乳腺MRI在乳腺癌保留乳头乳晕复合体Ⅰ期乳房重建中的应用

目的：探究乳腺磁共振成像（magnetic resonance imaging,MRI）在乳腺癌保留乳头乳晕复合体（nipple-areola complex,NAC）Ⅰ期乳房重建中的应用价值。方法：选取惠州市第三人民医院75例乳腺癌患者,均行保留NACⅠ期乳房重建。术前采用乳腺MRI评估乳房内肿瘤边缘与皮肤的距离、肿瘤边缘与NAC的距离,依据术前MRI测量数据评估皮下腺体切除的范围,计算计划切除组织体积,指导假体大小选择。并于术中测量乳房肿瘤边缘与皮肤的距离、肿瘤边缘与NAC的距离,测量术中实际切除组织体积、植入假体体积,比较MRI与术中测量数据,采用Pearson相关系数分析两组数据的线性关系,统计术后并发症发生情况、乳房重建美容效果。结果：乳腺MRI测量乳房内肿瘤边缘与皮肤的距离与术中测量比较,差异无统计学意义（P>0.05）,两者呈正相关（r=0.747,P<0.05）;乳腺MRI测量肿瘤边缘与NAC的距离与术中测量比较,差异无统计学意义（P>0.05）,两者呈正相关（r=0.752,P<0.05）;乳腺MRI测量计划切除组织体积与实际切除组织体积、植入...     

高压氧综合治疗对保留乳头乳晕的乳房切除术后乳头存活的疗效观察

乳腺癌是女性最常见的恶性肿瘤之一,发病率逐年增长,且发病年龄有年轻化趋势,中国城乡女性乳腺癌的发病均呈逐年上升趋势。手术是治疗乳腺癌的重要手段,为提高患者生活质量,改善心理状态,手术方式也由单一的乳腺癌改良根治术逐渐侧重于保证肿瘤完整切除前提下的乳腺重建整形术,其中保留乳头乳晕的乳房切除术(nipple sparing mastectomy,NSM)也逐渐受到施术者及患者的青睐。本研究回顾性分析2014年6月至2018年6月烟台山医院乳腺外科行NSM手术后联合高压氧(hyperbraic oxygen,HBO)治疗的30例乳腺癌患者的临床疗效。现报告如下。     

改良阴式全切术治疗非脱垂子宫的临床分析

目的探讨改良阴式全切术治疗非脱垂子宫的优点、手术要点、适应证及在基层医院的临床应用价值。方法对30例非脱垂子宫良性病变患者实施改良阴式全子宫切除术,与同期30例非脱垂子宫良性病变患者行经腹全子宫切除术进行对比研究。结果30例改良阴式全切者,无中转开腹、无盆腔脏器损伤,无1例发生术后尿潴留;两组术中出血、手术时间差异无显著性,阴式组排气时间,住院时间显著低于经腹组。结论改良阴式全子宫切除术具有手术时间短、创伤小、术后疼痛轻、并发症少、恢复快、住院时间短、腹部无瘢痕、费用低等优点,是在基层医院值得推广的理想术式。     

纵形劈开宫颈在腹腔镜辅助阴式子宫全切术中的应用探讨

目的探讨纵形劈开宫颈在腹腔镜辅助阴式子宫全切术中的临床应用价值。方法对40例因各种良性妇科疾病而需行子宫全切除术的患者,采用腹腔镜辅助阴式子宫全切术式,术中转为阴式手术时均采用纵形劈开宫颈处理。结果 40例行腹腔镜辅助阴式子宫全切术中,1例中转开腹手术,中转率2.5%。手术时间60～240 min,平均100 min。出血量约30～400 ml。平均住院日为7 d。结论腹腔镜辅助阴式子宫全切术术中采用纵形劈开宫颈的手术方法术中出血少,手术时间短,住院时间短。     

Treatment options in early breast cancer

Conservative management of early breast cancer with limited surgical excision and radiotherapy is now being accepted as a viable alternative to mutilating surgical procedures. In this paper, the major steps in the historical development of conservative management are traced, and the results of the current randomized trials are summarized. An innovative method used at the University of Kansas Medical Center delivers a "boost" dose to the tumor bed with interstitial Ir-192 immediately following resection of the primary tumor mass. The results obtained in terms of local control and cosmesis with this technique are presented, and the current state of the art is discussed.     

Hypofractionated radiotherapy in the treatment of early breast cancer

Radiotherapy (RT) after tumorectomy in early breast cancer patients is an established treatment modality which conventionally takes 6-7 wk to complete. Shorter RT schedules have been tested in large multicentre randomized trials and have shown equivalent results to that of standard RT (50 Gy in 25 fractions) in terms of local tumor control, patient survival and late post-radiation effects. Some of those trials have now completed 10 years of follow-up with encouraging results for treatments of 3-4 wk and a total RT dose to the breast of 40-42.5 Gy with or without boost. A reduction of 50% in treatment time makes those RT schedules attractive for both patients and health care providers and would have a significant impact on daily RT practice around the world, as it would accelerate patient turnover and save health care resources. However, in hypofractionated RT, a higher (than the conventional 1.8-2 Gy) dose per fraction is given and should be managed with caution as it could result in a higher rate of late post-radiation effects in breast, heart, lungs and the brachial plexus. It is therefore advisable that both possible dose inhomogeneity and normal tissue protection should be taken into account and the appropriate technology such as three-dimensional/intensity modulated radiation therapy employed in clinical practice, when hypofractionation is used.     

Roentgen symptoms of early cancer of the breast

Based on 68 verified cases of early breast cancer, the radiologic signs in early breast cancer are analyzed. The relative incidence of the different mammographic signs and the diagnostic value of each when it occurs in isolation are elaborated. The diagnostic and therapeutic consequences are discussed.     

Modern radiation techniques in early stage breast cancer for the breast radiologist

Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1–2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.     

Amyloidosis of the breast mimicking recurrence in a previously treated early breast cancer

Amyloid involvement of the breast is infrequently reported and may have clinical and radiological features suspicious for a primary breast malignancy. We describe a case of amyloid of the breast in which asymptomatic mammographic findings were suspicious for locally recurrent disease in a patient with previously treated breast cancer.     

Improvement in the early detection of breast cancer by thermography

In the last few years thermography lost some of its value in the diagnosis of breast cancer because of the changeover to x-ray mammography and ultrasound mammography. Nevertheless, it is still a very useful additional method, especially if the doctor can only perform a clinical examination. Combination of thermography and clinical examination produces better results. In case of pathological vascularisation, clinically occult carcinomas can be detected.     

单管或双管引流对乳腺癌改良根治术后皮下积液影响的研究

目的比较单管和双管引流对乳腺癌改良根治术后患者皮下积液形成与转归的影响。方法将89例乳腺癌改良根治术后患者分为两组,腋窝单管引流组（48例）和腋窝及胸壁双管引流组（41例）,观察术后皮下积液的发生及变化。结果双管引流41例患者,术后皮下积液发生率为22％（9／41）,单管引流48例患者,术后皮下积液发生率为25％（12／48）,p＞0．05,无统计学意义。结论单管或双管引流对于乳腺癌改良根治术后皮下积液的预防效果无明显差异。     

早期乳腺癌保乳手术治疗的临床研究

目的探讨早期乳腺癌保乳手术治疗的适应证及方法。方法分析我院近5年来20例保乳手术治疗的乳腺癌患者临床资料。结果保乳术后患者乳房外形均较好,两侧乳房基本对称,患者3年生存率为95％,复发率为5％。结论早期乳腺癌保乳手术治疗安全、疗效确切,全身综合治疗是保乳手术治疗成功的关键。