背阔肌瓣前移在乳癌根治假体植入术中的应用研究

目的探讨乳腺癌改良根治术I期假体植入、背阔肌瓣前移覆盖裸露假体新手术方法的特点，以及手术后患者的心理状态等。方法对行上述新的手术方法的20例乳腺癌患者与单纯改良根治术I期假体植入的22例乳腺癌患者作为对比研究。结果研究组患者术后伤152愈合佳，双侧乳房基本对称，患者对人造乳房外形很满意。而对照组中有6例术后出现皮瓣坏死，导致假体移位或外露，手感欠佳。两组患者对乳房外形的满意程度差异有统计学意义（P〈0．01）。结论在乳腺癌改良根治术即时假体植入时，行背阔肌瓣前移覆盖裸露的假体，能使术后伤152愈合更佳，人造乳房外形更美观，更好地满足肿瘤治疗和形体美容的要求。     

保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效对比

目的对比分析保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入与传统乳腺癌改良根治术的临床疗效。方法收集吉林大学第二医院2009年12月-2015年12月确诊为早期原发性乳腺癌行保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入的患者60例为观察组,并选取同期行传统的乳腺癌改良根治术的80例患者为对照组。对比观察两组患者的术后效果。结果两组患者术后拔管时间、切口恢复时间及术后并发症差异无统计学意义(P>0.05)。观察组术后满意率93.33%明显高于对照组的43.75%,差异有统计学意义(P<0.05)。两组不良事件发生率(5.00%与6.25%)、局部复发率(3.33%与3.75%)及远处转移率(0.00%与1.25%)差异均无统计学意义(P>0.05)。结论保留乳头乳晕的乳腺癌改良根治术联合Ⅰ期假体植入治疗早期乳腺癌安全、可行,且美容效果好,患者满意度高。     

乳腺癌改良根治同期背阔肌移植乳房再造术的探讨

目的探讨乳腺癌改良根治术后同时行背阔肌移植乳房再造术的可行性及效果。方法分析笔者所在医院2004年1月至2008年12月35例乳腺癌患者行乳腺癌改良根治术同时行同侧背阔肌移植乳房再造术的效果。结果全部病例肌皮瓣成活,无淋巴漏、无局部复发,再造乳房形态满意。结论乳癌改良根治术后同时行背阔肌肌皮瓣移植再造乳房,效果好,值得临床推广。     

乳腺癌术后Ⅱ期假体植入患者围手术期感染的相关因素分析

目的探讨乳腺癌术后Ⅱ期假体植入患者围手术期感染的相关因素及相应预防对策,为降低患者围手术期感染率、提高患者植入手术成功率提供科学依据。方法选择2012年1月-2017年6月医院进行乳腺癌术后Ⅱ期假体植入手术患者182例为研究对象,将Ⅱ期乳房假体植入术围手术期内出现感染的患者纳入感染组,未出现感染的患者纳入对照组,将年龄、体质指数、手术时间、术中出血量、术后引流时间、TNM分期、合并糖尿病情况、术前贫血情况、假体类型、保留乳头乳晕情况、腋下淋巴结清扫情况等可能影响两组患者Ⅱ期乳房假体植入围手术期感染的相关临床资料进行单因素及多因素Logistic回归分析。结果 182例进行乳房再造患者Ⅱ期假体植入术后共有21例患者出现围手术期感染,感染的发生率为11.54%。单因素及多因素Logistic回归分析结果显示手术时间、术后引流时间、体质指数≥28kg/m2、清扫腋下淋巴结、保留乳头乳晕是乳腺癌术后Ⅱ期假体植入患者围手术期感染的独立相关因素。结论乳腺癌术后Ⅱ期假体植入患者围手术期感染的相关因素较多,应全面评估患者状态,针对围手术期感染的高危人群,应加强围手术期感染的监测以及术后预防性抗感染治疗,最大程度地减少患者的感染发生,提高乳房重造的安全性和成功率。     

乳房再造时机对乳腺癌改良根治术患者生存质量的影响

目的评价即刻乳房再造与延期乳房再造对乳腺癌改良根治术患者生存质量的影响。方法问卷调查110例乳腺癌改良根治术患者,分为即刻乳房再造组和延期乳房再造组,各55例。进行为期2年的随访,对两组患者的生存质量进行评价。结果术前两组患者的生存质量比较无统计学差异（P〉0.05）;随访2年后,即刻乳房再造患者在生理、心理、社会及环境支持4个因子的生存质量评分均明显高于延期乳房再造组（均P〈0.05）。结论乳腺癌改良根治术即刻乳房再造患者的生存质量要优于远期乳房再造术患者。     

乳腺癌改良根治术后Ⅰ期乳房再造临床预后的Meta分析

目的使用Meta分析评价乳腺癌改良根治术后Ⅰ期乳房再造的临床预后。方法计算机检索万方资源数据库、维普信息资源系统、中国期刊全文数据库、中国知网(CNKI)、中文科技期刊数据库(VIP)、Cochrane Library、EMbase、PubMed, 检索时间从各数据库建库至2021年8月25日。收集与乳腺癌根治术后Ⅰ期乳房再造有关的临床对照试验组和随机对照试验组, 提取相关资料, 并采用RevMan 5.3软件进行Meta分析。结果最终纳入12篇文献。Meta分析结果显示, 采用改良根治术后Ⅰ期乳房再造和采用单纯改良根治术对局部复发率、远处转移率、3年无瘤生存率和并发症无影响(OR = 0.91, 95%CI 0.50～1.68, P = 0.77;OR = 0.66, 95%CI 0.42～1.06, P = 0.09;OR = 1.22, 95%CI 0.77～1.93, P = 0.40;OR = 0.91, 95%CI 0.58～1.41, P = 0.66)。采用改良根治术后Ⅰ期乳房再造对生命质量评分的影响优于采用单纯改良根治术(MD = 9.79, 95%CI 8.82～1...     

Ⅲa期乳腺癌新辅助化疗后行根治手术并乳房再造12例报告

目的 探讨新辅助化疗后行根治手术并乳房再造治疗Ⅲa期乳腺癌的可行性.方法 2002～2004年治疗12例女性乳腺癌患者,给予新辅助治疗,多西他赛+盐酸表柔比星3个周期,新辅助治疗结束后2周行乳腺癌改良根治术Ⅰ式,同期单蒂下腹部横形腹直肌肌皮瓣乳房再造术,腹壁缺损行尼龙网修补术.结果 术后12例再造乳房均成活,8例切口愈合良好,3例皮肤血运欠佳,1例部分缺血坏死,无腹壁疝出现.随诊24～51个月乳房形态良好,生活及工作较前无明显影响,无局部复发及远处转移.结论 新辅助治疗作为晚期乳腺癌乳房再造手术的术前治疗,改善分期后,可提供合理的手术时机,达到再造要求,并不带来术后更多并发症,提高患者生活质量.     

Ⅲa期乳腺癌新辅助化疗后行根治手术并乳房再造12例报告

目的探讨新辅助化疗后行根治手术并乳房再造治疗Ⅲa期乳腺癌的可行性。方法2002-2004年治疗12例女性乳腺癌患者，给予新辅助治疗，多西他赛＋盐酸表柔比星3个周期，新辅助治疗结束后2周行乳腺癌改良根治术Ⅰ式，同期单蒂下腹部横形腹直肌肌皮瓣乳房再造术，腹壁缺损行尼龙网修补术。结果术后12例再造乳房均成活，8例切口愈合良好，3例皮肤血运欠佳，1例部分缺血坏死，无腹壁疝出现。随诊24-51个月乳房形态良好，生活及工作较前无明显影响，无局部复发及远处转移。结论新辅助治疗作为晚期乳腺癌乳房再造手术的术前治疗，改善分期后，可提供合理的手术时机，达到再造要求，并不带来术后更多并发症，提高患者生活质量。     

Ⅰ期假体植入乳房重建在乳腺癌术后的临床应用分析

目的 探究乳腺癌术后Ⅰ期硅胶假体植入乳房重建的方法、重建手术之后的效果和方案的可行性.方法 选取2013年5月到2015年1月于大连医科大学附属大连市中心医院乳腺外科行乳腺癌术后Ⅰ期硅胶假体植入乳房重建术的患者46例,对重建乳房的外形、患者的审美评价和复发情况等进行分析.结果 46例患者中,38例符合保留乳头乳晕复合体的标准,另10例切除乳头乳晕复合体后接受背阔肌肌皮瓣转移术、乳房对称整形术等.所有患者术后乳房外观良好,1例患者乳头血运差略发黑,换药后自行愈合,外形无明显变化;1例发生皮下积液、经穿刺后好转;其余患者均无皮瓣坏死、伤口裂开、假体移位等并发症.46患者行植入乳房重建,客观满意度和主观满意度均为93.47%.结论 Ⅰ期假体植入乳房重建手术操作简单易行,美学效果满意,无严重并发症,术后不影响乳腺癌的辅助治疗和远期疗效,是一种安全、可靠的治疗方法,适宜临床推广.     

乳腺癌根治术同期单蒂TRAM乳房再造术护理

目的为探讨乳腺癌根治术同期单蒂TRAM皮瓣乳房再造术的护理方法。方法对5例乳腺癌根治术同期单蒂TRAM皮瓣乳房再造术的患者做好术前心理护理、术后护理及患肢功能锻炼。结果 5例患者除1例乳房外形欠佳,其余4例患者再造乳房外形、手感良好,无皮瓣坏死等严重并发症。结论加强围术期的护理是预防术后并发症发生,确保手术成功的关键。     

Reconstruction of a breast following mastectomy

Breast reconstruction has become an available option for most patients undergoing mastectomy. Breast reconstruction has been shown to lessen the psychological disturbances associated with mastectomy. Reconstruction with a silicone breast prosthesis is selected when the preserved tissues after subcutaneous mastectomy, total mastectomy or modified radical mastectomy, have an adequate quantity and quality for insertion of the prosthesis. Frequently these tissues are quantitatively deficient. In these cases the use of tissue expanders allows the expansion of deficient soft tissues. Anatomically shaped expanders produce breasts with a natural appearance, adequate ptosis and a well-defined submammary fold. When the skin has poor quality or has been irradiated, or when a radical mastectomy has been performed, additional autogenous tissue needs to be brought to the breast area with a flap. The two most commonly used musculocutaneous flaps are the latissimus dorsi and the transverse rectus abdominis flap (TRAM). To get a good result nipple-areola reconstruction is necessary, and it is often necessary to modify the contralateral breast.     

保留乳头改良根治术治疗Ⅰ,Ⅱ期乳腺癌的临床价值分析

目的 探讨保留乳头改良根治术治疗Ⅰ,Ⅱ期乳腺癌的疗效.方法 选择2006年3月至2012年6月在我院实施保留乳头改良根治术治疗乳腺癌的患者40例为研究对象,其中Ⅰ期乳腺癌24例,Ⅱ期乳腺癌16例,所有患者均符合保留乳头改良根治术手术适应证（本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会的批准,征得受试对象的知情同意,并与之签署临床研究知情同意书）.结果 在40例患者中,术后发生乳头表皮部分坏死为4例（乳头皮肤痂下愈合为2例,乳头坏死为2例）,皮下积液为2例（经抽取液体后治愈）,切口Ⅰ期愈合为34例.全部病例乳头基底部切线病理组织学检查均无癌细胞浸润.术后40例全部接受随访,最长为70个月,平均为48个月;其中,38例无局部复发和远处转移,另2例系肿瘤位于乳头3 cm处,于术后24个月复发,行乳头乳晕复合体切除术,随访22个月无复发.结论 保留乳头改良根治术治疗Ⅰ,Ⅱ期乳腺癌是可行的.     

Changing trends in the surgical management of breast carcinoma in Japan

Modified mastectomy, which involved removal of the breast, overlying skin and axillary contents but spares the pectoralis muscle, has recently been established as an entirely satisfactory approach for Stage I and Stage II breast carcinoma. In a sequential series of patients, we noted that the traditional mastectomy followed by radiation to axilla and adjacent area failed to confirm the efficacy to support the prevention for local relapse in the past decade. The concepts of adjuvant chemotherapy evolved primarily from clinical trials: CMF and CAMF have been shown to influence favorably the therapy of premenopausal women with positive. nodes. Additional endocrine adjuvant treatment in postmenopausal women with positive nodes was significantly superior to that with CAMF. Immediate breast reconstruction following modified mastectomy or subcutaneous mastectomy was safe, simple, and possible to produce the patient's satisfaction. There was a positive effect on life style and on sexual, social or work relationships. Finally, in recent years, several studies have reported that more conservative treatment, such as partial mastectomy and nodes dissection with postsurgical radiotherapy are as effective as modified mastectomy. Present research will likely continue to modified current treatment as more data are gathered and analyzed clinically and histologically.     

保留肋间臂神经和胸前神经在乳腺癌改良根治术中的临床意义

目的 探讨保留胸前神经和肋间臂神经在乳腺癌腋淋巴结清扫术中的方法及临床应用价值。方法 2000年3月至2007年3月Ⅰ、Ⅱ、Ⅲa期乳腺癌患者288例,随机分为两组,试验组152例,保留胸前神经和肋间臂神经。对照组136例,切除胸前神经和肋间臂神经。术后对患者上臂内侧感觉功能和胸大肌萎缩度进行随访。结果 试验组患侧上肢感觉异常发生率为39．5％,对照组发生率55．9％,两者相比均有显著性差异（P〈0．01）。术后胸大肌重度萎缩：试验组78例,对照组105例,两组相比均有差异性。结论在Ⅰ、Ⅱ、Ⅲa期乳腺癌改良根治术中施行保留胸前神经和肋间臂神经是可行的,它保存了患侧上臂内侧及腋部皮肤感觉功能和胸大肌的外形,明显减少术后患者上肢感觉障碍和疼痛,提高了患者的生活质量。     

Perioperative variables associated with surgical site infection in breast cancer surgery

Despite the fact that breast operations are usually categorized as clean procedures, higher surgical site infection (SSI) rates are reported. This study aimed to determine the perioperative variables related to SSI in breast cancer patients. Medical records of breast cancer patients undergoing surgery between January 2005 and August 2007 at a university based hospital were reviewed. Preoperative, intraoperative, and postoperative clinical data from 199 patients were extracted and analysed. Overall, the SSI rate was 19.1% (38 cases). SSI was associated with a high body mass index (P=0.001), history of diabetes mellitus (P<0.0001), smoking (P<0.0001), or active skin disorders (P<0.0001). Other SSI-related variables included a tumour at an advanced clinical stage (P=0.003) and neoadjuvant therapy (P=0.003). Breast-conserving operations were less frequently associated with SSI than were radical procedures (mastectomy alone and mastectomy followed by immediate reconstruction) (P=0.0001).     

间质化疗在乳腺癌术中应用的临床意义

目的探讨乳腺癌术中放置氟尿嘧啶植入剂间质化疗的临床意义。方法60例行乳腺癌改良根治术患者按术中是否使用氟尿嘧啶植入剂分为治疗组（40例）和对照组（20例）。对照组常规手术治疗,治疗组在常规手术后,蒸馏水冲洗创面,分别在肿瘤区域下方、胸大小肌间、腋窝血管下0．5cm均匀放置氟尿嘧啶植入剂（剂量0．4g）。观察两组术后骨髓抑制、肝肾功能、胃肠道反应、皮瓣坏死、皮下积液、局部复发等情况。结果两组骨髓抑制、肝肾功能异常、皮瓣坏死、皮下积液及胃肠道反应发生率比较差异无统计学意义（P〉0．05）。治疗组局部复发率低于对照组[0比20．0％（4／20）],差异有统计学意义（P〈0．05）。结论乳腺癌改良根治术中应用氟尿嘧啶植入剂是安全有效的。     

乳腺癌改良根治术与乳腺癌根治术的比较

目的探讨乳腺癌改良根治术及根治术的效果,为临床治疗提供帮助。方法回顾分析2005年7月至2011年12月我院收治的52例乳腺癌术后患者,其中根治术是25例,改良根治术是27例。结果乳腺癌术后均辅以化疗等综合治疗,随访3～60个月后,改良根治术存活25例,2例死亡,乳腺癌根治术1人死亡。结论乳腺癌改良根治术辅以化疗等综合治疗仍是基层医院主要的治疗手段。     

乳腺癌根治术后患者心理压力与家庭功能的调查研究

目的调查乳腺癌根治术后患者心理压力及家庭功能状况,分析乳腺癌根治术后患者心理健康影响因素,为乳腺癌患者心理干预(或护理)提供理论依据。方法采用住院肿瘤患者心理压力评定量表和家庭关怀度指数(APGAR)量表对61例乳腺癌根治术后患者心理压力与家庭功能状况进行调查。结果乳腺癌根治术后患者心理压力总评分及功能纬度评分明显低于常模(P<0.01);评分高功能家庭42例(68.9%),中度功能家庭15例(24.6%),低功能家庭4例(6.6%);影响乳腺癌根治术后患者心理压力的主要因素为文化程度和家庭功能状态且与其呈负相关(P<0.05)。结论根治术后阶段乳腺癌患者心理压力总体明显优于其他肿瘤患者,但不同文化程度和家庭功能状态仍是影响患者心理压力的主要因素,护理人员应重视低功能家庭、低文化程度患者的心理护理。     

Three men with breast cancer

In three men, aged 81, 66 and 58 years, breast cancer was diagnosed. All three were treated by modified radical mastectomy and axillary-node dissection. They received tamoxifen and the first and the third patient also received radiotherapy. Presentation of these patients is usually delayed, because of the rarity of and unfamiliarity with the disease. Consequently, the disease is often in a more advanced stage at presentation and overall mortality is higher in comparison with women with breast cancer. However, survival of male patients is similar to survival of female patients when matched for age and stage. This stresses the importance of a timely diagnosis. As in women, of the known risk factors for male breast cancer, a positive family history is one of the most important ones. Modified radical mastectomy, combined with sentinel-node biopsy by experienced teams, is the standard treatment. Criteria for adjuvant systemic treatment are identical for men and women, although hormonal therapy (tamoxifen) has a more prominent place in the adjuvant setting because of the high percentage of positive hormone receptors in men.