乳腺癌术后皮瓣下积液的预防附54例体会

乳腺癌的手术治疗逐步普及和规范,但其术后并发症仍有发生,尤其在广大的基层医院,乳腺癌术后皮下积液等仍较多,本文通过对手术方式的改进及术后有效引流管的放置和包扎方式的改变,很好的预防了皮瓣下积液的发生。     

乳腺癌术后并发症预防的护理体会

目的：探讨乳腺癌术后并发症预防的方法,提高护理质量。方法术前针对患者的不同情况做好术前宣教,采取各种方法做好心理护理。在患者手术之后对其进行密切的观察,给予其进行功能锻炼、负压吸收、心理护理、管道护理等方面的治疗和护理措施。并且做好出院宣教。结果 220例患者均痊愈出院,无护理并发症发生。结论有效的针对乳腺癌患者术后并发症进行护理,采取针对性的护理措施,提高患者的生存质量。     

Drainobag真空高负压引流瓶在乳腺癌术后引流的护理

乳腺癌是我国目前发病率和死亡率上升最快的癌症,已成为危害我国女性健康的重要问题。目前手术仍是治疗乳腺癌的主要手段之一。术中常规在胸骨旁及腋下分别置引流管,目的是排出积血、积液、促进皮瓣和组织紧密相贴。充分引流对创口的愈合极为重要。德国贝朗公司生产的Drainobag真空高负压引流瓶,与传统负压引流相比,它充分有效的引流和持续的高负压可拉近创面的距离,增加创面血流量,减少皮下积液和皮瓣坏死的发生。我院2009年12月至2011年8月,     

乳腺癌术后淋巴水肿的防治和护理

据报道,按目前的关于乳腺癌改良根治术方法,术后上肢淋巴水肿的发生率为6％-14％,并且发病率随时间的推移逐渐增加,术后3—6个月的发病率可以从5％上升到11％,77％的乳腺癌患者术后3年内发生了上肢淋巴水肿,之后上肢淋巴水肿的发病率以每年1％的幅度增加,如何防治减轻水肿和护理,同仁们做了大量的研究和方法改进,现综述如下：     

年轻女性乳腺癌术后的心理护理

目的：探讨年轻乳腺癌患者的心理反应,针对性进行心理护理,稳定患者的情绪,提高患者的生活质量方法：针对年轻乳癌患者的心理特点分析可能的原因后,进行有针对性的心理护理。结果：通过对年轻乳癌患者进行心理干预,大大减轻患者的抑郁焦虑情绪,改善他们的生活质量。结论：有针对性的心理护理能纠正患者的不良认知,使得他们以积极乐观的心态配合术后的继续治疗,提高生活质量。     

缝合打包在乳腺癌术后的应用

目的：探究缝合打包在乳腺癌术后的应用。方法：选取2010年5月至2012年5月在我院进行缝合打包的30例乳腺癌患者,其中女29例,男1例,年龄45～72岁,平均56＋5岁。20例术中快检诊断为乳腺癌,10例术前穿刺确定诊断。导管癌20例,湿疹样癌1例,乳头状癌5例,髓样癌2例,鳞状细胞癌2例。观察疗效。结果：30例患者,术后无一例出现皮下积液。6例创缘部分变黑坏死,经换药愈合。结论：缝合打包被应用到乳腺癌手术后,能够可防止皮瓣移动,让皮瓣与皮下多点牢固接触,抑制液体积聚,能够有效减少乳腺癌术后皮下积液的发生,不影响呼吸与胸廓整体舒缩运动,还有利于血液的循环,对于乳腺癌术后恢复具有很好的疗效,值得临床推广。     

食道癌术后并发症体会

目的：探讨食管癌手术治疗后出现的各种并发症。方法分析60例食管癌术后出现的各种并发症的发生情况,总结经验。结果笔者所在医院治疗60例此类患者,发生并发症共15例（25.00%）,心血管并发症5.00%,3.33%的患者发生吻合口瘘并发症,20.00%患者发生肺部并发症。并发症病死率为0.17%（1/60）。结论手术后的主要并发症为吻合口瘘、肺部并发症,这也是患者发生死亡的主要原因,故给予患者精心的护理措施,可以避免患者发生死亡。     

食道癌术后并发症体会

目的:探讨食管癌手术治疗后出现的各种并发症。方法:分析60例食管癌术后出现的各种并发症的发生情况,总结经验。结果:笔者所在医院治疗60例此类患者,发生并发症共15例(25.00%),心血管并发症5.00%,3.33%的患者发生吻合口瘘并发症,20.00%患者发生肺部并发症。并发症病死率为0.17%(1/60)。结论:手术后的主要并发症为吻合口瘘、肺部并发症,这也是患者发生死亡的主要原因,故给予患者精心的护理措施,可以避免患者发生死亡。     

乳腺癌术后再发卵巢癌的预防与诊治

乳腺癌是女性最常见的恶性肿瘤,如有未婚未育史、家族遗传史、三阴性乳腺癌、术后口服选择性雌激素拮抗剂及BRCA1/BRCA2基因突变者,应特别警惕乳腺癌术后再发卵巢癌的可能。通过基因检测、临床筛查及降风险输卵管卵巢切除术(risk-reducing salpingo-oophorectomy,RRSO)的方法,可以有效预防乳腺癌术后再发卵巢癌。而对于乳腺癌术后已经发现卵巢癌者,应尽早接受治疗。乳腺癌与卵巢癌的发病间隔≥5年的患者所占比例最高,提示获得长期生存的乳腺癌患者也要警惕卵巢癌的发生。     

Spread of ovarian cancer after laparoscopic surgery: report of eight cases

OBJECTIVE: The aim of this study was to describe early occurrences of metastases after laparoscopy of ovarian masses later found to be malignant. METHODS: The hospital charts of eight women having undergone laparoscopic surgery for ovarian mass were reviewed and analyzed. RESULTS: The mean age of the patients was 40 years (range 25 to 66). Size of the tumor ranged from 2 to 15 cm. In four patients the ovarian mass was suspected to be malignant in the laparoscopy. Diagnostic procedure (biopsy of the tumor) was performed in two and salpingo-oophorectomy in six patients. Staging laparotomy was performed within the mean of 17 days (range 7-29). In four patients (50%) the cancer had spread from a localized to an advanced stage during the delay. Ascites was present in the laparoscopy in two of the four patients with port site or abdominal wall metastases. CONCLUSIONS: Laparoscopic surgery of ovarian mass later found to be malignant can cause considerable and early spread of the cancer.     

Wound complications after gynecologic cancer surgery

Objective

To explore clinical correlates of wound complications in high-risk women undergoing abdominal gynecologic surgery in a tertiary referral center.

Methods

Retrospective analysis of patient demographics, pre-operative and intra-operative information, and outcomes was performed in a cohort of patients who underwent abdominal surgery for suspected gynecologic malignancy between 1/2005 and 6/2008. The primary outcome was wound complication within 6 weeks of surgery. Univariate and multivariate logistic regression analyses were employed. A nomogram predicting post-operative wound complications was created and validated by receiver operating characteristic (ROC) curve analysis and 10-fold cross-validation.

Results

Median age of 373 women analyzed was 57 years (range 25-88), median body mass index (BMI) 32.3 kg/m² (range 14.0-70.7). A total of 150 patients (40%) had prior abdominal surgery; 40 (11%) had a pre-operative serum albumin < 3.5 g/dl; and 78 (21%) had pulmonary disease. Wound complications occurred in 125 patients (34%). In multivariate analysis wound complications were correlated with BMI of 30-39.9 kg/m² (OR = 5.62, 95% CI 2.08-15.19, p < 0.0001) and BMI ≥ 40 kg/m² (OR = 10.27, 95% CI 3.66-28.88, p < 0.0001), prior abdominal surgery (OR 3.28, 95%CI1.89-5.70, p < 0.0001), serum albumin ≤ 3.5 g/dl (OR 4.24, 95%CI 1.87-9.61, p = 0.0005), pulmonary disease (OR 2.22, 95%CI 1.09-4.51, p = 0.03), lysis of adhesions (OR 3.57, 95%CI 1.04-12.26, p = 0.04), and length of surgery (OR 2.42, 95%CI 1.35-4.35, p = 0.003). Risk for wound complication was lower with pelvic drain placement (OR 0.26, 95%CI 0.11-0.64, p = 0.003).

Conclusions

Wound complications are common in gynecologic oncology. Further studies should explore whether risk factor modification decreases complications.     

Paraneoplastic neurological syndrome: patient with anti-Yo antibody and breast cancer: a case report

Presented here is the case of a paraneoplastic cerebral degeneration (PCD) in a female patient with breast cancer and the indication of anti-Yo antibodies in the cerebrospina fluid (CSF) and serum. The patient's primary indications were dizziness and a severe gait ataxia. The indication of anti-Yo antibodies led to the conclusion of the existence of a paraneoplastic cerebral degeneration. The antibodies in question are anti-Purkinje-cell autoantibodies acting against the antigens common to tumor and Purkinje cells which occur in association with a certain percentage of breast or ovarian cancers. The diagnosis of the primary tumor, that is clinically undetectable with conventional imaging processes, is performed with the aid of positron emission tomography (PET) to detect the presence of axillary lymph node metastases. The micro-invasive mammary carcinoma was able to be localized with the aid of MR mammography and, after MR mammography marking, was removed. The patient subsequently received adjuvant treatment with epirubicine and cyclophosphamide. This treatment failed to influence the paraneoplastic neurological symptoms. The first two authors contributed equally to this work     

Clinical outcome and complications of laparoscopic surgery compared with traditional surgery in women with endometrial cancer

Introduction The purpose of this study was to evaluate the feasibility, clinical outcome and complications of laparoscopic surgery in women with endometrial cancer and to compare surgical outcome and postoperative early and late complications with results of traditional laparotomy. Methods Forty women with endometrial cancer underwent laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Each patient operated by laparoscopy was matched by age, preoperative clinical stage and histology of the endometrial cancer with a patient treated by the same operation but using traditional laparotomy. Half of these patients underwent total pelvic lymphadenectomy and half had pelvic lymph node sampling. The groups were compared in clinical characteristics, surgical outcomes, recoveries and early and late postoperative complications. Results The patients in the laparoscopy group had less blood loss, more lymph nodes removed, shorter hospital stay but longer operation time than those treated by laparotomy. Only one (2.5%) laparoscopy was converted to laparotomy due to pelvic adhesions. There were no intraoperative complications in either group. Postoperative complications were more common (55.0%) in the laparotomy than in the laparoscopy group (37.5%). Only one major complication (2.5%) occurred among patients undergoing laparoscopy as compared with three (7.5%) major complications in the laparotomy group. Superficial wound infection was the most common (20%) infection in laparotomy patients while vaginal cuff cellulitis occurred in 10% of laparoscopy patients. Late (>42 days) postoperative complications were almost equally frequent (20.0 and 22.5%) in both groups. Lower extremity lymph edema or pelvic lymph cyst was found in 12.5% of all cases. As a result of surgical staging the disease of 6 women (15%) in both groups was upgraded. Conclusions Laparoscopic surgery is a viable alternative to traditional surgery in the management of endometrial cancer. The surgical outcome is similar in both cases. In laparoscopic procedures the operation time is longer but the postoperative recovery time shorter than in laparotomy. Severe complications were limited in both groups, while wound infections can be avoided using laparoscopy.     

134例乳腺癌患者妇科并发症临床病理分析

目的 观察乳腺癌患者妇科并发症的临床病理特征，判断其与服用三苯氧胺（TAM）的关系。方法 对90例术后服用TAM的乳腺癌患者（TAM组）及另外44例同时期无TAM服药史的乳腺癌患者（对照组）进行回顾性分析。结果两组患者的就诊原因有明显的差异，TAM组B超检查发现异常占68．9％，对照组中阴道淋漓出血或月经改变的比率明显增加为31.8％，具有统计学意义（P〈0．05）。TAM组子宫内膜息肉的发生率为25．6％，明显高于对照组9．1％（P〈0．05）；TAM组子宫内膜增生的发生率为30．0％，明显高于对照组13．6％（P〈0．05）。TAM组及对照组出现子宫内膜癌的情况为1：3例。TAM组子宫肌瘤／腺肌症的发生率为66．2％，明显高于对照组44．1％（P〈0．05）。两组患者的宫颈及卵巢病理改变无明显差异，其中宫颈的病理改变以慢性宫颈炎为主（82．8％），卵巢的病理改变以功能性卵巢囊肿为主（34．2％）。服用TAM时间的长短与某些妇科异常情况出现的频率相关，如随着TAM服药时间的延长，子宫内膜息肉与宫颈息肉的发生率明显升高，具有统计学意义（P〈0．05）；而服用TAM时间的长短与肌瘤的发生、肌瘤变性无明显关系（P〉O．05）。134例乳腺癌患者妇科手术治疗以全子宫＋双附件切除术为主，TAM组为68．9％，对照组为61．4％，上环治疗分别占10．0％与2．3％。结论 乳腺癌患者服用TAM后子宫内膜病变与子宫肌瘤／腺肌症的发生增多，前者与服药时间长短有关。对所有乳腺癌患者应进行规律的妇科TVB监测或官腔镜检查，并接受有效的低刨治疗。     

妊娠期乳腺癌的诊断与治疗(附3例临床病例分析)

目的 探讨妊娠期乳腺癌的诊断、治疗和预后。方法回顾性分析北京大学人民医院1994年～2004年收治的3例妊娠期乳腺癌患者的临床资料。结果妊娠期乳腺癌的发生率是0．02％，平均年龄为30岁。主要临床表现为乳腺肿物，经针吸细胞学或手术活检病理确诊，其中2例患者从出现症状到临床确诊的时间超过9个月。2例患者为Ⅱ期，1例Ⅳ期。Ⅱ期患者放弃胎儿行流产后，衍乳腺癌改良根治术，并辅以化疗，分别随访8年6个月和10年8个月；Ⅳ期患者妊娠已足月，行剖宫产后仪切除乳腺肿物，虽辅以化疗，仅生存15个月。结论妊娠期乳腺癌的临床表现和诊断方法与非妊娠期相同，但常延迟诊断。治疗依据肿瘤的临床期别、妊娠周数及患者对胎儿的需求程度。妊娠对乳腺癌的预后无明显影响。     

In vivo evidence of increased malignant cell proliferation following surgery in ovarian cancer

Flow cytometric evaluation of cellular DNA-ploidy and S-phase fraction was undertaken in serial post-operative peritoneal washings in 43 patients with histologically proven ovarian carcinoma, and 20 control patients. Five patients had FIGO stage I, two stage II and the remainder stage III/IV disease. Daily sampling of peritoneal fluid was performed commencing at day 0 (operation day) until the seventh post-operative day. Samples were analyzed fresh using a flow cytometer. Aneuploidy was detected in 168 (62.5%) of samples. Three patients had persistent diploidy throughout the study period, and were excluded from analysis. The mean aneuploid count rose from 24.7% [SEM (standard error of mean) = 4.6] on day 0 to 43.6% (SEM = 5.7) on day 4 ( P < 0.008). The S-phase fraction for the aneuploid populations fell significantly ( P < 0.02) from 4.9% (SEM = 1.2) on day 0 to 2.2% (SEM = 0.8) on day 1, but subsequently continued to rise. Cytologic evaluation confirmed malignant cells in 79% of aneuploid samples. Three patients in the control population had similar patterns to malignant conditions, two of these patients having benign ovarian cysts and ascites. These findings show an increased proliferative activity of aneuploid malignant cells following surgical intervention, as detected in peritoneal lavage samples of patients with ovarian cancer.     

子宫内膜癌腹腔镜手术32例临床分析

目的探讨腹腔镜手术治疗子宫内膜癌的临床效果。方法回顾性分析北京大学人民医院2004年2月至2008年12月具有完整资料的子宫内膜癌腹腔镜手术32例患者,并与同期开腹手术32例比较,观察两组的围手术期指标和近期疗效。结果腹腔镜组术中出血量（345．31±276．60）ml,切除淋巴结数量（20．53±8．35）个,开腹组术中出血量（568．75±345．62）ml,切除淋巴结数量（30．41±11．17）个,差异均有统计学意义（P〈0．05）。两组手术时间比较,差异无统计学意义（P＝0．375）。腹腔镜组和开腹组肛门排气时间分别为（1．91±0．86）d和（2．91±1．67）d（P〈0．05）,平均住院时间分别为（17．22±6．19）d和（21．72±6．84）d（P=0．002）,差异均有统计学意义。腹腔镜组淋巴囊肿形成、切口愈合不良等术后并发症发生率明显低于开腹组（P〈0．05）。两组术后无瘤生存率（P=0．629）、总生存率（P=1．000）及复发率（P=0．629）差异均无统计学意义。结论腹腔镜手术术中出血量少、术后并发症少,近期疗效满意,是治疗早期子宫内膜癌较好的手术方式,但其远期治疗效果及长期预后需进一步研究。     

Urological and colorectal complications following surgery for rectovaginal endometriosis

Objectives  To report the short- and medium-term complications of laparoscopic laser excisional surgery for rectovaginal endometriosis.
Design  Retrospective cohort study.
Setting  University teaching hospital, UK.
Population  A total of 128 women with histologically confirmed rectovaginal endometriosis who underwent laparoscopic laser surgery between May 1999 and September 2006.
Methods  Women were identified from operative database, and a case note review was performed. Data for surgical outcome and surgical complications were collected.
Main outcome measures  Rates of urinary tract and colorectal complications.
Results  A total of 128 women underwent surgery. Of these, 32 required intraoperative closure of a rectal wall defect, including 3 segmental rectosigmoid resections. There were three rectovaginal fistulae and one ureterovaginal fistula. Ureteric damage occurred in two women, and five women suffered postoperative urinary retention. The risk of intraoperative bowel intervention was increased in women who complained of cyclical rectal bleeding.
Conclusion  Laparoscopic laser excision of rectovaginal endometriosis is a safe procedure with similar, if not lower, complication rates to other published surgical series.     

Successful pregnancy after conservative surgery for stage IC ovarian cancer with serous borderline tumor on controlateral ovary: a case report

BACKGROUND: In invasive ovarian cancer, fertility saving surgery is confined to early-stage and low-grade disease, and only few study reported sparing fertility up to FIGO stage IC ovarian cancer. CASE: We present a rare case of a 30-year-old woman affected by IC ovarian cancer with borderline tumor on controlateral ovary who underwent "conservative" debulking surgery followed by adjuvant chemotherapy. A spontaneous planned pregnancy occurred 5 years postsurgery. At 60-month follow-up, patients have no evidence of disease. CONCLUSIONS: Nowadays, preservation of ovarian function in women with tumors in early stage should be evaluated for conservative surgery. It is important to emphasize that patients selected for conservative surgery should have complete surgical staging. Careful follow-up is mandatory to ensure safety of this procedure.