超声刀对乳腺癌改良根治术患者疗效的影响

目的探讨超声刀对乳腺癌改良根治术患者疗效的影响。方法选取146例乳腺癌患者,按照随机数字表法随机分为对照组73例和观察组73例。手术方式均为改良根治术,对照组使用电刀清扫腋窝淋巴结,观察组使用超声刀清扫腋窝淋巴结。比较两组患者的手术时间、术中出血量、淋巴结清扫数量、术后总引流量、术后拔引流管时间、伤口愈合时间、总住院时间及术后7天内并发症(皮下积液、皮瓣坏死、术后出血)的发生情况。结果两组患者的淋巴结清扫数量比较,差异无统计学意义(P﹥0.05);观察组患者的术中出血量、术后总引流量明显少于对照组(P﹤0.01),手术时间、术后拔引流管时间、伤口愈合时间、总住院时间均明显短于对照组(P﹤0.01);观察组患者术后皮下积液、皮瓣坏死、术后出血的发生率均低于对照组(P﹤0.05)。结论与使用电刀比较,乳腺癌改良根治术中使用超声刀清扫腋窝淋巴结,可缩短手术时间,降低术中出血量、术后总引流量及皮下积液等并发症的发生率,值得临床推广使用。     

早期乳腺癌外科手术方式的选择

目的分析早期乳腺癌的手术方法。方法将79例早期乳腺癌病人随机分为2组，一组病人施行根治术，另一组施行简化根治术。随访5年，比较两组病人术后并发症和局部复发率与生存率，结果早期乳腺癌根治术和简化根治术两组病例术后5年生存率及局部复发率无统计差异，而根治术术后并发症显著增多。结论早期乳腺癌首选简化根治术。     

乳腺癌改良根治术217例随访分析

Modified radical mastectomy (MRM) was performed in two hundred and seventeen patients with operable breast cancer during 1972-1982. Having been followed for 5 to 10 years, the results were compared with those of radical mastectomy (RM) during the same period. There was no significant difference in 5 and 10 year survival rates between the two groups. MRM had the advantages of insignificant deformity, better function and easy breast reconstruction in comparison with RM. The authors believe that MRM should be recommended as the treatment of choice for breast cancer.     

不同手术方式对乳腺癌患者生活质量的影响

目的 本研究是为了比较乳癌改良根治术及保乳手术对乳腺癌患者术后生活质量的影响,进而提高患者的生活质量.方法 选取符合条件的患者110例,其中改良根治术65例,保乳手术55例.从患者的生理领域、心理领域、社会关系领域、环境领域四个方面进行问卷调查,评估乳癌改良根治术和保乳手术两种术式对乳腺癌患者术后生活质量的影响.结果 不同术式等对乳腺癌患者各领域的影响当中,尤其对心理领域和生理领域两方面影响比较显著具有统计学意义(P《0.05),而对社会领域和环境领域两方面影响没有明显的统计学意义(P》0.05).结论 保乳手术患者在术后生活质量当中心理领域和生理领域两方面优于根治改良术患者,但在社会领域和环境领域两个方面两种手术方式对患者没有显著区别,其中社会领域包括个人关系、所需社会支持的满足程度和性生活,虽然保乳手术患者在术后性生活质量优于改良根治术,但是由于两种术式对社会领域前两个方面(个人关系、所需社会支持的满足程度)的影响没有区别,从而抵消了其对性生活的影响.     

术后放疗对T1-T2期乳腺癌患者预后的影响

目的:探讨术后放疗对T1-T2期伴有1～3个腋淋巴结转移、腋窝淋巴结清除相对彻底的乳腺癌患者的疗效及其对预后的影响。方法:选择2009年8月1日-2012年1月15日上海交通大学附属第六人民医院收治的185例T1-T2期伴有1～3个腋淋巴结转移的乳腺癌患者为研究对象,分为研究组(n＝93)和对照组(n＝92)。对照组行乳腺癌改良根治术以及腋窝淋巴结清除术,研究组在此基础上行放疗。观察两组患者1、2、3年总生存率、无病生存率,并分析影响预后的独立危险因素。结果:研究组1、2、3年总生存率分别为97.83%、96.74%、89.13%,与对照组相比,差异无统计学意义(P＝0.235 6,P＝0.181 2,P＝0.128 1);研究组1、2、3年无病生存率分别为94.57%、92.39%、89.13%,显著高于对照组(P＝0.041 8,P＝0.039 0,P＝0.039 0);单因素分析表明患者术后无病生存率可能与肿瘤分期、腋窝淋巴结转移数、PR、放疗与否有关,而与患者年龄、ER、月经状态无关,进一步Cox回归分析显示腋窝淋巴结转移数(P＝0.046)、放疗与否(P＝0.012)是影响无病生存率的独立预后因素。结论:术后放疗可提高T1-T2期伴有1～3个腋淋巴结转移的乳腺癌患者无病生存率,腋窝淋巴结转移以及放疗与否是影响患者预后的独立危险因素。     

加速康复外科理念对乳腺癌改良根治术患者术后恢复的影响

目的 探讨加速康复外科理念在乳腺癌改良根治术后恢复的作用.方法 选取2018年2月至2019年4月间陕西省肿瘤医院收治的90例乳腺癌患者,采用随机数字表法分为研究组和对照组,每组45例,均采用乳腺癌改良根治术.观察组患者采用加速康复外科理念护理模式进行干预,对照组患者采用常规护理模式进行干预,比较两组患者术后愈合情况、...     

不同治疗方法对年轻乳腺癌患者的生存情况及生活质量的影响

目的 观察年轻乳腺癌患者(年龄≤35岁)保乳手术及改良根治术后的疗效.方法 临床纳入年轻乳腺癌患者90例.其中,保乳手术患者45例,进行改良根治术患者45例.观察两组患者3年生存情况、手术情况、生活质量等.结果 保乳组3年生存率、局部复发率、远处转移率分别为95.56%、2.22%、2.22%,根治组3年生存率、局部复发率、远处转移率分别为91.11%、4.44%、6.67%,均无显著差异性(P>0.05);保乳组手术时间、出血量、引流量及住院时间均优于改良组,差异有统计学意义(P<0.05);且保乳组生理机能(PF)、生理职能(RP)、躯体疼痛(BP)、社会功能(SF)以及精神健康(MH)评分均明显优于改良组,差异有显著性(P<0.05).结论 年轻乳腺癌患者进行保乳手术以及改良根治术均能够起到较好的临床治疗效果,对患者的生存率及复发率均没有明显的影响.但保乳手术具有创伤小、临床恢复快且能够提高生活质量优点,值得推广.     

乳腺癌术中保护胸前神经对胸大肌功能的意义

目的:提高乳腺癌改良根治术后患侧上肢的运动功能。方法:对1997～2001年间所施行的乳腺癌改良根治术进行回顾性分析,观察两种方法腋窝淋巴结清扫数量,术后患侧胸大肌外缘厚度变化及胸大肌功能,与对照组比较。结果:观察组术后胸肌功能全部良好,胸大肌外缘厚度变化无显著差异(P>0.05),对照组大部分胸肌功能欠佳,胸大肌外缘厚度变化有显著差异(P<0.05),腋窝淋巴结清扫数量两组无显著差异(P>0.05)。结论:保留胸前神经可有效地提高患者术后患侧上肢功能,对手术疗效无不良影响。     

放化疗联合生物靶向治疗对乳腺癌早期改良根治术后患者远期生存率的影响

目的 分析放化疗联合生物靶向治疗对乳腺癌早期改良根治术后患者远期生存率的影响.方法 选取乳腺癌早期改良根治术患者86例,将其随机分为对照组与联合组,对照组患者术后行放化疗(多西紫杉醇结合顺铂化疗+三维适形放疗)辅助治疗,联合组在对照组基础上行生物靶向(曲妥珠单抗)治疗,对比两组患者术后并发症发生率及生活质量,比较两组患者术后1年、3年局部复发率、远处转移率、生存率.结果 联合组患者并发症发生率(4.65％)明显低于对照组(44.19％),差异显著(P<0.05);联合组术后生活质量各指标评分均高于对照组,差异明显(P<0.05);两组患者治疗后1年复发率、远处转移率、生存率比较均无明显差异(P>0.05);联合组术后3年远处转移率、复发率均低于对照组,但差异不明显(P>0.05).结论 乳腺癌早期改良根治术后患者实施放化疗联合生物靶向治疗可有效减少并发症提高其生活质量,远期生存率较好,可在临床上推广应用.     

Ⅰ、Ⅱ期乳腺癌的外科治疗--附326例分析

目的总结326例Ⅰ、Ⅱ期乳腺癌外科治疗的疗效.方法施行Auchincloss改良根治术204例;Halsted根治术122例.结果治疗后局部复发32例,其中根治术13例,占10.7%(13/122);改良根治术19例,占9.8%(19/204).死于肿瘤复发与远处转移42例,其中死于改良根治术27例,为15%(27/181);死于根治术15例,为13.4%(15/112)按术后满5年随访统计,改良根治术Ⅰ、Ⅱ期5年生存率分别为90.3%(28/31)和84%(126/150).根治术Ⅰ、Ⅱ期5年生存率分别为92.9%(13/14)和85.7%(84/98).结论改良根治术与根治术局部复发率及5年生存率无显著差异(P0.05).     

麻醉与手术对乳腺癌患者围手术期免疫功能的影响

[目的]探讨喉罩通气全凭静脉麻醉下乳腺癌改良根治术对患者围手术期T淋巴细胞亚群及自然杀伤细胞（NK细胞）的影响。[方法]随机选择Ⅱ～Ⅲ期术前化疗或非化疗乳腺癌患者各25例．A组为术前未化疗组,B组为术前化疗组：分别于麻醉前、手术结束时、术后第1d及术后第3d用流式细胞仪检测T淋巴细胞亚群、NK细胞值。[结果]与麻醉前相比,两组患者术后第1d、第3d的CD8^＋和NK细胞下降明显（P〈0．05）．而CD4^＋／CD8^＋显著性升高（P〈0．05）;但两组间术后第1d、第3dCD3^＋、CD8^＋、NK细胞以及CD4^＋／CD8^＋比较差异无显著性（P〉0．05）。[结论]喉罩通气全凭静脉麻醉下乳腺癌改良根治术对术前化疗或非化疗患者的免疫系缔部有一定的抑制作用．而这种抑制作用与患者术前是否讲行辅助化疗无关．     

The Impact of Diabetes Mellitus on Breast Cancer Outcomes: A Single Center Retrospective Study

Diabetes mellitus has been implicated to affect the prognostic outcomes of patients with various types of cancer. This study explores the impact of diabetes mellitus on the survival outcomes of patients with all stages of breast cancer. We performed a retrospective analysis of 255 patients with all stages of breast cancer. Survival outcomes were compared for diabetic and non-diabetic patients. A greater percent of patients in the non-diabetic group (54.1 %) presented with early-stage (stage 0 and 1) cancer than diabetics for which 41.2 % presented with stage 0 or 1 breast cancer; however this difference did not achieve statistical significance (p?=?0.068). Overall, we observed a significant difference in survival between the diabetics and non-diabetic subjects (p?=?0.001). Even after adjustment for all covariates and after stratification for Body Mass Index (BMI), diabetics were found to have a poorer prognosis in terms of survival time. In patients with breast cancer, diabetes mellitus is an independent predictor of lower overall survival rates, even after adjusting for other comorbidities. Primary caregivers and oncologists alike should aggressively screen breast cancer patients for diabetes mellitus and vice versa.     

Type 2 Diabetes Mellitus and Characteristics of Breast Cancer in China

Studies have showed an association between type 2 diabetes and breast cancer in Western countries. The association should be confirmed in an Asian population which has a lower incidence of breast cancer. Our study aimed to compare the clinicopathologic characteristics of breast cancers in women with and without type 2 diabetes mellitus in China. Each group included 143 cases, similar in parity, body mass index, family history, mode of diagnosis, menarche age and hormone receptors except for progesterone receptor (PR). The diabetic patients were older, with a mean age of 58.3±10 years and the percentage of postmenopausal patients was 52%, which was higher than non-diabetic patients. Significant differences were found in tumor stage, the amounts of lymph node and with metastasis, these persisting after adjustment for age. Furthermore, a positive association with higher TNM status and PR negative rate was noticed in premenopausal but not postmenopausal diabetic patients. Our results indicate that type 2 diabetes mellitus is a negative prognostic factor for breast cancer, especially in premenopausal women.     

保留乳房手术治疗老年乳腺癌112例

目的:分析老年乳腺癌保留乳房手术治疗的临床效果及预后,进而探讨腋淋巴结清扫术在老年乳腺癌中的意义.方法:对1986年12月～2006年12月在天津医科大学附属肿瘤医院行保留乳房手术治疗的112例乳腺癌患者的临床病理资料进行分析.患者年龄均≥60岁,均接受乳腺癌局部广泛切除术,其中59例同时行腋窝淋巴结清扫术,即保乳手术.结果:51.8%(58/112)的患者合并其它疾病.行腋窝淋巴结清扫术的,临床N.期患者中,30.6%(15/49)的患者累及腋窝,仅2.0%(1/49)的患者淋巴结转移数＞3枚.中位随访31个月(7～288个月),保乳手术组与局部广泛切除术组5年累积生存率分别为84.0%和82.8%(P=0.703);10年累积生存率分别为70.9%和55.0%(P=0.382),差异均无统计学意义.其中临床触诊腋淋巴结阴性患者中49例行保乳手术,36例行局部广泛切除术.术后5年累积生存率分别为84.7%和84.9%(P＝0.795),差异亦无统计学意义.保乳手术组与局部广泛切除术组5年复发率分别为3.7%和8.2%(P=0.258).结论:保留乳房手术术后并发症少,恢复快,适用于老年乳腺癌患者.腋淋巴结清扫并未明显增加老年乳腺癌尤其是,临床触诊腋淋巴结阴性患者的生存率.     

乳腺癌患者保乳整复术应用现状

摘 要：随着医疗技术的发展,更多乳腺癌患者获得保乳机会。保乳整复手术的应用,实现了保乳手术安全性和美容性的统一。全文就保乳整复术的产生背景、手术简要操作过程、可能出现的并发症以及术后美观效果评价作一概述。     

Applicability of Oncoplastic Breast Conserving Surgery in Asian Breast Cancer Patients

Background: There are limited studies on oncoplastic breast conserving surgery in Asian women. We aimed to determine the applicability and safety of oncoplastic surgery, highlighting the specific circumstances when it will be most useful and compare our preferred technique with the worldwide practice of oncoplastic approaches. Materials and Methods: Breast cancer patients who underwent oncoplastic breast conserving surgery at a single institution from 1st May 201431st March 2015 were included. Data on patient demographics, tumor characteristics and the type of oncoplastic surgery performed were collected. Results: Nineteen breast cancer patients were identified. 42.1% of patients had grade I ptosis. The indications for surgery included a large tumor to breast size ratio (52.6%), multifocal/multicentric lesions (36.8%) and asymmetric breasts (10.6%), averting a mastectomy in 89.4%. Round block was the commonest technique in 63% of patients, in contrast to the inverted T pattern most frequently used in renowned institutions in the West. Mean and median tumor size and weight of specimen were 29.4/25mm (11 75mm) and 77g/64g (10 246g) respectively. Reexcision rate was 10.5%. Complete mastectomy was performed for one patient. One patient developed wound dehiscence which was treated conservatively. Cosmetic outcome was rated as excellent/good by 94.7% of patients. The patients remained clinically well after a median 16 months follow up. Conclusions: Oncoplastic breast conserving surgery is useful in a specific subgroup of Asian patients with a relatively small breast volume and minimal ptosis. Round block was the commonest technique in our series, in contrast to the worldwide utility of oncoplastic techniques. It is oncologically safe and has good cosmetic outcomes.     

The Feasibility of Endoscopy-Assisted Breast Conservation Surgery for Patients with Early Breast Cancer

Purpose

Breast conservation surgery (BCS) has become a standard treatment method for patients with early breast cancer. Endoscopy-assisted BCS (EABCS) can be performed through an inconspicuous periareolar and a small axillary incision for sentinel node biopsy, which may give better cosmetic outcomes than conventional BCS skin incisions. This study was designed to evaluate the feasibility of EABCS for patients with early breast cancer.

Methods

Forty-three patients were candidates for EABCS, and EABCS was performed in 40 patients with breast cancer between January 2008 and July 2010. Their clinicopathological features were retrospectively analyzed. Operative time, margin status, complications, and relapse-free survival were compared with those of patients treated by conventional BCS and who were treated at the same institute during the same period.

Results

The most common lesion site of the EABCS and conventional BCS groups was the upper area of the breast. Tumor size in all patients was less than 4 cm (range, 0.4-3.7 cm), and nodal involvement was found in eight (20%) patients in the BCS group. The mean operative time was 110 minutes for the EABCS group and 107 minutes for the conventional BCS group, and those were not significantly different. No significant difference in frozen or final margin status was observed between the EABCS and conventional BCS groups. Relapse-free survival was statistically equivalent between the groups with a median follow-up of 12 months. Postoperative complications occurred in five cases in four patients with EABCS, which was not significantly different from conventional BCS.

Conclusion

Performing EABCS in patients with early breast cancer seems to be feasible and safe. Further study with a longer-term follow-up may be needed to confirm the clinical value of EABCS.     

结直肠癌合并2型糖尿病患者MAPK通路相关靶点表达差异及对预后的影响

[目的]探究 ERK1/2、JNK、SNX1 及 miR-95在结直肠癌(colorectal cancer,CRC)合并2型糖尿病(type 2 diabetes mellitus,T2DM)患者肿瘤组织中的表达情况及与预后的关系.[方法]回顾性分析71例CRC以及46例T2DM合并CRC患者病理标本,采用免疫组化和...