早期乳腺癌保乳手术探讨

目的 探讨早期乳腺癌保乳手术加放疗治疗效果.方法 分析近6年76例保乳术后加放疗的乳腺癌病人临床资料.结果 76例患者3,5年生存率分别为96.05%,94.8%;3,5年局部复发率分别为5.3%,6.6%;术后3,5年乳房保留率分别为96.05%,93.3%;仅1例胸壁复发,无死亡病例.该复发病例25岁,未婚,保乳愿望强烈,复发后再次行乳房切除及化疗,现健在.术后形体美容效果满意度80.5%.结论 早期乳腺癌采用保乳手术及放射治疗可取得满意结果,规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.     

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.     

The role of Oncoplastic Breast Surgery in the management of breast cancer treated with primary chemotherapy

ObjectiveThe purpose of this study was to evaluate the benefit of Oncoplastic Breast Conserving Surgery (BCS) compared to standard BCS after primary CT, in terms of oncologic safety and cosmetic outcomes.BackgroundThe development of new drugs has led to greater use of primary chemotherapy (CT) for bulky breast cancer (BC) and has allowed wider indications for conservative surgery.Patients and methodsWe identified 259 patients consecutively treated with BCS for primary BC from January 2002 to November 2010. All patients had undergone Oncoplastic Breast Surgery (OBS) or standard BCS after primary CT. Mastectomy rates, and oncological and cosmetic outcomes were compared.ResultsA total of 45 OBS and 214 standard BCS were analyzed. The median tumor size was 40 mm in the two groups (p = 0.66). The median operative specimen volumes were larger in the OBS group than in the standard group (respectively, 180 cm³ and 98 cm³, p < 0.0001). Re-excision (9% vs 2%) and mastectomy (24% vs 18%) rates were similar (p = 0.22 and p = 0.30) in the standard BCS group and in the OBS group respectively. At a median follow-up of 46 months, local relapse (p = 0.23) and distant relapse (p = 0.35) rates were similar.ConclusionOBS allows excision of larger volumes of residual tumor after primary CT. OBS outcomes results were similar to those of standard BCS.Oncoplastic Breast Conserving Surgery (BCS) after primary chemotherapy allows wider breast resection than standard BCS. Survival and relapse probabilities are similar in both groups.     

残留腺体转位整形法在乳腺癌保乳手术中的应用价值

目的 分析在乳腺癌保乳手术中应用残留腺体转位整形法的应用价值。方法 选取2019年12月-2021年6月西安国际医学中心医院甲乳外科收治的接受保乳手术干预乳腺癌患者80例,通过随机数字表法分为试验组与参照组,各40例。试验组采用残留腺体转位整形法,参照组采用直接缝合皮肤法,比较两组炎症因子指标（肿瘤坏死因子-α、降钙素原）、美容效果、并发症发生率。结果 两组治疗后肿瘤坏死因子-α、降钙素原水平高于治疗前,但试验组低于参照组,差异有统计学意义（P＜0.05）;试验组美容效果高于参照组,差异有统计学意义（P＜0.05）;试验组并发症总发生率为7.50%,低于参照组的30.00%,差异有统计学意义（P＜0.05）。结论 残留腺体转位整形法在乳腺癌保乳手术中的美容效果良好,可降低患者的炎症因子水平,且并发症发生率低。     

The relationship between surgical factors and margin status after breast-conservation surgery for early stage breast cancer

Background

The study's aim was to identify technical factors that are predictive of negative margins after breast-conserving surgery (BCS).

Methods

This was a retrospective, cohort study of patients who underwent BCS for early-stage cancer from 2000 to 2002. Pathological and specific surgical factors were compared with margin status. Univariate and multivariate regression analyses were performed.

Results

Four hundred eighty-nine cases were reviewed. The positive margin rate after the initial surgery was 26%. In univariate analysis, lobular histology, size, grade, multifocality, and the presence of EIC and LVI were associated with positive margins (P < .05). The absence of cavity margin dissection and specimen orientation labeling, the absence of a confirmed diagnosis, and smaller volumes of excision were also associated with positive margins (P < .05). In multivariate analysis, confirmed diagnosis, small tumor size, ductal histology, absence of LVI and multifocality, palpability, cavity margin dissection, and larger volumes of excision were predictors of negative margins.

Conclusions

This study shows that specific surgical factors are predictive of margin status. Both tumor and technical factors should be considered when planning BCS.     

Influence of breast cancer margin assessment method on the rates of positive margins and residual carcinoma

BACKGROUND: We hypothesized that the method of breast cancer margin assessment may be associated with different rates of positive margins and residual carcinoma. METHODS: A total of 178 breast cancer specimens were divided into 2 groups (A and B) based on the margin assessment method used. Rates of positive margins, re-excision, and residual carcinoma at re-excision were compared and analyzed statistically. RESULTS: At least 1 margin was positive in 64.7% in group A and in 65.2% in group B. At directed re-excision 54% in group A and 51% in group B had residual carcinoma. The lateral margin was positive in 44% in group A compared with 26% in group B (P = .06). The posterior margin was positive in 19% in group A and in 51% in group B (P = .001). CONCLUSIONS: Two different breast cancer specimen margin assessment methods had comparable rates of positive margins and residual carcinoma at re-excision. Different patterns of specific margin positivity suggest that the method of margin assessment may alter results.     

保留乳头乳晕的改良根治术联合假体即刻置入术治疗早期乳腺癌的临床研究

目的观察保留乳头乳晕的改良根治术联合假体即刻置入术治疗早期乳腺癌的临床价值。 方法回顾性分析93例乳腺癌患者的临床资料,根据患者手术方案不同分为假体置入组(采取改良根治术联合假体置入术,n＝48)与传统手术组(行传统改良根治术,n＝45)。应用统计学软件SPSS19.0处理数据,两组年龄、肿瘤直径、体重指数采用( ±s)表示,行独立样本t检验;TNM分期、乳房外观优良率、术后心理状况及生活质量、并发症总发生率采取χ²检验,P<0.05为差异有统计学意义。 结果假体置入组与传统手术组并发症总发生率分别为25.0%与20.0%(P>0.05)。假体置入组术后3个月的乳房外观优良率为93.8%,显著高于传统手术组77.8%(P<0.05)。假体置入组术后6个月的焦虑、抑郁、恐惧、人际敏感、自我形象紊乱发生率分别为25%、16.7%、31.3%、20.8%、14.6%,显著低于传统手术组的46.7%、35.6%、53.3%、40%、33.3%(P<0.05)。两组2年无瘤生存率、随访期间复发率、转移率、死亡率均无统计学意义(P>0.05)。 结论保留乳头乳晕的改良根治术联合假体置入术治疗早期乳腺癌可满足患者乳房重建的需求,不影响根治效果且提高了患者乳房外形美观度,患者术后心理与生活质量得到改善,值得推广。     

DCE-MRI 在乳腺肿瘤保乳术中的应用价值

目的 分析并讨论DCE-MRI在乳腺肿瘤保乳术中的应用价值。方法 随机选取我院2021年 5月-2023年5月收治的70例乳腺肿瘤患者,所有患者均采取保乳术治疗。依据临床诊断方式差异将其分为 FFDM组与DCE-MRI组,FFDM组采取FFDM进行检查,DCE-MRI组采取DCE-MRI进行检查,在病理检测 结果的基础上比较两组乳腺肿瘤良恶鉴别率以及两种检查方式的临床灵敏度及特异度。结果 DCE-MRI组 良、恶性鉴别准确率高于FFDM组（P＜0.05）;DCE-MRI组临床灵敏度及特异度高于FFDM组（P＜0.05）。 结论 在乳腺肿瘤保乳术中采取DCE-MRI具有很高的诊断率、临床灵敏度及特异度,能够有效评估患者 的治疗效果,因此具有很高的临床应用价值。     

Breast Conserving Surgery after Primary Chemotherapy in Locally Advanced Breast Cancer

Purpose: Primary chemotherapy is being given in the treatment of locally advanced breast cancers (LABC), but a major concern is local recurrence after therapy. The aim of this study was to assess the role of breast conserving surgery (BCS) in patients with locally advanced breast cancer.

Material and Methods: Twenty-eight patients, presenting LABC (T any, N 012, M0) were treated with primary chemotherapy comprising of cyclophosphamide, doxorubicin and fluorouracil and then BCS followed by radiotherapy were examined between the years 1992-2002 retrospectively. Before neoadjuvant chemotherapy, seven patients (25%) were Stage IIB, 19 patients (68%) Stage IIIA and two patients (7%) Stage IiIB. Survival times and curves were established according to the Kaplan-Meier method and compared by means of the log-rank test. The chi-square test and log rank test were performed for univariate statistical analysis of each prognostic factor. P values in multivariate analysis were carried out by the Cox’s proportional hazards regression model. All p values were two-sided in tests and p values < 0.05 were considered significant.

Results: Clinical down staging was obtained in 25 (89%) of patients. Three (11%) patients had complete clinical response, 22 (78%) patients with partial response and 3 (11%) had stable disease. The primary tumour could not be palpated after chemotherapy in 6 (21%) of 28 patients presenting with palpable mass, therefore needle localization was performed for BCS. Median follow-up was 51.9 months (ranging 10 to 118 months). Local recurrence was detected in 4 (14%) patients. Distant metastasis developed in 5 (18%) patients. Three of the patients died of distant metastases and two of them are alive at 49 months. Five-year survival rate was 66%. Statistically, there were no significant factors in terms of local recurrence. Histological grade and menopause status were significantly associated with overall survival (p = 0.018) and nuclear grade was the one significant factor on distant disease-free survival in univariate analysis (p = 0.006). In multivariate analysis, there were no significant factors in terms of overall and distant disease-free survival Conclusions: Negative margin is more important than the clinical and histological parameters, such as pretreatment stage, clinical response rate, ER and PR in terms of local recurrence. BCS can be performed safely by achieving free surgical margin in patients who have small sized tumour and with either N2 axillary involvement or skin invasion.     

Impact of initial surgical margins and residual cancer upon re-excision on outcome of patients with localized breast cancer

Background

A significant proportion of patients undergoing breast conservation therapy require additional operations to obtain clear margins. The aim of this study was to assess the impact of initial margins and residual carcinoma found on second surgery on the outcomes of breast cancer patients.

Methods

In this retrospective study, Cox proportional-hazard regression analysis was performed to evaluate data from 437 patients with stage I to IIIA breast cancer who underwent initial breast-conserving surgery between 1994 and 2004.

Results

The distant recurrence rate was higher among patients with initial positive margins than among those with initial negative margins (15.5% vs 4.9%; hazard ratio, 3.6; 95% confidence interval 1.5-8.7; P = .003). For patients who had underwent second surgery, the finding of a residual invasive carcinoma was associated with increased risk for distant recurrence (22.8% vs 6.6%; hazard ratio, 3.5; 95% confidence interval, 1.8-7.4; P = .0001).

Conclusion

Invasive residual carcinoma found during subsequent surgery after initial compromised margins is an important prognostic marker for distant recurrence.     

加速康复外科护理在乳腺癌保乳手术中的应用效果

目的 分析加速康复外科护理在乳腺癌保乳手术中的应用效果。方法 选取2021年1月-12月于 我院行保乳手术的70例乳腺癌患者作为研究对象,随机分成对照组和观察组,各35例。对照组和观察组 分别实施常规护理和加速康复外科护理,比较两组护理效果、不良情绪、生活质量及并发症发生情况。 结果 观察组护理总有效率为97.14%,高于对照组的68.57%,差异有统计学意义（P＜0.05）;观察组干预 后SAS和SDS评分低于对照组,差异有统计学意义（P＜0.05）;观察组情感功能、心理状态、身体功能和 社会功能各项评分均优于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为2.86%,低于对 照组的28.57%,差异有统计学意义（P＜0.05）。结论 加速康复外科护理应用于乳腺癌保乳手术中效果理 想,能够缓解患者不良情绪,提升生活质量,降低并发症发生率。     

预见性护理对乳腺癌整形保乳术患者乳房美观度的影响

目的 观察预见性护理应用于乳腺癌整形保乳术后对患者乳房美观度的影响。方法 选择2022年 5月-2023年2月于我院行乳腺癌整形保乳术的44例患者为研究对象,采用随机数字表法分为对照组和研究 组,每组22例。对照组给予常规护理,研究组给予预见性护理,比较两组乳房美观度、乳房美容效果及心 理状况。结果 研究组乳头纵向移位距离、乳头横向移位距离、乳房凹陷程度、瘢痕增生、乳房对称性评 分均高于对照组（P＜0.05）;研究组乳房美容优良率为90.91%,高于对照组的59.09%（P＜0.05）;研究组 护理后HAMD评分、HAMA评分均低于对照组（P＜0.05）。结论 为乳腺癌整形保乳术后患者提供预见性 护理能有效改善乳房美容度,提升乳房美容效果,有利于调节患者的不良情绪,值得临床应用。     

局部皮瓣在乳腺癌保乳术后一期修复中的应用

目的 观察应用局部皮瓣修复保乳术后乳房缺损的临床疗效。方法 2004年7月至2013年1月,对9例早期乳腺癌患者保乳手术所遗留的乳房缺损进行即刻修复,采用外侧胸背筋膜皮瓣7例,胸腹壁皮瓣2例,观察皮瓣成活情况、并发症和术后美观效果。结果 术后外观评价8例为优,1例为良。1例患者出现皮瓣局部坏死,经保守治疗愈合。1例患者出现皮瓣供区感染,口服抗菌素治疗,未影响手术效果。术后平均随访22个月,未见局部复发病例。结论 应用局部皮瓣修复保乳术后乳房部分缺损,手术效果好,并发症少,可扩大肿瘤周围的切除范围,降低肿瘤局部复发风险。     

保乳术与改良根治术对育龄期乳腺癌患者复发及生存情况的影响

目的：比较保乳术与改良根治术对育龄期乳腺癌患者术后复发及生存情况。 方法：收集2005年1月—2010年6月收治的育龄期乳腺癌82例临床资料,其中行保乳手术48例（保乳组）,乳腺癌改良根治术34例（改良根治组）。对两组患者手术情况、并发症、复发、转移及生活质量进行评估。 结果：与改良根治组比较,保乳组手术时间[（74.4±8.3）min vs.（92.6±10.7）min]、术中出血量[（46.8±6.7）mL vs.（77.0±68.4）mL]、引流量[（398.8±41.3）mL vs.（601.4±62.7）mL]均明显减少、住院时间明显缩短[（13.4±3.2）d vs.（17.9±2.8）d],并发症发生率明显降低（6.3% vs. 14.7%）（均P<0.05）;两组1,2年复发和转移率比较,差异无统计学意义（P>0.05）;保乳组的社会功能、情绪功能、角色功能和躯体功能评分均高于改良根治组（均P<0.05)。 结论：对育龄期乳腺癌患者,保乳术与改良根治术在复发和转移方面无差异,但前者术后的生存质量优于后者。     

预见性护理对乳腺癌整形保乳术患者术后并发症及乳房美容效果的影响

目的 探究预见性护理对乳腺癌整形保乳术患者术后并发症及乳房美容效果的影响。方法 选择 2022年3月-2023年3月我院收治的80例乳腺癌患者为研究对象,通过随机数字表法分为对比组和试验组, 每组40例。对比组采用常规护理,试验组采用预见性护理方法,比较两组心理状态、生活质量、乳房美容 效果、并发症发生情况、病情恢复时间及住院时间。结果 试验组护理后SAS评分、SDS评分均低于对比组 （P＜0.05）;试验组护理后生活质量各项评分均高于对比组（P＜0.05）;试验组乳房美容效果各项评分均 高于对比组（P＜0.05）;试验组并发症发生率为7.50%,低于对比组的25.00%（P＜0.05）;试验组病情恢复 时间及住院时间均短于对比组（P＜0.05）。结论 针对乳腺癌整形保乳术患者给予预见性护理干预的效果 确切,可降低术后并发症发生率,提高乳房美容效果,有利于提升患者的生活质量,促进患者快速康复。     

肿瘤整形技术对早期乳腺癌保乳手术患者美容效果及预后的影响

探讨对早期乳腺癌患者应用乳腺肿瘤整形保乳术治疗对其术后乳房美观度及预后的影响。方法 选取我院2019年3月-2021年6月收治的60例早期乳腺癌患者为研究对象,随机分为对照组和观察组,每组30例。对照组采用常规保乳术治疗,观察组采用乳腺肿瘤整形保乳术治疗,比较两组术后乳房美观度和预后状况。结果 观察组术后乳房美观优良率为96.67%,高于对照组的73.33%（P＜0.05）;两组治疗1年后均无复发和远处转移,生存率均为100.00%;两组治疗2年后生存率、复发率及远处转移率比较,差异无统计学意义（P ＞0.05）。结论 乳腺肿瘤整形保乳术在早期乳腺癌患者中的应用效果确切,可提升患者的术后乳房美观度,且预后状况较好,不会增加复发率及远处转移率。     

新辅助化疗联合保乳手术在中晚期乳腺癌中临床疗效的分析

目的：探讨新辅助化疗联合保乳手术在中晚期乳腺癌治疗中的临床疗效及应用价值。 方法：回顾性分析2008年2月—2010年2月收治的II~III期乳腺癌97例的临床资料,其中新辅助化疗联合保乳手术41例（保乳组,术前行新辅助化疗）和改良根治术56例（改良根治组,术前未行化疗）,对两组临床疗效进行评估。 结果：保乳组客观缓解率高于改良根治组（73.17% vs. 57.14%,P<0.05）。经23.2个月中位随访,保乳组全部存活,局部复发1例,未发生远处转移;改良根治组局部复发6例,5例发生远处转移,其中3例死亡;保乳组与改良根治组中位无进展生存期分别为32.3个月和22.1个月（P<0.05）。保乳组乳房外形评价82.93%为优;患者美观满意度90.24%为非常满意,7.32%为基本 满意。 结论：保乳术前辅助化疗可明显使中晚期乳腺癌临床分期降低,且术后近期疗效和美观效果均好,这对部分中晚期患者来说具有重要临床价值。     

Breast cancer in patients with schizophrenia

Background

Schizophrenia has a powerful impact on the outcomes of treatment for physical disorders. This study sought to estimate how the presence of schizophrenia disrupts the course of diagnosis and initial treatment of breast cancer.

Methods

We searched the Patient Treatment File, a comprehensive computer-based system for inpatient data in the Department of Veterans Affairs (DVA) medical system, to identify patients with codes for schizophrenia or schizoaffective disorder who later developed breast cancer. These data were augmented with chart-based clinical data.

Results

There were 56 evaluable patients from 34 DVA facilities; 37 (66%) were female. Delay in diagnosis was common. The mean size of the primary tumor was 4 cm in those for whom these data were recorded. Delay in diagnosis was common and many never received the indicated surgery. Distant metastases were present on diagnosis in 12 (21%) and developed after diagnosis in 14 (25%) others, including 7 who inappropriately delayed or refused indicated surgery and 4 who inappropriately delayed or refused indicated neoadjuvant chemotherapy. Twelve verbally abused or physically attacked caregivers.

Conclusions

Patients with schizophrenia who later develop breast cancer often deny they have cancer. They often have high-stage disease at diagnosis and often delay or refuse therapy. Breast-conserving multimodality therapy is often not feasible.     

影响乳腺癌患者保乳手术边缘阳性因素的临床研究

目的探讨乳腺癌的临床病理学特征对保乳手术边缘阳性的影响。方法189例预行保乳手术术(BCT)的原发性乳腺癌患者,分析她们的临床特征(年龄,活检类型)和病理学特征(肿瘤大小,组织学类型,激素受体状态,HER2状态,和腋窝淋巴结状态)与阳性手术边缘的关系。结果189例患者中本组室心针肿脾物案例活检确诊79例,门诊或手术中切除活检确诊128例。61例手术边缘阳性(32.3%)。结论本研究的结果揭示:肿瘤直径大于2cm,腋窝淋巴结阳性PR阳性和年龄小于50岁是乳癌保乳手术边缘阳性的高危因素对1999年1月～2004年7月189例乳腺癌患者按受保乳手术进行回顾性分析,并总结手术切口边保阳性与临床特征病理案组但表现及激素受体状态的关系。     

早期乳腺癌保乳手术247例报告

目的：探讨早期乳腺癌保乳手术的技巧和近期疗效。方法：1995年-2004年收治女性乳腺癌2548例，选择临床0～Ⅱa期、非乳晕区单发肿瘤247例施行保乳手术。对肿瘤直径〈2cm者，行肿瘤局部扩大切除；对肿瘤直径2～3cm者则行象限切除，切缘行冰冻检查，常规腋淋巴结清扫。乳晕部残留腺体作阶梯状对缝。术后胸壁行50Gy放疗，瘤床追加10Gv放疗。腋窝淋巴结阳性及高危病人接受化疗；雌激素受体阳性者接受内分泌治疗。结果：247例手术全部成功，无并发症发生。总保乳率9．7％（247／2548），占同期乳腺癌保乳率22．6％，美容满意率达93．6％。平均随访69个月，随访率74．1％（183／247例）。局部复发率1．63％（3／183例），腋淋巴结复发率1．09％（2／183例），复发时间为术后3年2个月：远处转移率1．09％（2／183例），术后4年半1例肺转移，1例肝转移；随访期中，死亡3例，1例死因为心肌梗死，2例为肺、肝转移；5年无病生存率95．6％（175／183例），总生存率98．4％（180／183例）。结论：乳腺癌保乳手术近期总疗效属满意。