乳腔镜在乳腺外科手术中的应用现状

20世纪后期临床外科学的重大进步之一是微创外科理论逐渐成熟和作为微创外科重要标志的腔镜手术的迅速发展。在乳腺外科发展进程中，缩小手术范围、微创、保留功能和注重美容是近年的主要趋势。继乳腺癌保乳手术和前哨淋巴结活检技术出现之后，乳腔镜手术成为乳腺外科技术的又一主要进展。经过临床工作者十多年来的努力探索，乳腔镜手术在技术上已基本成熟，治疗效果基本不存在争议。     

腔镜技术在乳腺外科中的应用进展

腔镜技术已经被广泛应用于外科领域,在乳腺外科中的应用也不断深入,尤其是近年来腔镜微创的理念被更多人所重视,腔镜技术的变革也越来越多。对既往建腔方法、手术方式存在问题的思考催生了一些新观点、新术式和新技巧。笔者针对近10年来腔镜技术在乳腺外科应用的发展和变革进行综述,一方面总结了乳腺外科建腔方法的思路变革,从经典的3孔充气法到隐蔽的单切口设计,更体现"无痕化"的人文关怀理念;另一方面阐述了腔镜技术在乳腺癌保留乳房手术、保留乳头、乳晕的皮下全乳切除术、乳房重建修复整形术、腋窝淋巴结处理以及乳腺良性疾病等手术中的应用进展,探索优化手术操作流程、规范学习曲线对腔镜技术推广的意义。随着微创理念的推广,乳腺腔镜技术将会成为一部分合适患者的优选方案。     

2007年第二届全国乳腺微创手术学习班暨学术研讨会纪要

近年来，乳腺疾病尤其是乳腺癌的临床治疗取得较大进展。外科医生更加注重在治疗疾病的同时保持乳房的形态和心理康复。为适应新的变化，以乳腺腔镜手术为代表的微创外科手术发展较快，该项技术的应用使外科医生改变了部分临床治疗的理念和方法，达到更好的治疗效果，更符合现代临床医学模式要求。为推动乳腺外科新理论、新技术、新观念的普及，使更多的外科医生了解和掌握乳腺腔镜手术等微创外科技术，     

腔镜在乳腺外科的临床应用

目的 探讨腔镜在乳腺外科的临床应用及存在的问题.方法 对45例乳腺癌患者行腋窝脂肪抽吸后,采用腔镜施行腋窝淋巴结清扫,并对3例乳腺多发性纤维腺瘤和3例男性乳房发育症患者行腔镜下乳腺肿物切除术或皮下乳房切除术.结果 全部患者均顺利完成手术,手术历时50～180 min.除1例术后有切口内出血外,其余患者术后恢复顺利.结论 腔镜在乳腺外科的应用具有传统手术无法达到的微创优势和美容效果,提高了患者的生活质量,是对传统手术方法的挑战.     

腔镜乳腺皮下腺体切除14例分析

因乳房为实质性器官,腔镜用于乳腺手术起步较晚.但经过10余年的探索,腔镜乳房手术已经涉及乳腺外科的各个方面.腔镜手术独特的微创和美容效果,使得其日益受到乳腺外科医师的关注.本院肿瘤外科于201 1年3月开始探索腔镜乳腺皮下腺体切除的手术方法,至2013年3月已完成14例,取得了良好的疗效和美容效果,现报道如下.     

乳腺导管镜在乳腺囊性增生症中的临床应用

目的通过乳腺导管镜对无乳头溢液的乳腺囊性增生症者的检查和药物介入冲洗治疗，探索无乳头溢液病人导管镜的成功插入技术，观察乳腺囊性增生症冲洗后的镜下表现。为早期发现乳管内占位性病变尤其是早期乳腺癌提供可能。方法首先应用乳管扩张剂对无乳头溢液的乳腺囊性增生者进行乳管扩张，然后行乳管镜检查。结果102例无乳头溢液的乳腺囊性增生症者，成功进镜78例（76．5％）。78例中，有4例是导管内乳头状瘤，2例导管癌，均经镜下诊断后手术治疗并病理证实。其余72例均行导管内冲洗，冲洗后管腔黏膜改变不明显的7例，手术活检5例为不典型增生，2例为细胞增生活跃。余65例均经多次冲洗后管腔黏膜光滑，色泽红润，恢复正常，其中94％的病例均能经3次冲洗后疗效满意，6％（4／65）的病例需增加冲洗次数。在治疗初期有1例并发局部感染，经青霉素等抗炎治疗后痊愈，无穿孔．乳头凹陷等其它并发症。结论无乳头溢液的乳腺囊性增生症者，在乳管扩张剂扩张后大多数能无阻力进镜，乳管扩张剂Ⅰ、Ⅱ号扩张效果无统计学差异；经过导管内的药物介入治疗，观察镜下的改变，能早期发现乳腺癌及不典型增生的乳腺病病人。早期诊断、早期治疗，减少和避免了乳腺癌及导管内疾病的误诊和漏诊。为临床早期诊断乳腺癌提供一个新的检查手段。     

乳腺外科最后堡垒

目前乳腺外科发展趋势不单注重规范化治疗,更关注个性、微创、精准以及保护患者身心健康。微创和功能治疗是最后的堡垒。改良根治术开创了"乳腺微创"的临床实践新纪元,乳腺癌腋窝淋巴结亦进入了"微创功能性清扫"时代。乳腔镜技术在诸多方面己经和正在改变着传统乳腺外科的治疗方法和理念,是应用外科新理论和技术解决现有临床问题、在治疗疾病的同时探索患者生理和心理康复方法的典型手术范例,成为乳腺外科"微创与功能"的最佳体现。目前,手术微创化、保留功能性等各种个体化、人性化的治疗方式逐渐成为趋势。践行乳腺外科的"加减法","微创与功能"这一乳腺外科最后堡垒终将融合汇聚成共同体。     

乳管镜在乳腺导管内肿瘤诊断及治疗中的应用

目的：评价乳管镜在乳腺导管内肿瘤临床诊治中的作用及应用价值。方法：我科2013年1月－2014年6月经门诊乳管镜诊治乳头溢液患者共1709人次,其中诊断为乳腺导管内肿瘤患者123例,在我科行手术治疗患者105人,回顾性分析其术前诊断、术后病检及治疗过程。结果：123例患者在乳管镜下见乳腺导管内肿瘤样病变,105人行病变导管及所属腺叶部分切除术,术后病检85例确诊为乳腺导管内乳头状瘤,5例确诊为乳腺导管内原位癌,3例确诊为乳腺浸润性导管癌,12例确诊为乳腺囊肿等其他良性病变。结论：乳管镜可早期发现乳腺导管内肿瘤,是诊治及手术定位的重要辅助手段。     

染色标记技术在精准乳腺外科中的应用

染色标记技术是直接肉眼或影像学(超声、X线、乳管镜)辅助下注射特定染色剂(如亚甲蓝、纳米炭等染料)来标记病灶部位、示踪淋巴结，以指导外科手术或复查等诊治过程的方法。染色标记技术用于病理性乳头溢液的乳腺微小病灶及触诊阴性乳腺病灶的术前定位，可实现病灶的精准切除；用于乳腺癌腋窝淋巴结示踪，可指导前哨淋巴结活组织检查和腋窝淋巴结清扫；用于乳腺癌新辅助治疗前，可避免新辅助治疗后临床完全缓解患者行保留乳房手术时的盲目性。临床上，在熟练掌握染色标记技术操作要领的基础上，还要根据各种染色剂的不同特点，选用合适的染色剂和剂量，并在恰当的时间实施标记，才能满足不同的临床需求。染色标记技术的合理应用，提高了实现"最小范围的有效切除"和"最大限度保留正常乳腺结构和生理功能"的可行性，有助于精准乳腺外科理念与技术的发展。     

纤维乳管镜和乳腺超声在伴有乳头溢液的乳管内占位性病变中的诊断价值

目的探讨纤维乳管镜与乳腺超声在伴有乳头溢液的乳管内占位性病变中的诊断价值。 方法回顾性分析重庆医科大学附属第一医院内分泌乳腺外科2017年1月至2018年2月收治的133例乳头溢液患者临床资料,分析纤维乳管镜与乳腺超声检查在乳头溢液患者乳管内占位性病变诊断中的应用情况。采用配对χ²检验比较2种检查间乳管内占位性病变检出率的差异,以及纤维乳管镜与乳腺超声诊断乳管内乳头状瘤敏感度的差异,并用Fisher确切概率法比较亚组间乳管内占位性病变为恶性肿瘤的概率。 结果133例患者中,有63例患者行溢液乳管腺段切除术,4例行乳腺结节微创旋切术,穿刺或包块切除术明确为恶性肿瘤后行根治术各1例,53例患者未行手术,11例患者失访。65例常规手术患者(非微创旋切术)术后病理结果：乳腺恶性肿瘤4例,乳管内乳头状瘤57例,乳腺增生4例。纤维乳管镜检查对乳管内占位性病变的检出率为57.1% (76/133),高于乳腺超声检查的24.8% (33/133)(χ²＝31.339,P<0.001),且纤维乳管镜诊断乳管内乳头状瘤的敏感度优于乳腺超声检查[93.0%(53/57)比42.1%(24/57),χ²＝33.652,P<0.001)。纤维乳管镜提示乳管内占位性病变的患者中,乳管内占位性病变出血或合并乳房包块者与未出血且无乳房包块者相比,发生恶性肿瘤的概率更高[3/13比2.3%(1/44),P＝0.034]。 结论纤维乳管镜对乳管内占位性病变的诊断具有优势,可以作为乳头溢液患者的常规检查。对于乳管内占位性病变合并乳房包块或者瘤体出血的患者,应行手术切除以明确诊断。     

Ringworm in animals in a farm in Assiut

Bericht über das Auftreten von Hautmykosen bei Tieren auf der Farm der Landwirtschaftlichen Fakultät der Universität Assiut. Von 70 Kälbern waren 42 pilzkrank, davon 22 durch T. mentagrophytes, 20 durch T. verrucosum. Von 180 Kühen waren 8 pilzbefalien, sämtlich durch T. mentagrophytes. Von 2 kranken Bullen wurde T. verrucosum isoliert. Auch die 3 Pferde und 2 Maultiere der Farm waren pilzinfiziert; Erreger war in diesen Fällen T. equinum. Auch ein Kalb war von T. equinum befallen. Die gleiche Pilzart wurde ferner von 3 Tierpflegern isoliert, die Pilzherde am Hals und an den Armen aufwiesen.     

Statistical challenges in preprocessing in microarray experiments in cancer

Many clinical studies incorporate genomic experiments to investigate the potential associations between high-dimensional molecular data and clinical outcome. A critical first step in the statistical analyses of these experiments is that the molecular data are preprocessed. This article provides an overview of preprocessing methods, including summary algorithms and quality control metrics for microarrays. Some of the ramifications and effects that preprocessing methods have on the statistical results are illustrated. The discussions are centered around a microarray experiment based on lung cancer tumor samples with survival as the clinical outcome of interest. The procedures that are presented focus on the array platform used in this study. However, many of these issues are more general and are applicable to other instruments for genome-wide investigation. The discussions here will provide insight into the statistical challenges in preprocessing microarrays used in clinical studies of cancer. These challenges should not be viewed as inconsequential nuisances but rather as important issues that need to be addressed so that informed conclusions can be drawn.     

Trends in zygomycosis in children

Zygomycosis, or mucormycosis, is associated with significant morbidity and mortality in both children and adults. Studies in adults have shown an increase in the incidence of zygomycosis, particularly among haemtopoietic stem cell transplant (HSCT) recipients and patients with haematologic malignancies. There is a paucity of data on the epidemiology of zygomycosis in children. We performed a retrospective analysis to describe trends in zygomycosis between 1 January 2003 and 31 December 2010. We used the Pediatric Health Information System (PHIS) database to identify paediatric patients who were diagnosed with zygomycosis during the study period. Administrative data on diagnoses, demographics, underlying conditions and clinical experiences were collected. Summary statistics were calculated and tests for trend were conducted. We identified 156 unique patients with zygomycosis. The prevalence of zygomycosis did not significantly increase over time (P=0.284). The most common underlying condition was malignancy (58%) and over half received intensive care. Voriconazole utilisation among all hospitalised children significantly increased during the period (P=0.010). Our study demonstrates that the incidence of zygomycosis is not significantly increasing. During the time period there was a significant increase in the use of voriconazole among children.     

Hemoglobin in lymphogranulomatosis in children

The peculiarities of hemoglobin content and properties in lymphogranulomatosis were studied in children by different methods. In most patients the content of fetal hemoglobin and methhemoglobin was found to increase and the rate of ferricyanide oxidation of hemoglobin also increases. Simultaneously, the rate of non-homogenicity of basic hemoglobin fractions was observed to increase on account of immunologically different components.     

Dermatomycosis in Goats in India

Summary: In an extensive survey involving 2176 goats 1.56% of goats manifested clinical lesions of ringworm infection. Animals below the age of 6 months were affected most (4.20%). The incidence of infection was higher during the winter months. T. verrucosum, T. mentagrophytes and M. gypseum were isolated from the skin scrapings of 12, 4, and 2 goats respectively. It is suggested that the infected animals could be a source of disease to human population in which the zoophilic dermatophyte invasion is characterized by severe inflammatory lesions of the skin. The zoonotic importance of different dermatophytes is stressed.
Zusammenfassung: In einer ausgedehnten Untersuchung an 2176 Ziegen wurden bei 1,56% klinische Zeichen einer Hautmykose festgestellt. Tiere, die jühger als 6 Monate alt waren, zeigten mit 4,20% am häfigsten Krankheitssymptome. In den Wintermonaten war die Erkrankungshäufigkeit am gröBten. T. vermcosum, T. mentagrophytes and M. gypseum wurden jeweils von 12,4 bzw. 2 Ziegen isoliert. Die inflzierten Tiere köinnen eine Infektionsquelle für die menschliche Bevölkerung darstellen und dort Mykosen mit stark entzündlichen Veränderungen auslösen. Die Bedeutung verschiedener Dermatophyten als Erreger von Zoonosen wird hervorgehoben.     

Sex hormones in women in rural China and in Britain

Plasma concentrations of certain hormones linked to breast cancer risk were measured in age-pooled samples from 3,250 rural Chinese women in 65 counties, and 300 British women, all aged 35-64. In age-groups 35-44, 45-54 and 55-64 respectively, mean oestradiol concentrations were 36% (P = 0.043), 90% (P less than 0.001) and 171% (P = 0.001) higher in the British than in the Chinese women, and mean testosterone concentrations were 48% (P less than 0.001), 68% (P less than 0.001) and 53% (P = 0.001) higher in the British than in the Chinese women. The difference in testosterone concentrations between the two countries appeared to be due largely to the lower average body weight in the Chinese women. Sex hormone binding globulin did not differ significantly between the two countries in age groups 35-44 and 45-54, but was 15% (P = 0.002) lower in the British than in the Chinese women at ages 55-64. Prolactin concentrations did not differ significantly between the two countries in any age group.     

Temozolomide treatment in glioma--experiences in two university hospitals in Finland

Thirty-two patients with relapsing glioma were treated with temozolomide in two university hospitals in Finland. One patient (3%) had complete response and 9 (28%) partial response, with 8 patients (25%) showing stable disease. Median progression-free survival for these 18 patients (56%) was 7 months (range 2-11+). The remaining either had progressive disease (25%) or only clinical evaluation (19%). Karnofsky score improved in 34% of patients and decreased in 3%. Symptoms were alleviated in 44% and deteriorated in 9%. Grade 3-4 toxicity was detected in 9% of the patients. Only 4% of the days in treatment were spent in hospital. An average 1.8 neuroradiological investigations, 6.9 laboratory visits, and 5.3 visits to the oncologist were made. This study confirms that temozolomide has positive effects on the outcome of often heavily pretreated glioma patients. High drug costs are compensated by prolonged home care and even the possibility to maintain working capacity.