乳腺癌保留乳房术后放射治疗规范与进展

乳腺癌保留乳房治疗在我国已有迅速普及推广的趋势，为了规范保留乳房术后放射治疗指征及技术，介绍了此方面国内外研究进展及自己的临床经验。     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

保留乳房的乳腺癌切除术108例

目的 研究保留乳房的乳腺癌切除术的适应证、术中技巧及预后.方法 回顾分析2001年7月至2007年7月接受保乳手术的108例乳腺癌患者的临床资料.结果Ⅰ期22例,Ⅱ期81例,Ⅲ期5例,肿瘤局部扩大切除并腋窝淋巴结清除术48例,象限切除并腋窝淋巴结清除术52例,单纯肿块局部扩大切除5例,象限切除或肿块局部扩大切除联合前哨淋巴结活检3例,术后给以放、化疗综合治疗,随访3～89个月(中位时间29个月),局部复发率为2.78%(3/108),远处转移率为1.85%(2/108).术后综合治疗结束后满半年的患者乳房外形评估,优良为60.19%(65/108),差为39.81%(43/108).结论 对单发性的乳腺癌,肿瘤直径≤3 cm的早期乳腺癌患者进行保留乳房的综合治疗,可以取得与根治术相同的临床疗效.     

Minimally invasive surgery for breast cancer

Breast conservation surgery has become a standard operation as a minimally invasive surgery for breast cancer in Japan. Now sentinel lymph node biopsy (SLNB), day surgery, and endoscopy assisted surgery are being introduced as more minimally invasive surgeries for breast cancer. When blue dye and/or isotope are injected into the peri-tumoral breast gland, the sentinel lymph nodes (SLN) can be detected easily, and node negative patients can be selected with certainty. When no metastasis is found in SLN by frozen section, T1N0 breast cancer patients can be treated without lymph node dissection. Using this technique, day surgery for patients who have clinically node-negative small breast cancer (less than 1.5 cm in diameter) is performed under local anesthesia. We have developed an endoscopy assisted conservation surgery for breast cancer. Using endoscopy, partial or total glandectomy with radical axillary lymph node dissection is performed via a 5 cm skin incision on the middle axillary line. When the amount of glandectomy is over one third, we perform immediate reconstruction using the latissimus dorsi. These minimally invasive surgeries for breast cancer will result in a better quality of life for breast cancer patients.     

Minimally invasive surgery for small breast cancer

BACKGROUND AND METHODS: So-called minimally invasive techniques make percutaneous eradication of breast tumors possible, thus leading to breast-conserving treatment (BCT) without surgery. This paper reviews and discusses the feasibility of minimally invasive techniques for breast cancer. RESULTS: Although a wide variety of ablation techniques have been investigated for the treatment of primary breast cancer, radiofrequency ablation (RFA) remains one of the most promising and potentially useful tools. RFA therapy results in effective cell killing in a predictable volume of tissue with a low complication rate. On the other hand, ultrasonography is useful for guiding the needle within the tumor but cannot predict the extent of thermal ablation accurately. Early post-procedural magnetic resonance imaging (MRI) may be useful for assessing whether complete tumor ablation has been achieved by RFA. Whether adequate ablation of the tumor has been achieved can be confirmed by extensive core needle sampling of the treated area. However, validation of the margin status is also important and this needs to be tackled in further studies. CONCLUSIONS: There are many problems that remain before RFA therapy can be considered for conventional treatment. Further studies are needed to determine whether the use of RFA alone for local treatment of primary breast cancer will result in local recurrence and survival rates equivalent to those seen with BCT.     

乳腺癌保乳手术治疗的临床研究

目的:总结保乳手术治疗早期乳腺癌临床经验及观察近期疗效.方法: 2000年1月至2006年12月采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫治疗临床单发的、肿瘤直径小于3.0cm、无区域淋巴结转移的女性乳腺癌患者51例,手术切缘距瘤缘2.0cm～3.0cm,术后行辅助放疗、化疗及内分泌治疗.结果: 全组随访3～84个月,局部无复发或远处转移.结论: 早期乳腺癌病人接受保乳手术治疗可以取得满意的临床和美容效果.     

胃癌微创治疗之路

外科手术是目前唯一可能治愈胃癌的手段,但传统的开腹手术通常伴随较高的并发症率和死亡率,还会对患者术后的生活质量产生较大影响。而微创外科技术由于可有效减少手术创伤,加快术后恢复,因此对于医生和患者均具有很大的吸引力,今后或将替代传统的开腹手术。目前,胃癌微创外科技术主要向着两个不同的方向发展,即内镜下肿瘤切除和腹腔镜手术。不久的将来,前哨淋巴结导航技术和机器人手术也将为胃癌治疗提供更多选择。随着各种微创技术的不断发展,胃癌患者术后的生活质量将显著改善。目前,许多有关各种微创技术的高水平临床研究正在进行当中,胃癌微创外科必将在世界范围内广为接受,并快速发展。      

Minimally invasive surgery for esophageal cancer

Esophageal cancer represents a major public health problem worldwide. Several minimally invasive esophagectomy (MIE) techniques have been described and represent a safe alternative for the surgical management of esophageal cancer in selected centers with high volume and expertise in them. This article reviews the most recent and largest series evaluating MIE techniques. Recent larger series have shown MIE to be equivalent in postoperative morbidity and mortality rates to conventional surgery. MIE has been associated with less blood loss, less postoperative pain, and decreased intensive care unit and hospital length of stay compared with conventional surgery. Despite limited data, conventional surgery and MIE have shown no significant difference in survival, stage for stage. The myriad of MIE techniques complicates the debate of defining the optimal surgical approach for treating esophageal cancer. Randomized controlled trials comparing MIE with conventional open esophagectomy are needed to clarify the ideal procedure with the lowest postoperative morbidity, best quality of life after surgery, and long-term survival.     

Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer

Background  

The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve "adequate" or "negative" surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS.     

Survey on breast cancer patients in China toward breast-conserving surgery

Objective: We sought to investigate attitudes toward breast‐conserving therapy (BCS) in early‐stage breast cancer (EBC) patients from P. R. China and assess the factors influencing their decision. Background: There exists geographical difference in decision to perform mastectomy or BCS for EBC patients. To date, there has been no report on attitudes toward BCS or factors influencing the surgical choice in mainland China. Methods: A structured questionnaire was delivered to 1800 EBC patients. The questionnaire elicited information about general patients' characteristics, attitudes toward BCS, the roles of doctors and spouses, the levels of understanding of BCS, and the reasons for their preferences. Results: Of 1590 participants, only 7.3% anticipated BCS and this was significantly associated with patient age, income, occupation, martial status, education, levels of self‐understanding of the disease, and doctors' and spouses' suggestions (P<0.05). Approximately 70% of doctors (71.0%) and 40% spouses (39.6%) advised patients not to conserve their breasts. Although the percentage of patients endorsing BCS was higher than that of those opposing it (43.7 vs 15.1%) and more patient believed BCS was beneficial for women (39.2%), even if given another opportunity, only 32.5% of patients preferred to choose it. Moreover, the level of understanding BCS among patients is low (well‐known: less‐known: never‐heard, 2.3 vs 47.4 vs 13.3%). Conclusions: These results suggested that Chinese EBC patients lack accurate and comprehensive understanding of BCS. More efforts are needed to educate breast cancer patients in mainland China toward BCS. Copyright © 2011 John Wiley & Sons, Ltd.     

整形技术在乳腺癌保留乳房手术中的应用

正【内容简介】目前,标准的保留乳房手术是局部切除加放射治疗。全球临床研究证实:保留乳房手术与乳房全切术相比,患者的术后生存率相当。但是,保留乳房手术后两侧乳房并不一定对称。针对这一问题,廖宁教授结合文献及临床实践,从保留乳房手术的目标、肿瘤整形外科手术的特点和核心技术(容积置换与容积替换),以及肿瘤整形外科手术的种类、切口选择、系统化方法等方面,对整形技术在乳     

充气法单孔腔镜保留乳房手术在早期乳腺癌治疗中的应用

目的探讨充气法单孔腔镜保留乳房(简称保乳)手术在早期乳腺癌治疗中的应用。 方法回顾性分析2017年5月至2018年11月在首都医科大学附属北京友谊医院诊断为Ⅰ、Ⅱ期乳腺癌且行保乳手术的102例患者临床资料,其中行单孔法腔镜保乳手术者48例(腔镜组),行开放保乳手术者54例(开放组),对患者的手术时间、美容效果、并发症及复发情况进行评估。2组患者间手术时间、美容效果的比较采用两独立样本的t检验。 结果102例患者均成功完成相应单孔法腔镜保乳或开放保乳手术,其中腔镜组手术时间为(184.2±76.2) min,开放组手术时间为(127.8±68.4) min,2组相比,差异有统计学意义(t＝3.923, P<0.001)。术后2个月进行美容效果评估：腔镜组美容效果评分明显高于开放组[(11.2±0.8)分比(9.1±0.9)分,t＝6.407, P<0.001]。2组患者术后均无皮肤坏死、活动性出血、感染等并发症。中位随访时间11.2个月,2组患者均无局部复发或远处转移病例。 结论充气法单孔腔镜保乳手术在保证早期乳腺癌肿瘤根治性的同时,可以较开放保乳手术获得更好的美容效果。     

Minimally invasive techniques in breast cancer treatment

Breast conservation therapy has largely replaced mastectomy as the surgical treatment of choice for early-stage breast cancer. As the sentinel lymph node mapping procedure, rather than routine axillary node dissection, becomes the standard of care, the next challenge is how to treat the primary tumor without surgery. Minimally invasive ablation of the primary tumor is possible with a variety of approaches; the goal is to either excise the tumor percutaneously or cool it (with cryotherapy) or heat it (with radiofrequency ablation (RFA), focused ultrasound, or laser interstitial therapy) sufficiently to cause complete cell death. These developing technologies may provide treatment options that are psychologically and cosmetically more acceptable to the patient than traditional therapies, but they need further investigation to prove that they are oncologically sound. This new frontier of surgery without scalpels will require surgeons to develop radiologic expertise and to acquire a basic understanding of molecular biology.