乳腺癌保乳手术中乳房缺损的修复方法

目的综述乳腺癌保乳手术中乳房缺损的修复方法。方法分析近年来相关文献,对有关乳腺癌保乳手术中乳房缺损的修复方法、适应证、切口选择以及优缺点进行分析。结果保乳手术后部分患者存在乳房畸形,美容效果不佳。如何选择手术切口、怎样修复肿瘤切除后的乳房缺损,以获得较好的美容效果是外科手术中的焦点问题。将乳房整形技术应用于保乳手术,可明显改善美容效果。结论选择合适的早期乳腺癌患者采用乳房整形技术进行保乳手术治疗,安全、有效,术后患者对乳房外形及整体美容效果满意度高,是值得推荐的一种技术。     

乳房整形术用于中青年早期乳腺癌保乳术后的效果及对患者生命质量的影响研究

目的:探讨乳腺外科整形修复术应用于早期中青年乳腺癌保乳手术患者的效果及对患者婚姻质量、创伤反应影响.方法:选取2018年6月-2020年3月笔者医院100例早期青年乳腺癌患者,根据手术方案分组,各50例.对照组行保乳手术,实验组行保乳手术+乳腺外科整形修复术.观察两组围术期情况、并发症、乳房美容效果及手术前后肿瘤标志物...     

乳房整形技术在乳腺癌保乳手术中的应用效果分析

目的：探究分析在乳腺癌保乳手术当中,乳房整形手术的应用临床效果。方法：选自我院2010年～2012年收治的在保乳手术当中应用乳房整形手术的患者共50例,对其,I盘床资料进行回顾性分析,对患者术后美容效果进行调查。结果：全部患者均成功完成手术,术后对患者进行随访,随访时间为（6～12）个月,无患者出现局部或者区域淋巴结肿瘤复发迹象;患者手术后乳房美容效果优良率为92％（46／5O）。结论：乳腺癌患者可以通过乳房整形技术进行保乳治疗,该手术方法有着安全高效的优点,手术之后患者乳房外形以及整体美容整体满意程度较高,值得临床推广。     

整形保乳手术和即刻乳房再造术在早期乳腺癌的临床应用

评估乳房整形术和即刻乳房再造术对早期乳腺癌手术患者乳房美容的效果。回顾性分析我院2013年1月—2015月12月收治的100例早期乳腺癌手术患者的资料,根据是否应用乳房整形手术将患者分为乳房整形组和传统手术组,每组各50例。比较2组术后复发率、局部转移率和术后18个月生存率,以及术后乳房美容主观满意度、术后乳房美容效果。2组术后复发率和局部转移率、术后生存率比较,差异无统计学意义(P>0.05);乳房整形组患者术后乳房美容主观满意度和术后乳房美容效果明显高于传统手术组,差异具有统计学意义(P<0.01)。对早期乳腺癌手术患者行整形保乳术和即刻乳房再造术,在尽可能多的切除肿瘤及其周边组织的同时,尽可能保留和恢复乳房的外形和对称性,提高了乳房外观美容效果。使部分肿瘤病灶位置特殊的患者获得保乳机会,不能保乳者可行即刻乳房重建,对保持乳房外观和女性形态美、减轻患者精神负担具有重要意义。     

整形保乳术治疗乳腺癌的美容效果及预后分析

探讨整形保乳术治疗乳腺癌的美容效果及对预后的影响。选取我院拟实施保乳手术治疗的72例乳腺癌患者,采用随机数字表法分为整形组(行整形保乳术治疗)和常规组(行常规保乳手术治疗),每组各36例,对比两组手术时间、出血量、切除标本体积、切除标本最小手术切缘、切除标本最大手术切缘、乳房美容效果客观评分满意度、术后3年复发及转移情况。整形组出血量与常规组差异无统计学意义(P0.05);整形组手术时间、切除标本体积、切除标本最小手术切缘、切除标本最大手术切缘均大于常规组(P0.05);手术后6个月,整形组患者的乳房对称性、凹陷程度、手术瘢痕、乳头纵向移位距离、乳头横向移位距离、乳房顺应性差值评分均高于常规组(P0.05),整形组的乳房质地与弹性、皮肤弹性评分与常规组差异无统计学意义(P0.05);手术后3年,整形组患者肿瘤复发率、肿瘤转移率与常规组比较,差异无统计学意义(P0.05)。整形保乳术治疗乳腺癌较常规保乳手术术后具有更好的美容效果,且不会增加肿瘤复发及转移的概率。     

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。     

早期乳腺癌保乳综合治疗临床疗效观察

目的:探讨早期乳腺癌保乳综合治疗的临床治疗效果和对乳房美容效果的影响.方法:回顾分析32例早期乳腺癌患者的临床资料,所有病例均经病理证实,择期在全身麻醉下行保乳手术,术后辅助放疗、化疗及内分泌治疗,评价手术疗效及美容效果.结果:32例保乳术患者均成功进行了手术,术后预后良好,随访5年,无一例死亡,无一例局部复发或出现远处转移,保乳手术后患者美容效果满意率为86.57%.结论:早期乳腺癌患者行保乳综合治疗,临床效果确切可靠,并取得满意的美容效果.     

肿瘤整形技术在早期乳腺癌保乳手术中的临床应用

目的:探讨肿瘤整形技术应用于早期乳腺癌保乳术的疗效及安全性。方法:回顾性分析2011年8月—2016年8月139例应用肿瘤整形技术进行保乳手术治疗的I~II期乳腺癌患者临床资料,并与同期1 271例行乳腺癌改良根治术的I~II乳腺癌患者的远期效果比较。结果:139例患者中,133例采用体积易位技术(局部腺体组织瓣转移修补法)进行保乳手术,其中45例同时接受对侧缩乳术,6例采用体积置换技术(自体组织移植修补法);78例行前哨淋巴结活检术,61例接受腋窝淋巴结清扫术。139例乳腺癌患者切除组织标本重30~187 g,平均69.5 g;美容效果评定结果为优秀79例(56.8%)、良好47例(33.8%)、一般10例(7.2%)、差3例(2.2%)。术后随访时间为3~63个月,平均28.8个月;与行改良根治术的患者比较,行肿瘤整形保乳术患者的术后2年局部复发率(4.3%vs.4.1%),总生存率(95.7%vs.95.5%),无病生存率(85.6%vs.85.3%)均无统计学差异(均P0.05)。结论:应用肿瘤整形技术对早期乳腺癌进行保乳手术具有较好的肿瘤学安全性和满意的美容效果,远期效果与改良根治术相当。选择适合的病例和合理的整形技术,是肿瘤整形保乳术取得最佳的术后效果的关键。     

乳腺癌保乳术联合巨乳缩小整形技术的临床应用

目的探讨乳腺癌保乳手术联合巨乳缩小技术的临床效果及意义。方法自2016年10月至2018年12月,乳腺外科与乳房整形修复外科实施联合手术对11例单侧乳腺癌患者采用乳腺癌保乳术联合巨乳缩小术治疗,并对术后临床效果进行总结分析。结果 11例均采用单侧乳腺癌保乳术加双侧巨乳缩小术。其中1例行前哨淋巴结活检术,10例行腋窝淋巴结清扫术。中位随访时间13.1个月(2～26个月),随访期内无远处转移和局部复发,患者对术后效果较满意。结论对于单侧乳腺癌同时伴有巨乳症状的患者,通过保乳手术联合巨乳缩小术,不仅达到了切除肿瘤的目的,同时改善了巨乳症状带来的困扰,术后可获得较好的美容效果,亦提高了患者的生活质量。     

新辅助化疗后乳腺癌保乳手术中利用肿瘤整形技术的临床应用效果

目的探索新辅助化疗后乳腺癌保乳手术中利用肿瘤整形技术的临床应用效果。方法回顾性分析2016年5月至2018年5月期间河南省肿瘤医院乳腺科收治的32例接受新辅助化疗后行保乳手术的女性原发性乳腺癌患者(cT2–3N0–3M0)的临床病理资料,32例患者均因肿瘤较大或肿瘤位置不能直接行传统保乳手术。观察新辅助化疗后肿瘤降期同时结合肿瘤整形技术行保乳手术的成功率、安全性及美容学效果。结果本组32例患者新辅助化疗后,31例达到完全缓解或部分缓解,1例患者疾病稳定。全部保乳成功,其中3例患者进行保乳联合容积置换,29例进行保乳联合容积移位。术后仅1例患者对美容效果不满意,余患者对美容效果均满意或基本满意。中位随访时间为18个月(5～24个月),32例患者均未出现局部复发及远处转移。结论通过新辅助化疗后肿瘤降期联合肿瘤整形技术,可以使一些原本因为肿瘤较大及肿瘤位置不适合保乳的患者成功保乳,同时安全性和美容学效果均较满意。     

“双环法”乳房整形治疗乳房肥大及乳房下垂对乳房形态以及松弛度的影响

目的 探讨“双环法”乳房整形治疗对乳房肥大及乳房下垂患者乳房形态和松弛度的影响。 方法 选取我院2014年1月-2022年6月收治的100例乳房肥大及乳房下垂患者为研究对象，使用随机数字表 法将其分为对照组和观察组，每组50例。对照组采用常规治疗，观察组在对照组的基础上采用“双环法” 乳房整形治疗，比较两组乳房形态及乳房大小、乳房对称性、乳房松弛度。结果 观察组乳房形态优良率 为98.00%，高于对照组的86.00%，差异有统计学意义（P＜0.05）；观察组治疗后乳房大小、乳房对称性、 乳房松弛度评分均高于对照组，差异有统计学意义（P＜0.05）。结论 采用“双环法”乳房整形治疗乳房 肥大及乳房下垂患者的效果确切，不仅可以有效提高乳房形态优良率，还可以改善其乳房大小、乳房对称 性和乳房松弛度。     

Routine Operative Breast Endoscopy During Lumpectomy

Background: Lumpectomy for the management of breast cancer is commonly directed by mammography or ultrasound. We hypothesized that fluid-producing ducts would likely connect to the site of the known cancerous or precancerous lesion and that endoscopic evaluation might reveal unsuspected additional disease.Methods: All women undergoing lumpectomy in a single surgeon practice from January 2000 to August 2001 were evaluated for fluid production from the nipple at the time of lumpectomy. All fluid-producing ducts were cannulated and endoscoped with a 0.9-mm Acueity microendoscope.Results: Of the 201 patients (16 with atypical ductal hyperplasia, 52 with ductal carcinoma-in-situ, and 133 with stage 1 or 2 breast cancers), 150 (74.6%) could be successfully dilated and scoped. Additional lesions outside the anticipated lumpectomy were identified in 41% (n = 83) of cases. If successful, the chances for a positive margin for cancer decreased from 23.5% to only 5.0%. Endoscopy proved to be a useful adjunct in this series of patients because it identified all cases of extensive intraductal component in early-stage breast cancer.Conclusions: Routine operative breast endoscopy can reduce the need for re-excision lumpectomy. It also finds substantially more cancerous and precancerous disease than anticipated by routine preoperative mammography and ultrasound.     

整形技术在乳腺癌乳房再造治疗中的应用

乳腺癌作为多发的恶性肿瘤疾病之一,临床常采用手术方式进行治疗。近年来,国内的医学诊 断和治疗技术不断得到提高,乳腺癌的手术诊疗手段也有很大的进展。但由于部分患者切除了病变乳房, 生理及精神均受到不同程度的创伤。因此,整形外科诊疗技术在乳腺癌治疗中被广泛使用,在解决患者癌 症病灶的同时能够兼顾患者的生理形态美,保证患者生活质量。基于此,本文就乳房再造术、乳房重建手 术类型及其辅助技术作一综述,旨在为乳腺癌患者的相关手术治疗提供参考     

Outcome Assessment of Breast Distortion Following Submuscular Breast Augmentation

Background  Animation deformity or breast distortion during pectoralis muscle contraction following subpectoral breast augmentation is a known entity, but its prevalence and significance remain unclear. The purpose of this study was to identify the incidence and severity of animation deformity as well as its effect on patient satisfaction and interference with certain activities. Methods  All procedures were performed by the senior author using a variation of a previously described dual-plane technique. The first part of this study was an evaluation of breast distortion by a group of independent observers in a series of 40 consecutive patients who underwent primary subpectoral breast augmentation. The second part of the study was a questionnaire sent to 195 consecutive patients asking about overall satisfaction, degree of animation deformity, and whether there was interference with any activities. Results  Of the 40 patients’ photographs that were evaluated, 9 (22.5%) had no distortion, 25 (62.5%) had minimal distortion, 4 (10%) had moderate distortion, and 2 (5%) had severe distortion. Of the 195 questionnaires, there were 69 responses, a 35% response rate. Fifty-six (82%) described mild to no distortion, 7 (10%) were moderate, and 5 (7%) were severe. According to the survey, the most common activities that were problematic were lifting weights and exercising (24 and 19%, respectively). Only one (1%) patient stated that she would not recommend subpectoral positioning. Conclusion  Although animation deformities do exist, nearly all patients in this study would still choose subpectoral positioning. Patients who may be better candidates for subglandular placement are those for whom exercise is central to their daily living. As a result of this study, surgeons and patients should have more accurate and reliable information regarding the significance of animation deformity after subpectoral breast augmentation. S. L. Spear is a paid consultant to Lifecell Corporation, Ethicon Inc., and Allergan, Inc. This study was conducted without any funding.     

乳腺癌转移抑制基因1抑制乳腺癌转移的作用机理研究进展

目的综述乳腺癌转移抑制基因1（BRMS1）在抑制乳腺癌转移中的作用机理研究进展。方法采用文献回顾的方法，对目前国内、外有关BRMS1在乳腺癌中的研究状况加以分析与综述。结果BRMS1与其他肿瘤转移抑制基因一样，主要抑制肿瘤的转移，并不影响肿瘤的生长，在乳腺癌中主要通过调节细胞间的信号转导及其他转移抑制基因的表达而抑制乳腺癌的转移。结论对BRMS1基因的深入研究有助于进一步深化对乳腺癌转移的认识，为肿瘤转移的分子诊断和基因治疗提供新的思路。     

Another Look at Breast Projection After Breast Reduction

A controversy exists between vertical mammoplasty and the “traditional” keyhole\inferior pedicle method of breast reduction. This article examines factors affecting breast projection by considering the difference in concept between vertical mammaplasty (using the modification proposed by Hall-Findley as an example) and the inferior pedicle\keyhole pattern. This article is not about “how to do” but rather about “why” things are done in a certain way. The emphasis is on understanding what is done and its effects rather than on technique. The breast can be considered a cone. Breast projection then is the ratio between the nipple projection and the breast base. Two key concepts need to be considered: the orientation of the ellipses during excision of breast tissue in breast reduction and the role of the breast base\inframammary fold. Breast projection is not determined by the scars. After an examination of each technique, methods to enhance projection are discussed.     

乳腺密度与乳腺癌保乳手术后复发风险的关系

目的探讨乳腺X密度等级与乳腺癌保乳术后复发风险的关系。方法 2002年1月～2005年7月,180例接受保乳手术的乳腺癌在术后5～8年(平均6.1年)进行随访,对术前X线乳腺钼靶像按照BI-RADS标准,以乳腺百分密度分为25%、25%～50%、51%～75%、75%4个等级,以包含乳腺密度在内的11个相关因素做单因素分析筛选出有意义的影响因素再进行logistic回归多因素分析,评价乳腺密度与乳癌保乳术后复发的关系。结果 logistic回归多因素分析显示术后放疗和乳腺密度是术后复发的影响因素(Waldχ2=9.429,P=0.002;Waldχ2=9.346,P=0.002);4个密度组的复发率依次为6.2%(3/48)、12.0%(6/50)、11.6%(5/43)、28.2%(11/39),乳腺密度越高,局部复发风险越大。乳腺密度不是术后转移的影响因素(Waldχ2=2.944,P=0.400),各密度组间远处转移率依次为16.7%(8/48)、14.0%(7/50)、7.0%(3/43)、7.7%(3/39),远处转移风险不随乳腺密度增高而加大。术后化疗和腋窝淋巴结转移是术后转移的影响因素(Waldχ2=4.334,P=0.037;Waldχ2=4.417,P=0.036)。结论乳腺密度与乳腺癌保乳术后复发有相关性,但不是术后远处转移的危险因素。     

Minimal-Scar Breast Reduction and Mastopexy

Background Classic breast reduction and mastopexy techniques leave a vertical scar, but are difficult to apply in cases requiring a large amount of breast tissue removal. This report describes a new breast reduction technique using a vertical incision for resections involving less than 600 g of tissue removal and an inverted T incision for larger resections. Results for the new technique are reported.Methods For 800 women, the reported technique was used for reduction mammaplasty (n = 640) and mastopexy (n = 160). Peridural anesthesia was used for 90% of the patients, and general anesthesia for 10%. The minimum follow-up period was 6 months for 90% of the patients. All the patients underwent mammary x-ray and ultrasonography before surgery.Results A short scar was obtained for all the patients. A new intervention for breast reduction was chosen by 16 patients (2%). For all the patients followed, the immediate results (projection of the areola and upper pole) remained unaltered at a late follow-up evaluation. There were no cases of infection or seroma. Hematoma occurred in 8 patients who underwent unilateral breast reconstruction, and 16 patients experienced temporary reduced sensitivity.Conclusions The new technique was effective in leaving a short scar and maintaining immediate results in the long term. Liposuction limited to the lateral chest wall prevented complications associated with breast tissue.