保留乳房手术治疗乳腺癌37例

目的：观察Ⅰ-Ⅱa期乳腺癌保留乳房手术加术后放疗及化疗的疗效。方法：有选择地对37例Ⅰ-Ⅱa期乳腺癌病人施行乳腺癌局部广泛切除加腋淋巴结清扫术。乳腺肿块位于1区原发癌灶与腋窝淋巴结清扫尽可能取与皮纹一致的梭形切口；位于2、4区原发癌灶取放射状切口；位于3区取放射状切口或乳腺下方弧形切口。腋窝淋巴结清扫取腋窝皱襞下横形切口，前端至胸大肌外缘，后缘不超过腋后线。术中将距肿瘤2cm边缘送快速病理检查，确保切缘无肿瘤残余。肿块切除后瘤床4个方向各放一金属标志物，以指导放疗。切线照射乳腺及胸壁，依据金属标记瘤床加用电子线照射瘤床，共达60-70cy，并辅以化疗、内分泌治疗。结果：平均随访52．8个月，均无局部复发，无远处转移，乳房无明显萎缩变形，保留乳房美容效果满意。结论：该术式是治疗Ⅰ-Ⅱa期乳腺癌的首选方法之一，并可提高病人的术后生存质量。     

早期乳腺癌保留乳房手术62例疗效评价

目的探讨早期乳腺癌保留乳房手术治疗疗效。方法回顾性分析1996～2004年经治的62例早期乳腺癌实施保乳手术治疗疗效。结果全部病人手术过程顺利,近期乳房外形保持良好。术后随访1～8年(平均2年),无局部复发、远处转移和死亡病例。无放疗后合并症。结论保乳手术治疗早期乳癌的近、远期疗效满意。术前严格掌握手术适应证,术后规范的综合治疗,是保乳手术获得良好疗效的保证。     

乳房保留术治疗乳腺癌22例体会

目前,兼顾疗效和患者生存质量的乳腺癌保乳术已成为欧美国家早期乳腺癌手术治疗的首选,我国这方面的研究也日益增多。2003年1月至2005年12月我科采用乳房保留术治疗Ⅰ、Ⅱ期乳腺癌22例,现报告如下。     

保留乳房改良术式治疗早期乳腺癌的临床研究

我院1 999年3月至2 0 0 3年4月对32例早期乳腺癌行保乳的原发癌灶局部扩大切除同时行腋窝淋巴结清扫,术后辅助放、化疗,并对手术切口进行了改良,观察术后近期疗效和美容效果。现报告如下。资料与方法1 .一般资料:本组年龄30～72岁,中位年龄4 5岁。病例均有自愿保留乳房的要求,并具备全程治疗(根治性放疗)的经济能力和接受终生随访的条件。分期标准:按1 988年美国癌症联合委员会(AJCC)与国际抗癌联盟(UICC)制定的TNM分期标准选择临床Ⅰ、Ⅱ期女性乳腺癌(T0 2 N0 2 M0 )作为治疗对象。Ⅰ期1 9例,Ⅱ期1 3例。肿瘤位于右侧1 5例,左侧1 7…     

保留乳房的乳腺癌手术

保留乳房的乳腺癌手术是近30年来乳腺癌外科治疗的主要进展,它包括乳腺肿瘤局部扩大切除或象限切除,腋淋巴结 清扫(ALND),术后辅助放化疗、内分泌治疗。资料证明保乳手 术能获得与根治性全乳切除术一样的治疗效果,又保留了乳房 的形态,给女性患者带来了实在的益处。由“切乳”转向“保乳” 被称作革命性变化,说明乳腺癌外科治疗理念已从局部解剖为 基础、单一追求手术根治性转向以肿瘤生物学现象为指导的综 合治疗时代,这更充分地体现人类对生命质量的重视。 一、保乳手术的背景 1894年Halsted提出乳腺癌…     

早期乳腺癌保留乳房术式的探讨（文献综述）

本文概述了国外有关乳腺癌保留乳房术式的发展过程和目前状况，随着对乳腺癌研究的进展，对手术切除治疗乳腺癌的作用也有了新的认识，即乳腺癌是一种全身性疾病，手术只能在起局部治疗作用。扩大切除并非起到根治作用，所以保留乳房术式在与其它术式的比较中得以发展，其适应证和禁忌证也逐渐明确。     

早期乳腺癌保留乳房术式的探讨(文献综述)

本文概述了国外有关乳腺癌保留乳房术式的发展过程和目前状况。随着对乳腺癌研究的进展,对手术切除治疗乳腺癌的作用也有了新的认识,即乳腺癌是一种全身性疾病,手术只能起到局部治疗作用,扩大切除并非起到根治作用,所以保留乳房术式在与其它术式的比较中得以发展,其适应证和禁忌证也逐渐明确。     

保留乳头的乳腺癌根治术即乳房重建术

目的：探讨早期乳腺癌行保留乳头的改良根治、即期硅胶假体植入乳房重建术的可行性.方法：利用早期乳腺癌极少侵犯乳头、乳晕及皮肤的特点，切除病灶及其上方部分皮肤后行皮下乳房切除＋腋淋巴结清扫术，并与硅胶假体植入术有机结合，达到一期重建乳房的目的.结果：对18例早期乳腺癌患者采用上述术式重建乳房后客观评价效果优良和尚好者达94.4%，主观评价效果优良和尚好者达100%，术后随访12～36个月，所有病例均无局部复发及远处转移.结论：保留乳头的非定型式乳腺癌根治与即期硅胶假体植入乳房重建术是治疗Ⅰ期及部分Ⅱ期乳腺癌安全可行的方法。     

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??Objective:o compare the effects of breast conservative therapy (BCT) with modified radical mastectomy (MRM) in women with early stage breast cancer. Methods: matched retrospective cohort study using data on patients derived from a prospectively collected breast cancer database was conducted.The database included patients who received MRM or BCT from 1995 to 2002 in Cancer Hospital of Fudan University.The match was conducted according with four variables:age at diagnosis,axillary lymph node status,sexual hormone receptor status and the dimension of tumor.The match ratio was 1??2.Controls were patients who received MRM (n=254).Cases were patients who received BCT (n=127).Median follow??up for the controls and cases were 58 months and 49 months respectively.The differences of incidence of loco??regional recurrence,disease free survival and overall survival at 5 years were compared.There were no significant differences in incidence of loco??regional recurrence,DFS and OS at 5 years between the two groups of patients. Results:he incidence of loco??regional recurrence was 1.4% in MRM group and 3??39% in BCT group (P=0.5).The OS in MRM and BCT patient were 97.7% and 96.73% (P=0.66).The DFS in MRM and BCT patients were 91.57% and 86??04% (P=0.37). Conclusion:For appropriate breast cancer patients,classic lumpectomy plus axillary lymph node dissection and post??operative radiotherapy lead to excellent local control and good survival rate.The BCT can result in the same effects as MRM in breast cancer patients with better cosmetic appearances.     

Burn injury and incidence of psychiatric disorders: A retrospective cohort study of 18,198 patients from Germany

AimsThe goal of this study was to investigate the association between burn injury and the incidence of psychiatric disorders in patients followed for up to five years in general practices in Germany.MethodsThis study included patients receiving an initial diagnosis of burn injury in one of 1178 general practices in Germany between 2015 and 2018 (index date). Individuals without burn injury were matched (1:1) to those with burn injury by sex, age, index year, and general practice. For patients without burn injury, the index date was a randomly selected visit date between 2015 and 2018. Study variables included burn injury with body region, psychiatric disorders (i.e. depression, anxiety disorders, reaction to severe stress and adjustment disorders, and somatoform disorders), sex, age, and the Charlson Comorbidity Index. The association between burn injury and the incidence of psychiatric disorders was studied using Kaplan–Meier curves and multivariable Cox regression models.ResultsThe study included 9099 patients with and 9099 patients without burn injury (53.8% of subjects were women; mean [standard deviation] age was 45.4 [18.5] years). After five years of follow-up, 29.4% of patients with burn injury and 26.2% of those without burn injury were diagnosed with any psychiatric disorder (log-rank p-value < 0.001). Furthermore, there was a positive and significant association between burn injury and the incidence of psychiatric disorders (hazard ratio = 1.32, 95% confidence interval = 1.22–1.43).ConclusionsBurn injury was positively associated with the incidence of psychiatric disorders in individuals followed for up to five years in general practices in Germany.     

乳腺癌保乳治疗的临床研究

目的探讨早期乳腺癌保乳综合治疗的疗效及可行性。方法将189例Ⅰ、Ⅱa期乳癌患者前瞻性非随机分为两组：（1）保乳组：92例行乳腺区段切除加腋窝淋巴结清扫术;（2）对照组：97例行乳癌改良根治术。两组术后均给予相同方案的放疗、化疗和内分泌治疗,术后进行定期随访,并进行美容评估。结果本组178例得到随访,随访率94.2%,中位随访时间为78个月。局部复发：保乳组3例,对照组1例。保乳组3年存活率97.7%,5年存活率94.1%,远处转移率7.9%。对照组3年存活率97.8%,5年存活率90.8%,远处转移率7.9%,两组局部复发和远处转移差异均没有统计学意义,两组3、5年生存率差异应用log-rank检验无统计学意义（P〉0.05）。COX比例风险模型分析发现年龄、ER、PR情况不是影响生存的风险因素,TNM分期与生存率有关。85.5%患者对保乳手术的美容效果满意。结论对早期乳癌使用保乳综合治疗可达到传统根治术相当的治疗效果,应作为早期乳癌的首选治疗方法。     

早期乳腺癌保留乳房和切除乳房的疗效观察

目的　评价早期乳腺癌保留乳房和切除乳房两种治疗方法的疗效。方法　 14 8例早期乳腺癌患者分保留乳房组 (保乳组 ,n =46 )和切除乳房组 (切乳组 ,n =10 2 )。前者行乳房的局部切除加腋淋巴结清扫 ,后者行乳房改良根治术。结果　 139例患者获得随访 ,随访期 3～ 13年。两组 3年、5年、10年的生存率分别为 10 0 %、87.88%、73.6 8%和 10 0 %、85 .92 %、75 .0 0 % ,局部复发率分别为 6 .98%、9.0 9%、5 .2 6 %和 7.2 9%、8.45 %、7.5 0 % ,远处转移率分别为 2 .33%、12 .12 %、10 .5 3%和 3.13%、12 .6 8%、12 .5 0 %。两组各指标差异无显著 (P >0 .0 5 ) ;而保留乳房组手术创伤小 ,乳房美观满意率 81.4% ,与后者相比差异有显著性 (P <0 .0 1)。结论　与乳房的改良根治术相比 ,乳房的局部切除腋淋巴结清扫加根治性放疗对于早期乳腺癌疗效可靠 ,生活质量提高 ,是一种安全、有效的方法 ,但应有严格适应证。     

Breast conservative surgery for well-differentiated ductal intraepithelial neoplasia: Risk factors for ipsilateral breast tumor recurrence

RationalWe retrospectively analyzed 232 patients affected by well differentiated ductal intraepithelial neoplasia (DIN1c or DCIS G1) treated with conservative surgery without adjuvant radiotherapy.Results25 invasive and 18 non-invasive local recurrences were observed (median follow-up 80 months; 5-year cumulative incidence: 12.2%). Seven of the 15 young patients (<40 y) developed local recurrence (2 in situ, 5 invasive). Age <50 (HR 1.89, 95% C.I. 1.01–3.45), multifocality (HR 3.21, 95% C.I. 1.46–7.06), Ki-67 > 7% (HR 2.33, 95% C.I. 1.20–4.55) and surgical margins <10 mm (HR 2.00, 95% C.I. 1.06–3.76) were significantly associated with an increased risk of local recurrence.ConclusionsYoung age, multifocality and small margins appeared as clear risk factors of local recurrence in DIN1c (DCIS G1) population. The presence of multiple poor prognostic features warrant a thorough discussion regarding local treatment.     

乳腺癌保乳术后乳房畸形修复手术的选择

目的 探讨保乳术后继发乳房畸形的原因及预防方法,以及根据乳房畸形的不同程度采用不同方法进行修复重建的治疗效果.方法 选择行乳腺癌保乳术后1年以上,化疗及放疗结束半年以上,无局部复发及远位转移,患侧乳房出现继发畸形,要求修复重建患者30例,对患侧乳房进行瘢痕切除、挛缩松解,并根据组织缺损的不同程度,选择不同的方法进行修复重建,7例应用局部乳腺瓣法,21例应用背阔肌肌皮瓣法,2例采用横行腹直肌肌皮瓣法.结果 术后乳房形态及手感良好,优23例(76.7％),良7例(23.3％).术后所有患者平均随访约2.5年,目前均处于无瘤生存状态.结论 保乳术后继发乳房畸形,可根据畸形不同程度,选择不同方法进行修复重建,修复重建后乳房形态良好.     

早期乳腺癌行保乳手术临床分析

目的观察早期乳腺癌保乳手术的治疗效果。方法分析2000—2005年临床0～Ⅱa期女性乳腺癌患者中87例行保乳手术的疗效。采用肿瘤局部扩大切除或象限切除，以及腋淋巴结清扫，术后辅以放疗、化疗或内分泌治疗。残留腺体做阶梯状对缝，以保证乳晕部的隆起。结果保乳手术后乳房外形总满意率为93．6％，无伤口感染，无皮瓣坏死、皮下积液。随访结果局部复发率1．15％，无远处转移，无死亡病例。结论保乳手术创伤小、并发症少、恢复快、形体改变小，疗效满意，病人心理状态良好，生存质量较高。     

A nationwide,multicenter retrospective study on the effectiveness and safety of eribulin in Korean breast cancer patients (REMARK)

PurposeApproval of eribulin for metastatic breast cancer was based on data primarily from Western patients, and there is a paucity of data on the effectiveness and safety of eribulin for Asian patients. To determine the effectiveness and safety of eribulin in Korean women with breast cancer in a real-world setting, we conducted a nationwide, multicenter, retrospective study.MethodsPatients with locally advanced or metastatic breast cancer who were treated with eribulin in 14 centers throughout Korea were included in this study. Eribulin was generally administered at a dose of 1.23 mg/m² (equivalent to 1.4 mg/m² eribulin mesylate) by intravenous infusion for 2–5 min, or as a diluted solution, on Days 1 and 8 of every 21-day cycle. The primary endpoint was progression-free survival (PFS) rate at 6 months. Secondary endpoints included median PFS, overall survival (OS), time-to-treatment failure (TTF), tumor response rate, and incidence of hematologic treatment-emergent adverse events (TEAEs).ResultsThe safety and full analysis populations included 398 and 360 (38 had no efficacy data) patients, respectively. The PFS rate at 6 months was 37.8%. Median PFS, OS, and TTF were 134, 631, and 120 days, respectively. Objective response rate, clinical benefit rate, and disease control rate were 18.1%, 50.6%, and 49.4%, respectively. Hematologic TEAEs were reported in 65.1% of patients; neutropenia (56.8%) and anemia (11.3%) were most common.ConclusionReal-world effectiveness and safety of eribulin in Korean breast cancer patients were consistent with previous reports; no new safety concerns were identified.