乳腺癌术中植入氟尿嘧啶植入剂的安全性研究

目的:探索进展期乳腺癌术中手术部位植入氟尿嘧啶植入剂化疗的安全性,寻找预防乳腺癌局部复发的新途径。方法:63例Ⅱ期乳腺癌患者随机分为术中植入氟尿嘧啶植入剂组(实验组)和对照组,实验组在胸大肌及腋窝植入氟尿嘧啶植入剂。观察植药后白细胞及丙氨酸氨基转移酶(ALT)、胆红素和肌酐变化,切口引流液的量,皮下积液,局部溃疡及有无淋巴漏等。结果:实验组与对照组的白细胞及ALT、胆红素和肌酐变化,皮下积液,局部溃疡及有无淋巴漏的发生率以及切口引流量差异无显著性;两组术后第1天血白细胞计数、ALT、胆红素和肌酐较治疗前有明显升高(P<0.05),但两组间差异无显著性(P>0.05)。结论:乳腺癌术中植入氟尿嘧啶植入剂安全可靠,是术后局部区域性化疗的有效途径。     

患肢制动专用袖套在乳腺癌术后患者中的应用

目的:探讨患肢制动专用袖套在乳腺癌改良根治术后患者中的应用效果。方法:将2013年1月~2014年1月收治的198例乳癌改良根治术后患者按抽签方法随机分为观察组和对照组各99例。观察组将患肢制动专用袖套应用于术后患肢制动治疗中,对照组只单纯将肢体放置在与观察组相同的位置,未增加任何外固定。比较两组患者皮下积液发生率、术后引流总量及带管天数及切口愈合情况。结果:观察组皮下积液发生率、切开愈合时间、术后引流总量及带管天数均少于对照组(P0.01)。结论:乳腺癌改良根治术后应用患肢制动专用袖套进行患肢制动,降低了术后皮下积液发生率,减少了术后引流总量及带管天数,有助于切口愈合,促进患者早期康复。     

1例乳癌术后大量皮下积液和切口裂开的护理

乳腺癌改良根治术后皮下大量积液和切口裂开严重影响着患者的身心健康。2005年6月9日，我科收住院1例乳腺癌患者，术前患者患有糖尿病、高血压病，术后大量皮下积液，术后第14天切口拆线后，切口裂开，整个皮瓣浮起，给患者造成了极大的身心痛苦。经过医护人员的精心治疗及护理，患者达到最佳的身心适应状态。     

金葡素治疗乳腺癌改良根治术后皮下积液的效果

目的观察金葡素在治疗乳腺癌改良根治术后皮下积液中的效果。方法回顾性分析2012年1月至2015年12月84例乳腺癌改良根治术术后发生切口皮下积液患者的临床资料,将患者随机分为两组,Ⅰ组40例,对术后皮下积液采用常规留置针穿刺抽液方法;Ⅱ组44例,采用注射器抽去皮下积液后注入金葡素,记录两组患者住院总天数、术后住院天数及切口愈合情况并进行比较分析。结果Ⅱ组患者住院总天数、术后住院天数明显短于Ⅰ组,且切口愈合程度优于Ⅰ组。结论采用皮下注射金葡素的方法在治疗乳腺癌改良根治术后皮下积液有一定的优越性,值得临床推广。     

切口不加压包扎联合早期功能锻炼在乳腺癌术后患者应用价值探讨

目的寻求预防或降低乳腺癌术后发生皮瓣坏死、皮下积液、患肢功能障碍、上肢淋巴水肿的方法,评价切口不加压包扎联合早期功能锻炼措施在乳腺癌术后患者中的应用价值。方法选取本院甲乳外科行单侧乳腺癌改良根治术的患者150例,随机分为实验组和对照组各75例,对照组采用常规方法护理,实验组采用快速康复外科相关措施进行干预,并随访至术后1年,对2组患者术后引流管拔除时间、伤口愈合、住院天数、治疗费用、患肢肩关节活动度、患肢淋巴水肿发生率及程度等指标进行观察分析。结果实验组患者皮瓣坏死、皮下积液、患肢淋巴水肿的发生率并不高于对照组。上肢运功功能的恢复情况显著优于对照组,差异有统计学意义(P0.05);2组拔管时间、住院天数、治疗费用无统计学差异(P0.05)。结论切口不加压包扎联合早期功能锻炼可有效应用在乳腺癌术后患者恢复中,具有临床应用价值。     

大肠癌术中腹腔植入氟尿嘧啶植入剂的临床观察

目的：探索进展期大肠癌术中腹腔植入氟尿嘧啶植入剂化疗的安全性，寻找预防大肠癌局部复发的新途径。方法：51例大肠癌根治分成术中植入氟尿嘧啶植入剂组和空白对照组，氟尿嘧啶植入剂组在肿瘤创面和沿淋巴引流途径，分多点植入氟尿嘧啶植入剂。观察植药后伤口愈合，有无吻合口漏、肠梗阻，肝肾功能变化，以及住院天数等。结果：术中植入氟尿嘧啶植入剂组与对照组的血常规，吻合口漏、伤口感染、肠梗阻发生率以及住院天数无明显异常；两组治疗后血白细胞计数、ALT和肌酐较治疗前有明显升高（P〈0.05）；但两组间无显著差异（P〉0．05）。结论：大肠癌根治术中植入氟尿嘧啶植入剂安全可靠，是术后局部区域性化疗的有效途径。     

术后早期功能锻炼对乳腺癌术后并发症的影响

目的确定不同时间开始肩关节功能锻炼对乳腺癌根治术后患者皮下积液、伤口裂开、患侧上肢水肿等相关并发症的影响。方法选取2012年1月~2014年12月96例接受乳腺癌改良根治术患者,随机分为两组,每组各48例,分别在护士指导下于术后72 h或引流管拔除后开始肩关节功能锻炼。评价不同肩部功能锻炼开始时间对术后皮下积液、伤口裂开及患侧上肢水肿的影响。结果术后早期肩部功能锻炼乳腺癌术后患者皮下积液(16.7%vs.10.6%,P0.05)及伤口裂开(8.3%vs.6.3%,P0.05)等发生率与对照组比较无统计学意义,但患侧上肢水肿发生率较对照组降低(6.5%vs.20.8%,P0.05)。结论术后早期肩关节功能锻炼是减少术后患肢水肿的有效护理措施,并且不明显增加术后伤口相关并发症的发生。     

肩肘约束带用于乳癌术后预防皮下积液的效果观察及护理

目的探讨肩肘部约束带用于乳腺癌改良根治术后防止皮下积液的效果。方法选择2010年3～10月乳腺癌改良根治术后162例患者,随机分为对照组和实验组,对照组采用传统单纯胸带加压包扎,观察组除胸带加压包扎外另加肩肘部约束带,观察两组创腔引流量,拔管时间及患肢功能恢复情况。结果实验组创腔引流量明显少,引流管置管时间短,患肢恢复良好,两组比较差异有显著意义（P〈0.05）。结论乳腺癌改良根治术后患者加用肩肘部约束带可有效防止皮下积液的发生,利于切口愈合,促进康复。     

不同引流方法对乳腺癌改良根治术后皮下积液的影响

目的：通过比较不同引流方法对乳腺癌改良根治术后皮下积液的影响,探讨减少乳腺癌改良根治术后皮下积液方法。方法：回顾性分析乳腺癌改良根治术患者216例,其中单管引流86例（A组）,双管引流130例（B组）,两组进行临床对比分析。结果：单管引流组与双管引流组术后引流总量、皮下积液量、拔管时间及切口愈合时间比较,有统计学意义。术后引流管表面皮肤红肿、疼痛发生率及切缘皮瓣缺血情况比较无统计学差异。结论：双管引流对乳腺癌改良根治术是一种理想术引流方式。     

微波治疗在降低乳腺癌改良根治术后切口并发症中的作用

目的:探讨微波治疗对于乳腺癌改良根治术后切口皮下积液及皮瓣坏死的作用效果。方法:选取2013年1月~2015年6月我科行乳腺癌改良根治术的患者116例,随机等分为对照组和观察组,对照组予以术后常规护理;观察组在常规护理基础上,手术切口给予微波治疗,每天2次,连续10 d。结果:观察组引流管引流量较对照组少(P0.05),拔管时间早于对照组(P0.05),差异有统计学意义;观察组皮下积液、皮瓣坏死发生例数少于对照组(P0.05),差异有统计学意义。结论:微波治疗能降低乳腺癌改良根治术后切口皮下积液及皮瓣坏死发生率,保证术后放疗及化疗顺利进行。     

The role of endocrine therapies in reducing risk of recurrence in postmenopausal women with hormone receptor-positive breast cancer.

Hormone receptor-positive breast cancer is increasingly considered a chronic disease, as there remains an ongoing risk of local and distant relapse for years after diagnosis. While early recurrence risk peaks 2-3 years post diagnosis, the majority of breast cancer recurrences and deaths occur following 5 years of adjuvant tamoxifen. Aromatase inhibitors have achieved greater relative reductions in recurrence risk than tamoxifen alone and are now widely recommended as adjuvant therapy for postmenopausal women with hormone-sensitive breast cancer. Although both anastrozole and letrozole have demonstrated superior disease-free survival compared with tamoxifen, letrozole to date offers the greatest significant reduction in the risk of distant metastases in patients with hormone-sensitive breast cancer. Anastrozole and exemestane also reduce local and distant recurrence risk in the "switch setting" following 2-3 years of tamoxifen. Extended adjuvant letrozole, given after 5 years of tamoxifen, significantly reduces local and distant recurrence as well as mortality in patients with node-positive disease. Specialist nurses and nurse practitioners facilitate informed choice for breast cancer patients through explaining treatment options and side effects; they thus need an understanding of which treatment strategies reduce recurrence risk, especially the risk of distant metastases.     

Immunotherapy of breast cancer

INTRODUCTION: Immunotherapy of breast cancer has been shown to prevent recurrence, improve survival and eliminate breast cancer in humans. AREAS COVERED: The reason for this review is to present the current information and the prospects for the future of immunotherapy of breast cancer in humans to include tumor antigens for vaccines and targets for monoclonal antibodies and adoptive T-cell therapy, and immune modulatory agents, such as adjuvants to stimulate the immune response and inhibitors of checkpoint blockade to prevent downmodulation of activated lymphocytes, to enhance these modalities. The research discussed and the literature search undertaken is of the clinical immunotherapy of breast cancer in humans, from 2000 to September, 2011. EXPERT OPINION: The key message of the paper is that one reason for the failure of the immune system to control macroscopic disease is that the immune escape mechanisms involving both tumor and the tumor stroma prevent the immune system from destroying the tumor. Changing the tumor microenvironment is necessary to eliminate macroscopic tumors. Prospects for improvement are proposals for combining current modalities of therapy with type 1 cellular immunity-inducing agents, all targeting multiple tumor antigens and in the context of minimal disease.     

早期乳腺癌保乳手术48例临床分析

目的探讨乳腺癌保乳治疗的方法与疗效。方法回顾性分析合肥市第一人民医院2006年11月至2011年2月间48例行保乳治疗的乳腺癌患者的相关资料。结果术后标本病理切片检查,切缘无癌细胞浸润。经6～57个月随访,无局部复发、远处转移和死亡病例。患侧乳房外形满意。结论早期乳腺癌患者的保乳治疗是安全可行的,可以获得术后良好的乳房外形。     

乳腺癌术后胸壁复发临床分析

目的探讨乳腺癌术后胸壁局部复发的相关因素，寻找预防和降低乳腺癌术后胸壁复发的有效措施。方法回顾性分析乳腺癌术后局部复发而无远处转移的67例患者的临床资料。结果本组患者占同期全部乳腺癌病例的7．6％，其中42例（62．7％）在手术后2年内复发。T1～T4复发率分别为0．9％、3．8％、12．7％和34．6％，腋窝淋巴结（-）与腋窝淋巴结（＋）患者的胸壁复发率分别为1．7％、7．8％，腋窝淋巴结转移≥4个者复发率高达t3％。结论腋窝淋巴结转移数目多、原发灶分期晚者易出现胸壁复发。对乳腺癌术后易复发的高危人群应规范化治疗，术后放疗是预防胸壁复发的有效措施。     

乳腺癌术后放疗全期的护理体会

目的:探讨肿瘤放疗科护士对乳腺癌术后围放疗期护理的效果,对保证治疗顺利完成、防止肿瘤复发、提高患者生存质量和改善预后、提高患者满意度有重要意义。方法:收治乳腺癌术后放疗患者56例,从心理、认知、行为等方面进行放疗全期护理,观察放疗护理的效果。结果:56例乳腺癌放疗患者治疗顺利完成,治疗依从性增高,满意度增高。结论:放疗全期护理对保证治疗顺利完成、防止肿瘤复发、提高患者生存质量和改善预后起到了不容忽视的作用。     

乳腺癌保乳手术后局部复发因素的分析

目的:探讨乳腺癌患者行保乳手术治疗后局部复发的相关因素。方法:收集2002年3月—2010年3月行保乳手术治疗的356例乳腺癌患者的临床及随访资料,分析年龄、淋巴结转移、肿瘤直径、人表皮生长因子受体2(HER-2)、雌激素受体(ER)/孕激素受体(PR)与术后肿瘤局部复发的相关性。结果:356例患者的中位随访时间为53(9~120)个月;其中14例(4.3%)患者出现同侧乳房局部复发,16例(4.9%)出现远处转移;5年无远处转移生存率为95.4%,5年总体生存率为99.1%,5年无病生存率为82.3%;乳腺癌患者行保乳治疗手术后2~3年是肿瘤局部复发的高峰时期,单因素以及多因素分析发现,患者的年龄、淋巴结转移及HER-2是肿瘤局部复发的独立危险因素。结论:淋巴结转移以及HER-2与乳腺癌患者行保乳手术后的局部复发相关。     

Immunotherapy of breast cancer

Introduction: Immunotherapy of breast cancer has been shown to prevent recurrence, improve survival and eliminate breast cancer in humans.

Areas covered: The reason for this review is to present the current information and the prospects for the future of immunotherapy of breast cancer in humans to include tumor antigens for vaccines and targets for monoclonal antibodies and adoptive T-cell therapy, and immune modulatory agents, such as adjuvants to stimulate the immune response and inhibitors of checkpoint blockade to prevent downmodulation of activated lymphocytes, to enhance these modalities. The research discussed and the literature search undertaken is of the clinical immunotherapy of breast cancer in humans, from 2000 to September, 2011.

Expert opinion: The key message of the paper is that one reason for the failure of the immune system to control macroscopic disease is that the immune escape mechanisms involving both tumor and the tumor stroma prevent the immune system from destroying the tumor. Changing the tumor microenvironment is necessary to eliminate macroscopic tumors. Prospects for improvement are proposals for combining current modalities of therapy with type 1 cellular immunity-inducing agents, all targeting multiple tumor antigens and in the context of minimal disease.     

FOLLOW-UP OF BREAST CANCER: TIME FOR A NEW APPROACH?

After treatment for breast cancer women are monitored for recurrent disease by means of routine hospital-based follow-up appointments. The aim of this study is to determine the efficiency of this system, by establishing how recurrence presents to our hospital. The study comes at a time of increasing pressure on breast clinics from new patient referrals and the need, since April 1999, to see all cases classified as urgent within two weeks of referral. A consecutive series of 643 patients who presented with operable breast cancer between 1992 and 1998 were reviewed. Details about the 108 patients who had locoregional or metastatic relapse were obtained from our breast cancer database and their clinical records. Full data were available on 104 patients: 77 (74%) were seen at expedited (interval) appointments and a further 18 (17.3%) drew attention to symptoms at a routine visit. Two cases of locoregional recurrence were revealed by surveillance imaging. Unsuspected disease, locoregional in all cases, was detected on examination in 7 (6.7%) patients. The median time to presentation of recurrence was 19 months for metastatic and 18 months for locoregional disease. Breast cancer recurrence usually presents to an interval clinic. Most cases that are confirmed following a routine review are already symptomatic. Long-term routine hospital follow-up after treatment for breast cancer appears inefficient and unnecessary. Following liaison with local general practitioners we propose to discharge patients from routine review after two years. Thereafter they will have scheduled appointments with their GPs with immediate access to specialist review in the breast care unit if required.