehensive experience in the Netherlands. Methods. Between 1987 and 1995 twenty-one patients with BCT-associated AS were diagnosed in the Netherlands. Follow-up after diagnosis of AS ranged from 6 to 82 months with a median of 24 months. Information on the total number of patients treated with BCT and on the numbers of angiosarcoma in the breast was obtained. Results. The median interval between BCT and AS was 74 months (range: 29–106) and appeared to decrease with higher age. Detection of skin changes followed by incisional biopsy provided the diagnosis. Two year overall (OS) and disease free survivals were 72% (s.e. 10.9) and 35% (s.e. 10.7), respectively. Two year OS after initial complete surgical resection was 86% (s.e. 9.3) compared to 0% after incomplete resection of the AS (P=0.04). The estimated incidence of AS after BCT is 0.16%. Conclusions. BCT-associated AS arises after a relatively short interval. Although the incidence of AS is low, the absolute number of patients at risk is increasing. This calls for vigilance concerning skin changes occurring after BCT. An incisional biopsy provides the only reliable diagnosis. The prognosis appears to be related to the completeness of surgical resection.     

A three-field breast treatment technique with precise geometric matching using multileaf collimator-equipped linear accelerators

PURPOSE: Many authors have studied the problems associated with the three-field breast treatment, yet the proposed solutions present their own difficulties. This study presents a technique that overcomes these difficulties, reduces scatter to the contralateral breast, and improves setup reproducibility. METHODS AND MATERIALS: Patients are set up with both arms raised superiorly on a breast board. A precise field-match is achieved by rotating the couch and collimator of the tangents, while the supraclavicular field is half-beam blocked using an independent jaw. The posterior borders of the tangents are conformally defined by multileaf collimation. Measurements were performed to verify the field matching and evaluate scatter doses. RESULT: A smooth dose transition was found at the match line at all depths. Corner blocks and lower wedges were not used, which reduced the scatter to the contralateral breast compared with our prior technique. CONCLUSION: The technique achieves a precise match while removing constraints on the tangents' length and decreasing scatter dose. Procedures for simulation, planning, and treatment have been devised, along with a new patient setup routine incorporating orthogonal setup films and tattoos. This technique has been successfully implemented in routine treatment since September 2001. A program calculating the setup parameters is available at our website.     

Lumpectomy with or without postoperative radiotherapy for breast cancer with favourable prognostic features: results of a randomized study

The aim of this trial was to study the value of adding post-operative radiotherapy to lumpectomy in a subgroup of breast cancer patients with favourable patient-, tumour-, and treatment-related prognostic features. 152 women aged over 40 with unifocal breast cancer seen in preoperative mammography were randomly assigned to lumpectomy alone (no-XRT group) or to lumpectomy followed by radiotherapy to the ipsilateral breast (50 Gy given within 5 weeks, XRT group). All cancers were required to be invasive node-negative, smaller than 2 cm in diameter and well or moderately differentiated, to contain no extensive intraductal component, to be progesterone receptor-positive, DNA diploid, have S-phase fraction 相似文献   

Conservative treatment for infiltrating breast cancer: Ten years follow-up experience

Introduction We retrospectively analyze our experience in conservative treatment for infiltrating advanced breast cancer before implementation of selective sentinel node biopsy, specially focusing on characteristics, incidence, treatment and evolution of local-regional recurrences, disease-free survival time, overall survival and patient’s satisfaction. Material and methods From January 1984 to 31^st December 1998, 739 female patients were operated in our institution, diagnosed as having infiltrating breast cancer. One hundred and eighty-eight patients (25.43%) received conservative treatment and they were followed up until December 2003. Results Average age when diagnosed was 50.42 years old (24–87 years). 53.19% of the patients were premenopausal. After a median follow-up of 129 months (60–198 months), 13 women (6.91%) presented local-regional recurrence and the disease-free time was 48.4 months (8–108 months). Global survival rate was 83.5% and disease free survival rate was 80.85%. Conclusions The management of choice for early stage (I and II) infiltrating breast cancer is nowadays conservative, with a low local-regional recurrence rate and survival rate that are comparable to radical mastectomy, according to the literature. It’s a safe and efficient method that let us preserve the breast with a good esthetical result. In selected cases, when a regional recurrence occurs, a second conservative management is possible with a good control of the disease, although the most widely accepted treatment in these cases is total mastectomy.     

The cosmetic outcome in early breast cancer treated with breast conservation

AIMS: To measure the cosmetic outcome of breast-conserving surgery and identify the factors which influence cosmesis. METHODS: A total of 254 patients with primary breast cancer treated by wide local excision, with or without radiotherapy, were subjectively assessed for cosmesis by a six-member panel using photographic evaluation and objectively by an independent observer using specific measurement. RESULTS: Good to excellent cosmetic results were achieved in 184 (72%) patients on panel subjective assessment and 201 (79%) patients on objective assessment. Good correlation (P<0.001) and agreement were found between the panel's subjective photographic assessment and the objective assessment. The main factors found to affect cosmesis negatively were: medially located tumours; weight of specimen; re-excision procedures; radiotherapy; small breasts and longer scars. CONCLUSION: These cosmetic results, combined with a low local recurrence rate following wide local excision, validate the operative method used.     

近乳晕区早期乳腺癌整形保乳术30例临床研究

目的：评价近乳晕区早期乳腺癌患者行整形保乳术的临床效果。方法：将2011年2 月至2013年11月唐山市人民医院乳腺外科（二）接受保乳手术治疗的60例近乳晕区早期乳腺癌患者随机分成两组,试验组30例行整形保乳术,对照组30例行标准保乳术,比较两组术中切除的乳腺局部标本质量,肿瘤距外科切缘最近的距离,术后患乳美容效果。结果：试验组与对照组患者术中切除的乳腺标本量为（71.03± 12.92）g vs .（41.53± 7.13）g,肿瘤距外科切缘最近的距离为（13.30± 2.97）mmvs .（10.63± 1.65）mm,比较两组差异具有统计学意义（P<0.05）;试验组与对照组术后患者满意率为93.33% vs . 83.33% ,差异无统计学意义（P>0.05）。 结论：试验组切除的乳腺组织量更大、范围更广,而术后患乳美容效果与对照组无差别。早期乳腺癌患者实施整形保乳术可行、有效。     

早期乳癌保乳术后放射治疗的疗效观察

目的:观察早期乳腺癌保乳术后放射治疗的疗效。方法:对30例Ⅰ～Ⅱ期乳腺癌患者行乳腺病灶局部切除加腋窝淋巴结清扫,术后全乳腺先用6MV-X线双切线半野照射,全乳腺剂量达40Gy～52Gy(平均46Gy),然后,用9MeV或12MeV电子线局部瘤床加量8Gy～20Gy。腋窝淋巴结有转移者,用6MV-X线和12MeV电子线混合加照锁骨上和腋顶淋巴结引流区域,总剂量50Gy。结果:1年生存率为96.7%,3年生存率为90.0%,5年生存率为86.6%,中位生存率为92个月,局部复发率为0(0/30)。乳房美容评价:医生打分满意度优、中的为86.67%(26/30),患者自评满意度优、中的为93.33%(28/30)。结论:早期乳腺癌保乳术后放射治疗可降低局部复发率,减少并发症,乳房美容效果好,但必须严格掌握保乳手术适应证及综合治疗的相关技术。     

早期乳癌保乳术后放射治疗的疗效观察

目的：观察早期乳腺癌保乳术后放射治疗的疗效。方法：对30例Ⅰ～Ⅱ期乳腺癌患者行乳腺病灶局部切除加腋窝淋巴结清扫，术后全乳腺先用6MV—X线双切线半野照射，全乳腺剂量达40Gy～52Gy（平均46Gy），然后，用9MeV或12MeV电子线局部瘤床加量8Gy020Gy。腋窝淋巴结有转移者，用6MV—X线和12MeV电子线混合加照锁骨上和腋顶淋巴结引流区域，总剂量50Gy。结果：1年生存率为96．7％，3年生存率为90．0％，5年生存率为86．6％，中位生存率为92个月，局部复发率为0（0／30）。乳房美容评价：医生打分满意度优、中的为86．67％（26／30），患者自评满意度优、中的为93．33％（28／30）。结论：早期乳腺癌保乳术后放射治疗可降低局部复发率，减少并发症，乳房美容效果好，但必须严格掌握保乳手术适应证及综合治疗的相关技术。