微波消融治疗乳腺癌的现状与争议

正近年来,乳腺癌的发病率逐年上升,乳腺癌已成为威胁中国女性身心健康及生命安全的最常见的恶性肿瘤~([1])。目前乳腺癌已进入一个以病理分子分型为指导,以手术、化疗、放疗、内分泌治疗和分子靶向治疗为一体的综合治疗时代,乳腺癌患者的生存率大大提高;同时,随着社会思想观念的改变以及技术的发展,乳腺癌患者对自身的生活质量及身体美学也提出了更高的要求,保乳手术成为早期乳腺癌的主要手术方式,但仅有80%的患者对保乳手术的     

肿瘤整形技术在保乳手术中的应用与进展

正外科治疗是乳腺癌治疗的基石,保乳手术是早期乳腺癌病人手术治疗的标准术式之一。随着乳腺癌病人生存时间的延长,病人对乳房外形美观度的要求增加。肿瘤整形技术将传统保乳手术与整形外科技术相结合,兼顾切缘安全和美学效果,更有利于病人的身心健康。一、肿瘤整形技术的发展NSABP B-06、EORTC 10801等多项前瞻性临床研究已经证实,乳腺癌的保乳手术联合辅助放疗与全乳切除术具有相同的肿瘤安全性,同时可通过保留乳房     

乳腺癌保乳手术的几个实际问题

迄今为止，乳腺癌的外科手术主要集中围绕两个选择，一个是切除原发肿瘤的保留乳房手术，另一个是切除患侧乳房同时行或不行乳房重建手术。在欧美国家保乳手术已经成为早期乳腺癌的首选术式。中国乳腺癌保乳手术仍为少数，但发展势头引人瞩目。随着科普知识的宣传与普及，人们头脑中治疗观念的与时俱进，医疗资源的合理利用，乳腺癌筛查的普遍开展，早期患者比例的增加，我国乳腺癌保乳手术拥有广阔的发展空间。保乳手术是以不降低生存率为原则，     

乳腺癌保乳手术的发展与变革

正乳腺癌是威胁女性健康的首位恶性肿瘤,自1984年Halsted报道了乳腺癌根治术以来,手术治疗一直是乳腺癌综合治疗中的主要手段,乳腺癌手术治疗在之后的1个多世纪中得到不断的发展。多项研究~([1-3])证明,保乳手术加术后放疗可获得与全乳切除相同的长期生存效果,因此保乳手术已成为目前早期乳腺癌患者的主要手术方式。保乳手术需要借助影像学检查来决定手术的范围,患者常规需要联合术后放疗,部分患者还需要联合药物治     

�����������ٰ������е�Ӧ��

近 30年来 ,随着人们对乳腺癌生物学特性的深入认识、乳腺癌早期诊断方法的改进、全身治疗的日渐重视以及病人对治疗方法的选择 ,乳腺癌外科从以局部解剖学为基础追求手术彻底性的根治手术向全身生物学改变为指导理论的防治方向发展 ,使乳腺癌的局部治疗发生了很大变革 ,保乳术已成为乳腺癌手术治疗的一种重要方式 ,且在我国已开展 ,其治疗规范化有待逐步完善 ,也是现代乳腺癌外科发展的趋势。WilliaumHalsted基于乳腺癌首先是局部播散 ,通过淋巴道向区域淋巴结转移 ,最后冲破淋巴结防御屏障进入血液导致远处转移的学说 ,在 1894年创建了乳…     

规范化保乳手术在乳腺癌治疗中的应用

1924年,Keynes[1]首次采用乳腺肿块切除加镭针插植术而非传统的Halsted根治术治疗乳腺癌获得成功.20世纪70年代, Fisher等[2]提出,乳腺癌一开始就是一个全身性疾病,不同手术方式对生存率无根本影响,改变了人们对乳腺癌生物学行为的认识.随后,多个医疗机构的大样本前瞻性试验证实了保乳手术同传统根治术在长期生存率上无明显差异,从而使得乳腺癌的手术治疗模式由"可以耐受的最大治疗"转为 "最小而有效的治疗",保乳手术逐渐成为乳腺癌,特别是早期乳腺癌的治疗趋势.我国的保乳率较低,保乳手术仅占同期手术治疗乳腺癌的9%[3].现就乳腺癌保乳手术的疗效、适应证、手术方式、切缘、美容效果等几方面讨论如下.     

乳腺癌保乳之中国经验

<正>手术治疗是乳腺癌治疗的重要组成部分,Fisher理论的出现,保乳手术应运而生。由此带来一系列关于安全性、手术操作规范和影像、病理的相关问题。本文就这些问题的国际进展及国内经验进行梳理。一、保乳手术的发展历程及安全性1955年,美国克里福兰市George Crile就开始有计划地作乳腺癌保乳术~([1]),NSABP-04试验证明乳腺癌在发病初期就是一种全身性的疾病,为保乳治疗提供了理论支持。关于保乳有6大前瞻性试验Gustave-     

乳腺癌保乳手术32例临床分析

目前，乳腺癌的发病率已上升至女性肿瘤中的第二位，有逐年上升且年轻化趋势，在某些地区已达女性恶性肿瘤的首位。随着肿瘤病理学等基础学科的进步，外科医生对乳腺癌的认识也发生了深刻的变化，乳腺癌治疗已由单一手术治疗发展成为全身综合性治疗。乳腺癌保乳手术合并放化疗已日渐成为对早期乳腺癌最多采用的治疗方法。我省处于高原地区，保乳手术开展较晚，我院2007年1月至2010年7月共实施保乳手术32例，报告如下。     

Ⅰ期乳腺癌保乳手术治疗的探讨

目的探讨保乳手术在I期乳腺癌治疗中的临床应用。方法对116例I期乳腺癌患者实施了保乳手术,术后辅以规范的综合治疗。结果116例患者保乳手术过程顺利,近期乳房外形保持良好。术后随访12～24个月,无局部复发,远处转移和死亡。结论保乳手术治疗Ⅰ期乳腺癌疗效满意,手术前全面细致地检查,有助于手术适应证的准确判定,术前、术后配合规范的综合治疗,是保乳手术疗效的可靠保证。     

浸润性乳腺癌的保乳治疗

乳腺癌治疗的发展是人们对乳腺癌的生物学行为不断认识，诊断方法和治疗方式不断进步的过程。乳腺癌的治疗已经从最初的单一Halsed根治性手术治疗逐步发展到了现今的综合治疗。随着早期乳腺癌检出率的提高，乳腺癌的保乳治疗将越来越多地应用于临床。保乳治疗从病人的选择到保乳手术后的综合治疗及随访都涉及多方面内容。     

Omega and inverted omega incision: a concept of uniform incision in breast surgery

In the history of breast surgery, we have seen a lot of changes in orientation, position, and localization of breast incisions. Most of the biopsy incisions have been made with no consideration of future mastectomy or reconstruction because a wide ellipse of skin removed during the mastectomy included the biopsy site. The primary surgical treatment was in the competence of the oncologic or general surgeon. Reconstruction was not an integral part of breast carcinoma therapy and was considered as a secondary, unimportant treatment to be preformed by a plastic surgeon at a later date if desired by the patient. Wide acceptance of conservative breast operations, skin-sparing mastectomy, and reconstruction as an integral part of breast cancer therapy necessitates new consideration about the initial incisions used for breast biopsy. We consider the omega incision not only as a type of incision but also as a concept that can be used for all breast surgery, including biopsy, lumpectomy, skin-sparing mastectomy, and reconstruction.     

A systematic review of decision aids for patients making a decision about treatment for early breast cancer

Several complex treatment decisions may be offered to women with early stage breast cancer, about a range of treatments from different modalities including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids can facilitate shared decision-making and improve decision-related outcomes. We aimed to systematically identify, describe and appraise the literature on treatment decision aids for women with early breast cancer, synthesise the data and identify breast cancer decisions that lack a decision aid.A prospectively developed search strategy was applied to MEDLINE, the Cochrane databases, EMBASE, PsycINFO, Web of Science and abstract databases from major conferences. Data were extracted into a pre-piloted form. Quality and risk of bias were measured using Qualsyst criteria. Results were synthesised into narrative format.Thirty-three eligible articles were identified, evaluating 23 individual treatment decision aids, comprising 13 randomised controlled trial reports, seven non-randomised comparative studies, eight single-arm pre-post studies and five cross-sectional studies. The decisions addressed by these decision aids were: breast conserving surgery versus mastectomy (+/− reconstruction); use of chemotherapy and/or endocrine therapy; radiotherapy; and fertility preservation. Outcome measures were heterogeneous, precluding meta-analysis. Decisional conflict decreased, and knowledge and satisfaction increased, without any change in anxiety or depression, in most studies. No studies were identified that evaluated decision aids for neoadjuvant systemic therapy, or contralateral prophylactic mastectomy.Decision aids are available and improved decision-related outcomes for many breast cancer treatment decisions including surgery, radiotherapy, and endocrine and chemotherapy. Decision aids for neoadjuvant systemic therapy and contralateral prophylactic mastectomy could not be found, and may be warranted.     

合并慢性肾功能衰竭乳腺癌病人的综合治疗(附6例报告)

目的:总结合并慢性肾功能衰竭乳腺癌病人的多学科合作和个体化治疗为主的经验。方法:回顾性分析2009年1月至2010年12月间本中心6例合并慢性肾功能衰竭乳腺癌病人诊治的临床资料。结果 :6例均行根治手术,其中4例行乳腺癌改良根治术,2例行乳腺癌保乳加腋窝淋巴结清扫术。1例长春瑞滨加表柔比星新辅助化疗,1例阿那曲唑新辅助内分泌治疗。随访至2014年2月,2例因慢性肾功能衰竭死亡,余4例均未出现复发转移。结论:慢性肾功能衰竭不是乳腺癌手术及全身治疗的禁忌证。通过多学科诊疗选择个体化的手术、化疗、放疗和内分泌治疗方案、严密监测肾功能,慢性肾功能衰竭病人仍可完成乳腺癌标准治疗,同样具有治愈可能。     

Conservative treatment of the central breast cancer with nipple-areolar resection: an alternative oncoplastic technique

Conservative surgery with radiation therapy is the standard treatment for early-stage breast cancer. Nevertheless, the patients with subareolar breast cancer have been often excluded from breast-conserving surgery and treated with mastectomy because of the unacceptable cosmetic effect associated with the resection of the nipple-areola complex (NAC), as well as oncologic concerns about multicentricity or multifocality associated with these tumours. We show a conservative "oncoplastic technique" in which the resection of the central portion of the breast, including the NAC, can allow a wide excision of the tumour with uninvolved margins of resection and good cosmetic results.     

Prognosis after breast recurrence following conservative surgery and radiotherapy in patients with node-negative breast cancer

BACKGROUND: Breast conservation surgery with radiotherapy is a safe and effective alternative to mastectomy for early-stage breast cancer. This retrospective study examined the outcome of patients with isolated local recurrence following conservative surgery and radiotherapy in node-negative breast cancer. METHODS: Between November 1979 and December 1994, 503 women with node-negative breast cancer were treated by conservation surgery and radiotherapy without adjuvant systemic therapy. RESULTS: After a median follow-up of 73 months the 5-year rate of freedom from local recurrence was 94 per cent. Thirty-five patients developed an isolated local recurrence within the breast as a first event. Thirty-three patients were treated with salvage mastectomy and two patients were treated with systemic therapy alone. The 5-year rate of freedom from second relapse was 46 per cent and the overall 5-year survival rate was 59 per cent for patients who had salvage mastectomy. Patients who developed breast recurrence as a first event had a 3.25 greater risk of developing distant metastasis (P < 0.001) than those who did not have breast recurrence as a first event. CONCLUSION: Salvage mastectomy after local recurrence was an appropriate treatment if there was no evidence of distant metastasis. Breast recurrence after conservative surgery and radiotherapy in node-negative breast cancer predicted an increased risk of distant relapse.     

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.     

History of breast cancer surgery and its perspectives

At the end of the 19th century, surgical treatment of breast cancer was revolutionized by the introduction of the Halsted radical mastectomy. Haagensen, who studied under one of Halsted's students, further strengthened the foundations of the technique, and the Halsted operation became the standard radical breast cancer surgery worldwide. This may have been responsible for the persistence of this operation, particularly in Japan. Some Halstedian surgeons espoused the extended radical mastectomy or super-radical mastectomy. However, breast-conserving surgery is now becoming the most common technique. In the early 1970s breakthroughs in the understanding of the biology of breast cancer led to a new era of adjuvant therapy. Consequently current surgical management of breast cancer is no longer possible without considering other therapeutic modalities. Consistent with this change, it should be realized that the disease is no longer diagnosed at the same stage as it was at the time of Halsted. Although the ultimate patient outcome is not likely to be influenced solely by locoregional treatment, surgery will continue to be employed as the most effective treatment modality, and every effort should be made to prevent locoregional tumor spread.     

Central quadrantectomy with resection of the nipple-areola complex compared with mastectomy in patients with retroareolar breast cancer

Appropriate surgery in women with retroareolar breast cancer should allow resection of the cancer with wide free margins and an acceptable cosmetic result. The aim of this study was to compare breast conservation surgery (BCS) to mastectomy for treatment of retroareolar breast cancer. In a prospective nonrandomized study, 69 women with retroareolar breast cancers underwent either central quadrantectomy (n=33) with complete removal of the nipple-areola complex or mastectomy (n=36). Two of 33 (6%) patients scheduled for BCS had a secondary mastectomy and immediate reconstruction due to involved margins. After a median follow-up of 42 month (range 17-99 months) in the BCS group and 43 months (range 16-118 months) in the mastectomy group local and regional recurrences as well as systemic disease were comparable between both groups. The postoperative cosmetic result after BCS as evaluated by the patients was rated as excellent in 80% and good in 20% with no poor result. BCS followed by radiation therapy is a feasible alternative to mastectomy in patients with retroareolar breast cancer.     

A standard mastectomy should not be the only recommended breast surgical treatment for non-metastatic inflammatory breast cancer: A large population-based study in the Surveillance,Epidemiology, and End Results database 18

BackgroundStandard mastectomy has long been the recommended breast surgical treatment for non-metastatic inflammatory breast cancer (IBC). The objective of this population-based study was to evaluate the significance of various breast surgical treatments for this highly aggressive subtype.MethodsThe Surveillance, Epidemiology, and End Results program registry was searched to identify women with non-metastatic IBC receiving standard treatment including breast surgery, radiation therapy and chemotherapy diagnosed between 1998 and 2013. Comparisons of the proportions of various breast surgery procedures over the years were performed using Pearson's chi-square test. Breast cancer-specific survival (BCSS) and overall survival (OS) were estimated using the Kaplan-Meier product limit method and compared across groups using the log-rank statistic. Cox models were then fitted to compare the association between various breast surgical procedures and BCSS or OS after adjusting for patient and tumor characteristics.ResultsA total of 3374 cases were identified. Over the years, the proportion of contralateral prophylactic mastectomy (CPM), breast reconstruction and both were increasing. The proportion of implant-based reconstruction was also increasing with no difference in survival compared with other types of reconstruction. There was no statistically significant difference in BCSS or OS among various breast surgery treatments, such as breast conserving surgery, CPM, breast reconstruction and standard unilateral mastectomy.ConclusionsBreast surgery is of great significance to the clinical outcome of IBC. Standard mastectomy should not be the only recommended breast surgical treatment.     

The surgical management of breast cancer

The management of breast cancer is highly controversial. Various operations have been performed in different hospitals. This controversy may arise from an incomplete knowledge of the biology of breast cancer. At present, surgeons are highly recommended to perform an adequate surgery which gives the ultimate in local control, does not compromise the chance of cure and gives the best cosmetic and aesthetic results. Recently, the choice of conservative surgery with aggressive radiation therapy versus more adequate surgery, total mastectomy and axillary dissection, is a major controversial problem for primary treatment of operable breast cancer. However, to avoid local recurrence with attendant worry for the patient, conservative surgery should only be indicated for a select group of patients with early breast cancer. At present, there is little doubt that mastectomy and regional lymph node dissection are the most beneficial methods of treatment in all other patients. So, adequate surgery and breast reconstruction are more preferably recommended for ensuring local control and for providing a better psychological impact.