改良扩大根治术治疗乳癌的临床应用

目的　探讨改良扩大根治术治疗乳癌的可行性及合理性。方法　对 1994～ 1997年间施行改良扩大根治术的 2 0例乳癌病人的临床资料进行回顾性分析。结果　 2 0例中 ,单纯癌 10例 ,浸润性导管癌 8例 ,髓样癌 2例 ;2 0例中有胸骨旁淋巴结转移 6例。未出现液气胸等并发症 ,随访效果满意。结论　乳癌改良扩大根治术理论上合理 ,在严格掌握手术适应证的前提下是安全、可行的。     

乳癌的外科治疗

目的　探讨乳癌外科治疗的策略。方法　回顾性分析 2 5 8例乳癌的临床资料。结果　 (1)13 6例Ⅰ～Ⅱ期患者行改良根治术 ,总生存率为 10 0 % ,无复发生存率为 92 .6%。 (2 )保留乳房的乳癌手术 2例 ,1例 (5 0 % )术后 5个月局部复发。 (3 )Ⅲ期乳癌行改良根治术 88例 ,行根治术 2 0例 ,两者的无瘤生存率与总生存率差异无显著性。 (4 )Ⅳ期患者有 5例行根治性手术 ,取得了较好的效果。 (5 )采用特制乳腺刀游离皮瓣和电刀切除 ,并合理清扫腋窝 ,手术输血率为 3 .5 %。局部并发症有术后皮下积血 2 .7% ,皮瓣坏死 7.4% ,皮下积液 18.6% ,患侧肢体水肿 4.3 %。结论　改良根治术是治疗Ⅰ～Ⅲ期乳癌的主要术式 ,乳腺刀和电刀的使用 ,可以减少手术输血 ,缩短手术时间 ;合理的腋窝清扫可以减少患侧肢体水肿的发生。     

根治术与改良根治术治疗早期乳腺癌的疗效比较

目的比较根治术与改良根治术治疗早期乳腺癌的疗效。方法回顾性分析Ⅰ、Ⅱ期乳腺癌患者行根治术者60例,改良根治术者84例的临床资料。结果改良组术后胸壁形态、患肢功能、患肢肿胀、皮瓣坏死的发生率均优于根治术组(P<0.05)。改良根治术组5年生存率Ⅰ期97.3%,Ⅱ期95.5%,根治术组5年生存率Ⅰ期95.7%,Ⅱ期94.3%,两组比较无明显差异(P>0.05)。结论采用改良根治术治疗乳腺癌生存率与根治术无异,但可明显提高患者生存质量。     

保乳术中癌及切缘组织中IDO的表达与T细胞和MVD表达的临床意义

目的探讨保乳术中癌组织、切缘组织中吲哚胺2,3-双加氧酶(IDO)的表达与调节性T细胞(Tregs)、新生血管微血管密度(MVD)表达的关系及与患者预后的关系。方法选取2008年至2011年收集的63例保乳术患者癌组织、切缘组织60例及正常乳腺组织标本30例,采用免疫组织化学法检测三组标本中IDO、Tregs、CD105标记的MVD(MVD-CD105)表达情况,数据分析在SAS 9.3软件包中处理,乳腺组织中IDO、MVD-CD105、Tregs阳性着色指数采用均数±标准差(x珋±s)表示,采用方差分析;IDO、MVD-CD105、Tregs阳性表达率、生存率比较采用卡方检验;相关性分析采用Pearson分析法;P0.05表示差异具有统计学意义。结果乳腺癌组织中IDO、MVD-CD105、Tregs阳性表达率均显著的高于切缘组织和正常乳腺组织(P0.05)。乳腺癌组织中的IDO阳性着色指数与MVD-CD105、Tregs阳性着色指数呈显著的正相关关系(P0.05)。乳腺癌组织中IDO阳性表达患者的5年总生存率71.11%显著的低于阴性患者的94.44%,差异有统计学意义(χ~2=4.050,P0.05)。结论乳腺癌组织中IDO表达水平显著的增高,并且与MVD形成有关,与患者的预后不良有一定的关系。     

骨肿瘤,骨转移癌患者免疫功能变化及临床意义

对６２例骨肿瘤、骨转移癌患者外周血中Ｔ淋巴细胞亚群（ＰＴＬＳ）、淋巴细胞转化率（ＬＴＲ）的变化进行研究。结果显示：骨肿瘤患者外周血中全Ｔ淋巴细胞（ＣＤ３＋）及辅助／诱导性Ｔ细胞（ＣＤ４＋）较对照组明显降低，抑制／细胞毒性Ｔ细胞（ＣＤ８＋）无明显变化，ＣＤ４＋／ＣＤ８＋比率显著下降，以恶性骨肿瘤组降低最明显。骨转移癌患者呈类似变化。淋巴细胞转化率，骨肿瘤、骨转移癌组显著低于正常组。证明患者的免疫功能变化与骨肿瘤的存在、发展密切相关。此外，观察了恶性骨肿瘤患者手术前后ＰＴＬＳ变化，术后ＣＤ３＋、ＣＤ４＋、ＣＤ８＋恢复正常水平，ＣＤ４＋／ＣＤ８＋比率升高。随访观察结果亦表明ＬＴＲ、ＣＤ３＋、ＣＤ４＋持续降低，ＣＤ４＋／ＣＤ８＋比率倒置的患者预后较差。提示动态观察恶性骨肿瘤患者外周血中Ｔ淋巴细胞及其亚群、淋巴细胞转化率的变化有助于判断预后。     

早期乳腺癌保乳手术与改良根治术远期疗效的比较

为探讨乳腺癌保乳手术与改良根治术远期疗效的差别。笔者回顾性分析了43例行保乳手术以及57例行改良根治术的乳腺癌患者的临床资料，对其5年疗效的差别作出评估。结果示保乳手术组5年生存率为 95.2%,根治术组为94.3%，差异无显著性（P>0.05）。提示保乳手术与改良根治术对于治疗早期乳腺癌的远期疗效相当，而保乳手术使患者保持良好的乳腺外观，可在早期乳腺癌的治疗中予以推广。     

II,III期乳腺癌行根治术与扩大根治术的疗效评价:附691例报告

目的　探讨乳腺癌根治术与扩大根治术治疗II ,III期乳腺癌的疗效。方法　回顾性分析691例II ,III期乳腺癌的两种手术方法治疗后的 5年和 10年生存率。 691例乳腺癌中II期行根治术 2 0 6例 ,行扩大根治术 14 2例 ;III期行根治术 193例 ,行扩大根治术 15 0例。结果　癌灶位于中央区及内乳区行扩大根治术的II ,III期患者的 5年生存率和III期的 10年生存率显著高于根治术患者 (均P <0 .0 1)。癌灶位于外上象限行扩大根治术的II ,III期患者 10年生存率和III期患者的 5年生存率亦显著高于根治术患者 (均 P <0 .0 5 )。结论　提示II ,III期乳腺癌病灶位于中央区及内乳区的患者、位于外上象限的III期患者应考虑行扩大根治术。     

改良根治术与保乳手术治疗早期乳腺癌患者的近远期疗效对照比较

目的比较改良根治术与保乳手术治疗早期乳腺癌患者的近远期疗效。 方法收集2011年6月至2014年1月早期乳腺癌的患者134例,采用随机数字表法将其分为根治组与保乳组,分别采用改良根治术与保乳手术进行治疗,采用SPSS19.0软件进行分析,术中术后指标和生活质量评分采用均数±标准差进行描述,采用独立t检验;1年和3年总生存率和无病生存率、并发症采用率进行描述,采用χ²检验;采用log－rank检验法对两组患者的生存率进行检验,检验水准为α＝0.05。 结果根治组患者术中的平均出血量低于保乳组,且手术时间和术后的平均住院天数均少于保乳组,根治组患者的生理职能和精神健康得分低于保乳组,差异均具有统计学意义(P<0.05);根治组患者的3年无病生存率和3年总生存率均高于保乳组(P<0.05);根治组患者的腋窝淋巴结转移率低于保乳组,差异具有统计学意义(P<0.05)。 结论改良根治术治疗早期乳腺癌患者的近期疗效和远期疗效均优于保乳手术,腋窝淋巴结的转移率低于保乳手术,更为安全有效,推荐在临床上使用。     

保乳术和改良根治术治疗年轻早期乳腺癌的疗效观察

目的探讨保乳手术和改良根治术治疗年轻早期乳腺癌的疗效对比研究。方法自2011年1月至2013年6月间70例年轻早期乳腺癌分为两组,保乳手术组(保乳组)和改良根治组(根治组),每组35例,对手术近期和远期疗效进行回顾性分析。采用SPSS13.0统计软件分析,手术时间、术中出血量、住院时间组间用t检验;术后生存率、局部复发率和远处转移率等用χ2检验,P<0.05为差异有统计学意义。结果保乳组的2年和5年生存率、局部复发率和远处转移率为100%、100%;0、11.4%;0、2.86%。根治组为100%、97.1%;0、8.57%;0、5.71%。两组比较差异均无统计学意义P>0.05。保乳组的手术时间、出血量、住院时间、并发症、上肢功能受限、形体美观、病员满意度为(95±22)min、(105±30)ml、(23.5±4.5)d、5.71%、2.8%、77.1%和94.3%,根治组为(145±28)min、(225±45)ml、(34.5±4.0)d、25.7%、20.0%、31.4%和48.6%;两组比较差异均有统计学意义,P<0.05,保乳组优于根治组。结论对年轻早期乳腺癌采用保乳手术联合综合治疗,具有操作简便、创伤小、恢复快,复发低、外观美容等优点,能显著提高患者的生活质量、不影响生存时间。     

Ⅰ～Ⅱ期乳腺癌患者机体细胞免疫功能变化的临床意义

目的 探讨早期乳腺癌的机体细胞免疫功能以及改良根治术和术后早期化疗对其的影响。方法 采集30名乳腺良性肿瘤患者和30名Ⅰ～Ⅱ期乳腺癌患者抗凝全血,测定外周血中T淋巴细胞亚群及NK细胞。乳腺癌患者术后5天开始给予化疗,持续5天。结果 ①乳腺癌与乳腺良性肿瘤患者术前 CD3~ 、CD4~ 、CD8~ 、CD4~ CD45~ 、CD8~ CD28~ 、NK和 CD4~ /CD8~ 比率均在正常范围,两组比较无显著差异(P>0.05),CD8~ CD28~-细胞百分比乳腺癌组高于良性肿瘤组,有显著性差异(P<0.05)。②术后5天,CD4~ 、CD4~ /CD8~ 、CD4~ CD45~ 、CD8~ CD28~ 高于术前,NK、CD3~ 、CD8~ 、CD4~ CD29~ 、CD8~ CD28~-略低于术前。③化疗前后,各项指标无显著性差异;术前与化疗前、化疗后各组相比,CD8~ CD28~-差异显著(P<0.05)。结论早期乳腺癌患者机体免疫系统紊乱不严重,施行乳腺癌改良根治术及术后早期化疗对患者机体免疫功能影响不显著。     

Sentinel lymph node biopsy performed with local anesthesia in patients with early-stage breast carcinoma

HYPOTHESIS: Sentinel lymph node (SN) biopsy performed with local anesthesia has a positive effect on patients' quality of life and on treatment management for early-stage breast carcinoma. This method represents an interesting development in breast-conserving surgery. DESIGN: We performed SN biopsy with local anesthesia in selected patients to test the feasibility of the technique and its impact on our organization and on patients' quality of life. PATIENTS AND METHODS: From September 2000 to December 2001, we studied 115 patients with a palpable breast tumor (maximum diameter, 2.5 cm). The axilla was clinically negative for metastasis in all cases. RESULTS: Forty-eight patients (41.7%) had SNs that were positive for metastasis. In 20 cases (17.4%), the SN was macrometastatic and in 28 cases (24.3%), it was micrometastatic (diameter <2 mm). The SN was negative for metastasis in 66 cases (57.4%). In 1 case, the histologic examination revealed the presence of a non-Hodgkin B-cell lymphoma. The complete axillary dissection performed in the subgroup of patients with macrometastatic SNs showed that in 9 cases (45%), the SN was the only positive node. In another 9 cases (45%), patients had fewer than 4 positive axillary lymph nodes; more than 4 axillary nodes were metastatic in 2 cases (10%). Among the 28 patients with SN micrometastasis, 21 received complete axillary dissection: 15 patients (53.6%) had no other metastasis to the axillary nodes and 6 patients (21.4%) had cancer cells in other axillary nodes. In case of micrometastasis, we suggested that patients enter the International Breast Cancer Study Group 2301 trial (15 of them accepted and signed the informed consent), which compared completion of axillary dissection with no further surgical treatment of the axilla. Based on randomization, 7 patients (25%) in the group with micrometastasis to the SN received no axillary dissection. Patients' tolerance to this kind of treatment was excellent. CONCLUSION: Our experience indicates that SN biopsy performed with local anesthesia can be a suitable alternative to standard intraoperative evaluation with general anesthesia in patients with unifocal, early-stage breast carcinoma.     

Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy

BACKGROUND: Patients receiving breast conservation therapy have a lifelong risk of local recurrence. To minimize this risk, surgeons have explored various approaches to examining the surgical margins of the resection specimen. If tumor cells are found at the margin, there is a high probability that residual tumor remains in the surgical cavity. This review examines published reports about standard and innovative approaches to assessing surgical margins, the clinical significance of margin size, and risk factors for positive margins. METHODS: Published literature abstracted in Medline was reviewed using the Gateway site from the National Library of Medicine. CONCLUSIONS: It is still not clear whether obtaining a radical margin will decrease the rate of local recurrence after breast conserving surgery. What is clear is that it is absolutely unacceptable to have tumor cells directly at the cut edge of the excised specimen, regardless of the type of post-surgical adjuvant therapy.     

Mapping sentinel nodes in patients with early-stage gastric carcinoma

BACKGROUND: Nodal status in gastric carcinoma is related not only to prognosis but also to the extent of nodal dissection. However, a method for accurate assessment of nodal status during operation has not been established. This study aimed to map the sentinel nodes of gastric carcinoma and to estimate the clinical usefulness of sentinel node biopsy. METHODS: Following laparotomy, a vital dye (0.2 ml 2 per cent patent blue) was injected through a gastroscope into the submucosal layer at four sites around a clinical T1 gastric carcinoma. The dye immediately appeared at the serosal surface and stained lymphatic vessels and nodes. The stained nodes were removed and examined by frozen sectioning. RESULTS: The assay was successful in mapping the lymphatic basins in 203 (96.2 per cent) of 211 patients. The dye stained one or more metastatic nodes in 31 patients, but failed to indicate a metastatic node in four patients with a large involved node. Meticulous postoperative examination of all resected nodes in the standard paraffin slices revealed no new metastases. The accuracy of the assay was 98.0 per cent. CONCLUSION: The method was accurate in predicting nodal status in patients with early-stage gastric carcinoma.     

Reassessing the role of axillary lymph-node dissection in patients with early-stage breast cancer.

INTRODUCTION: There is considerable controversy regarding the value of axillary lymph-node dissection in the adjuvant systemic therapy of patients with early-stage breast cancer. Our objective was to assess the impact of nodal status in assigning adjuvant chemotherapy to these patients. METHODS: We carried out a review of all patients with stage I or II breast cancer treated at 3 university-affiliated hospitals in Saskatoon between Jan. 1, 1998, and Dec. 31, 2000. Data collected included: patient age, sex, tumour size, hormone receptor status, nuclear grade and presence of lymphovascular invasion. Patients were categorized as being at low, high or intermediate risk for recurrence based on Canadian consensus guidelines and at low or high risk according to criteria established by the United States National Institutes of Health (NIH). The influence of nodal status on subsequent treatment was determined assuming that all patients younger than 70 years at high risk of recurrence would receive chemotherapy. RESULTS: We identified 327 women with stage I or II breast cancer in whom all prognostic factors were available for analysis. Applying the Canadian criteria to determine the need for adjuvant chemotherapy, 68% of women would receive chemotherapy regardless of lymph-node status. Applying the NIH criteria, 82.5% of women younger than 70 years would receive adjuvant chemotherapy regardless of nodal status. CONCLUSIONS: Nodal status has little influence on subsequent management. Adoption of a selective approach to axillary lymph-node dissection could avoid the potential morbidities of this procedure in many patients with early-stage breast cancer.     

Breast-conservation therapy in early-stage breast cancer patients with a positive family history

Background Our goal was to evaluate the role of breast-conservation therapy in early-stage breast cancer patients with a family history (FH) of breast cancer. Methods Between 1970 and 1994, 1324 female patients with breast cancer were treated with breast-conservation therapy at our institution. From these, we identified 985 patients with stage 0–II breast cancer and who had available information on FH status. FH was considered positive in any patient who had a relative who had been previously diagnosed with breast cancer. Disease-specific survival was calculated from the date of initial diagnosis using the Kaplan-Meier method. Results The stage distribution for the 985 patients was as follows: 0 in 65 (7%), I in 500 (51%), and II in 420 (43%). The median age was 50 years (range, 21–88), with a median follow-up time of 8.8 years (range, .25–29). The median tumor size was 1.5 cm. FH was positive in 31%. There were no significant differences in locoregional recurrence, distant recurrence, disease-specific survival, or incidence of contralateral breast cancer in patients with a positive FH versus patients with a negative FH. Conclusions Breast-conservation therapy is not contraindicated in early-stage breast cancer patients with a positive FH.     

Longterm outcomes of early-stage gastric carcinoma patients treated with laparoscopy-assisted surgery

BACKGROUND: Laparoscopy-assisted approaches have become popular for dissecting early-stage gastric cancer in Japan, but the outcomes after 5 years of followup have not been reported. STUDY DESIGN: Between January 1998 and March 2002, 94 patients with histologically proved early-stage gastric carcinoma participated in clinical studies and underwent gastrectomy with regional lymphadenectomy to evaluate feasibility and safety of the laparoscopy-assisted approach. Outcomes and pattern of disease failure during followup up to 5 years were evaluated in all patients. Multivariable analysis was performed to identify relevant prognostic factors. RESULTS: Conversion to open procedures occurred in three patients. Median blood loss was 90 mL (interquartile range, 160 mL), and duration of operation was 230 minutes (interquartile range, 60 minutes). Operative morbidity and mortality were 22.3% and 0%, respectively. Nine patients died during the course of followup, for an overall 5-year survival rate of 90%. Two patients died of recurrent disease, and 2 other patients have been diagnosed with recurrences, for a 5-year recurrence-free survival of 95.6%. Three patients with recurrent cancer, including 1 with port-site recurrence, had stage IA disease (pT1pN0) at operation. Diabetes mellitus as a comorbidity was prominent as a prognostic factor. CONCLUSIONS: Outcomes of patients with a preoperative diagnosis of early-stage cancer were excellent when treated with a laparoscopy-assisted approach, although rare patterns of disease failure were observed.     

膀胱癌患者红细胞免疫功能变化的观察

为了观察膀胱癌患者红细胞免疫功能的变化状况，对４１例膀胱癌患者（观察组）红细胞免疫功能和血清循环免疫复合物进行检测，并且与５５例健康对照组进行比较，结果观察组红细胞Ｃ３ｂ受体花环率（ＲＣＲ）明显低于健康对照组，而红细胞免疫复合物花环率（ＲＣＩＲ）明显增高，血清循环免疫复合物（ＣＩＣ）含量亦明显高于健康对照组（均Ｐ〈０．０１），Ｔ１－２期膀胱癌患者ＲＣＲ水平低于Ｔ３－４膀胱癌患者，而ＲＩＣＲ水平则明