肿瘤整形技术在保乳手术中的应用与进展

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.     

保乳手术经常遇到的几个问题

早期乳腺癌外科治疗由切除乳房到保留乳房，是源于治疗观念的转变，是由以局部解剖为基础，单一追求外科“根治”，转向以肿瘤生物学特性为指导的个体化保乳综合治疗，兼顾了疗效和生活质量。保乳手术自20世纪80年代一路走来，现已成为欧、美国家早期乳腺癌的首选术式。乳腺癌的保乳治疗在中国尚未普遍开展，主要原因是观念未能及时转变，顾虑较多；     

早期乳腺癌保乳术的围手术期护理

乳腺癌是女性最常见恶性肿瘤之一,全球范围内均为高发,且呈逐渐上升趋势,是严重危害女性健康的重大杀手。随着乳腺癌手术治疗的进步及物质生活水平的不断提高,乳腺癌患者不仅要求疾病得到治疗,而且还希望尽可能保留乳房外形,乳腺癌保留乳房手术已经是乳腺癌外科治疗的标准手术。2005年10月～2010年8月我院为18例早期乳腺癌施行了保乳手术,乳腺癌保乳术是通过保留乳腺及术后化     

乳腺癌保乳手术的年龄与切缘

随着乳腺癌治疗更加人性化、规范化、个体化,保乳手术必将成为我国早期乳腺癌外科的首选术式。本文就保乳术后局部复发风险的两个相关因素一患者年龄和保乳手术的安全切缘谈一点意见,供参考。     

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自20世纪80年代乳腺癌保留乳房(保乳)手术进入外科医生的视野以来,保乳手术在乳腺癌的手术治疗方面占有越来越重要的地位.随着对其应用的日益广泛,关于保乳手术安全性和远期疗效的探讨也在逐渐深入.     

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。     

乳腺癌外科治疗十大热点

外科治疗是乳腺癌最主要的治疗手段，近年来随着乳腺癌的全身治疗的不断发展，乳腺癌的外科治疗理念也在发生变化，包括导管原位癌的外科治疗策略、前哨淋巴结微转移或宏转移的腋窝处理策略、新辅助治疗后的前哨淋巴结活检和保乳的安全性、新辅助治疗后手术时机的选择、年轻乳腺癌的外科治疗、Ⅳ期乳腺癌的手术治疗、植入物乳房重建的放疗时机等，面对这些问题，乳腺外科医生往往存在困惑，本文结合近年来乳腺癌外科治疗领域的最新进展及国内外指南，对困惑着乳腺外科医生的乳腺癌外科治疗十大热点问题进行总结，使乳腺癌的外科治疗更加规范化、个体化。     

早期乳腺癌保乳综合治疗临床疗效观察

目的:探讨早期乳腺癌保乳综合治疗的临床治疗效果和对乳房美容效果的影响.方法:回顾分析32例早期乳腺癌患者的临床资料,所有病例均经病理证实,择期在全身麻醉下行保乳手术,术后辅助放疗、化疗及内分泌治疗,评价手术疗效及美容效果.结果:32例保乳术患者均成功进行了手术,术后预后良好,随访5年,无一例死亡,无一例局部复发或出现远处转移,保乳手术后患者美容效果满意率为86.57%.结论:早期乳腺癌患者行保乳综合治疗,临床效果确切可靠,并取得满意的美容效果.     

乳腺癌的微创治疗必须遵循循证医学的法则

20世纪80年代以来，早期乳腺癌保乳治疗获得了与根治术相同的临床疗效和良好的乳房美容效果，极大地提高了患者的生存质量。当今，保乳术已成为西方国家早期乳腺癌的标准术式，欧美早期乳腺癌保乳率已达50％～80％。保乳治疗是乳腺癌外科治疗中的标志性里程碑。前哨淋巴结活检为近年来乳腺外科研究领域中的又一热点，     

乳腺癌的手术治疗进展

乳腺癌是女性最常见的恶性肿瘤之一，近年来发病率逐年递增，同时还出现年轻化的趋势。手术治疗是乳腺癌的主要治疗方法之一，目前乳腺癌外科术式趋向于逐渐保守的方式，而其术后施行有计划的综合治疗变得愈来愈突出和重要。本文就乳腺癌治疗的演变、保乳治疗及术后复发等方面综述。     

乳腺癌手术治疗百年历史回顾与启示

自有记载以来,乳腺癌的治疗就是以局部治疗为主,特别是自1894年Halsted首创乳腺癌根治术后,该手术一直是乳腺癌治疗的核心术式,之后从扩大根治术到改良根治术,临床医生均遵循在无瘤切除的基础上以未恶化为标准的操作。Fisher团队提出乳腺癌为全身性疾病的概念后,乳腺癌的局部治疗向更小的操作范围发展,保留乳房的肿瘤局部切除加放疗成为可能,并延续至今。目前,以前哨淋巴结活检来判定是否行腋窝淋巴清扫的方法亦获得业内认可。经历百余年的发展,虽然乳腺外科手术治疗仍未能明显改善乳腺癌病人的预后,但对改善病人生活质量意义重大。随着全身系统治疗的迅速发展,乳腺癌的治疗趋势出现逆转。手术对局部控制的重要地位似乎被动摇,内分泌治疗与靶向治疗的强化,细胞毒药物的进一步优化,使乳腺癌的预后更依赖于全身治疗,放疗的进展亦影响手术的局部控制,特别是对腋窝淋巴结阳性的病人。在群体化医疗向个体化医疗转化,追求精准医疗的时代,分子分型指导系统治疗成为可能,然而其指导手术治疗尚未获得证据支持。因此,无瘤切除的理念尚不能改变,推荐最优生存结果的手术方式,发掘更优化的手术与系统治疗的组合势在必行。     

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??Centennial review and enlightenment of breast cancer surgery DUAN Xue-ning.Breast Disease Center,Peking University First Hospital,Beijing 100034,China
Abstract The treatment of breast cancer is mainly based on local therapy since its record. In particular, since 1894 Halsted pioneered radical mastectomy, surgery has always been at the heart of breast cancer treatment. From the attempt of extended radical resection to the advent of modified radical mastectomy, all patients were treated on the basis of tumor free resection, with the prognosis of patients who did not deteriorate. After the Fisher team put forward the concept of breast cancer as a systemic disease, local treatment of breast cancer is developing towards a narrower operation. Local excision and radiotherapy for breast conserving became feasible. Depending on status of sentinel lymph node to determine whether to carry out axillary clearance has also been recognized in this century. Over the past hundred years, surgical treatment has not significantly improved the prognosis of breast cancer, but has improved the quality of life. With the rapid development of systemic therapy, the trend of breast cancer treatment has been reversed. The importance of operation to local control seems to be shaken. The enhancement of endocrine therapy and target therapy, the further optimization of cytotoxic drugs make the prognosis of breast cancer more dependent on the whole body treatment, and the progress of radiotherapy also affects the status of the partial operation control, especially the presence of positive axillary nodes. In the age of group medical treatment to individualized medical treatment and the pursuit of precision medical treatment, molecular subtypes guidance systematic therapy is feasible, and the guidance of surgical treatment has not been supported by evidence. Therefore, the idea of tumor free resection cannot be changed. It is necessary to recommend the best way of operation to improve survival, and to find a better combination of surgery and systematic therapy.     

腹腔镜卵巢切除术在绝经前乳腺癌辅助治疗中的应用(附21例报告)

目的:探讨腹腔镜卵巢去势术辅助治疗绝经前乳腺癌的应用价值。方法:应用腹腔镜施行卵巢去势术21例,主要用于辅助治疗绝经前乳腺癌患者。结果:术后患者均恢复良好,未发生手术并发症,术后第2天均自行肛门排气。结论:对部分无法行药物性卵巢去势的患者,腹腔镜卵巢去势术是很好的选择。     

The Diagnosis and Treatment of Ductal Carcinoma In Situ of the Breast

Abstract: Ductal carcinoma in situ of the breast is the most favorable presentation of breast cancer; therefore appropriate local treatment is imperative. Intraductal carcinoma is being diagnosed more frequently with the increasing use of screening mammography. A number of pathologic features have been identified which are useful for classification and for prognostic information. In addition, the molecular pathology and its relationship to tumor behavior and prognosis is becoming more well understood. The role of axillary dissection has been examined in a number of series and is generally agreed to be unnecessary for this presentation of breast cancer, allowing many women to avoid the sequela of axillary surgery. This review discusses the use of breast conservation treatment and the evolving indications for excision alone in the treatment of ductal carcinoma in situ. The outcomes for breast conservation therapy from both randomized trials and institutional series have confirmed excellent survival rates. Salvage therapy for local recurrence is frequently successful, resulting in nearly equivalent survivals in women undergoing breast conservation therapy compared to mastectomy. In addition, intriguing but preliminary results from both breast cancer prevention studies and trials looking at the use of tamoxifen for intraductal cancer suggest a local control benefit in women using the drug.     

HER2阳性早期乳腺癌治疗年度进展

临床治疗指南推荐曲妥珠单抗作为HER2+早期乳腺癌的标准辅助治疗手段之一。在此基础之上,研究者继续尝试新的突破:一方面部分研究者试图通过双靶向治疗、延长用药期限等手段,进一步降低HER2+早期乳腺癌复发率;另一方面,其他研究者也在尝试缩短靶向治疗时间、减少传统化疗药物的使用等,以减少不必要的治疗及其带来的毒副作用。本文将对近期大型临床研究结果进行总结,围绕四个关于早期乳腺癌抗HER2辅助治疗的热点问题:HER2低表达患者是否需要抗HER2治疗?能否缩短抗HER2治疗的疗程?是否需要加强HER2+早期乳腺癌的靶向治疗?是否可以减少化疗药物的使用?为临床医生合理选择抗HER2靶向治疗提供参考。     

Neo-adjuvant hormonal therapy

Abstract:  Neo-adjuvant endocrine therapy has opened new alternatives for locally advanced breast cancer. Such therapy, which has permitted us to expand the treatment role of neo-adjuvant therapies, may be of great benefit to patient groups such as the elderly, those not suited for chemotherapy, and those whose response may not be optimal. This therapy also may be able to help us identify agents that could improve outcomes in the adjuvant setting as well as possible biologic predictors for outcome. The latest generation of endocrine therapy for breast cancer, aromatase inhibitors, has proved superior to tamoxifen in terms of toxicity and efficacy in the adjuvant setting and is currently being studied in other clinical trials. Current findings indicate that these agents are less toxic and better tolerated than neo-adjuvant chemotherapy and that third-generation anti-hormomal therapy offers improved tumor response compared with tamoxifen, which has resulted in increased breast conserving surgery. Biomarker findings of improved response in tumors that are both estrogen receptor positive and HER-2 positive as well as progesterone receptor positivity only will be important for planning future selective treatment and clinical trials.     

乳腺癌肝转移特征及诊疗

乳腺癌发病人数逐年攀升,相较于其他部位转移的患者,乳腺癌肝转移患者通常预后较差.目前国内外尚无针对乳腺癌肝转移诊疗的指南.本文旨在为乳腺癌肝转移的临床诊疗提供一定的思路和依据.本文对乳腺癌肝转移临床特点、发病机制的研究现状与治疗进展进行综述.早期肝转移患者往往没有明显症状或体征,考虑肝转移的患者最好行影像学引导下穿刺确...     

Current status of hormone therapy in patients with hormone receptor positive (HR+) advanced breast cancer

The natural history of HR+ breast cancer tends to be different from hormone receptor-negative disease in terms of time to recurrence, site of recurrence and overall aggressiveness of the disease.The developmental strategies of hormone therapy for the treatment of breast cancer have led to the classes of selective estrogen receptor modulators, selective estrogen receptor downregulators, and aromatase inhibitors. These therapeutic options have improved breast cancer outcomes in the metastatic setting, thereby delaying the need for chemotherapy.However, a subset of hormone receptor-positive breast cancers do not benefit from endocrine therapy (intrinsic resistance), and all HR+ metastatic breast cancers ultimately develop resistance to hormonal therapies (acquired resistance). Considering the multiple pathways involved in the HR network, targeting other components of pathologically activated intracellular signaling in breast cancer may prove to be a new direction in clinical research.This review focuses on current and emerging treatments for HR+ metastatic breast cancer.     

HER-2阳性乳腺癌靶向治疗进展

人类表皮生长因子受体-2（HER-2）阳性乳腺癌的诊治近年来一直是乳腺癌领域的研究热点,抗HER-2靶向治疗是HER-2阳性乳腺癌的标准治疗手段,单克隆抗体类靶向药物曲妥珠单克隆抗体的临床应用显著改善了HER-2阳性乳腺癌病人的预后。此外同类型靶向药物帕妥珠单克隆抗体、小分子靶向药物酪氨酸激酶抑制剂、抗体⁃药物偶联物等抗HER-2新药的相关研究也进展迅速,无论在辅助治疗、新辅助治疗还是晚期乳腺癌治疗方面均显示了巨大的临床应用前景,有助于进一步提升HER-2阳性乳腺癌病人的疗效。     

95例乳腺癌保乳治疗近期观察

目的探讨乳腺癌保乳治疗的方法与疗效。方法95例Ⅰ-Ⅱ期原发性乳腺癌,施行局部扩大切除并腋窝淋巴结清扫,手术后患侧乳房接受放射治疗。结果手术后6个月随访,患者本人对保留乳房的满意率100％,十分满意者为92％。经随访2～51个月,平均随访17个月,仅1例同侧乳腺局部复发,2年局部复发率1．4％。无远处转移和死亡病例。结论Ⅰ-Ⅱ期乳腺癌实施保乳治疗,近期疗效满意,远期效果有待长期随访观察。