早期乳腺癌保乳手术196例回顾性分析

目的：通过与改良根治术比较,探讨乳腺癌保乳手术的临床疗效。方法：回顾性分析广西医科大学第九附属医院自2001年9月—2006年9月早期乳腺癌患者196例,其中实施保乳手术96例,改良根治术100例,并对两者的临床资料进行研究,对比两组的切口长度、术中出血量、手术时间、术后住院天数、美容效果满意率、术后并发症及远期生存率。结果：保乳组切口长度、术后住院天数、手术时间、术中出血量、明显小（少）于改良组（P〈0.01）,美容效果满意率明显高于改良组（P〈0.01）;两组的生存率差异无统计学意义（P〉0.05）;保乳组术后发生3例皮下积液,改良组发生6例并有4例发生皮瓣坏死。中位随访时间61个月。两组5年的无病生存率分别为94%和96%,局部复发率分别为2%和1%。结论：早期乳腺癌行保乳治疗是安全可靠的,但必须掌握保乳手术指征并保证术后综合治疗。     

保乳手术治疗早期乳腺癌患者的临床应用价值

目的 探讨保乳手术对早期乳腺癌患者的应用价值.方法 回顾性分析2018-09—2020-03汝州市中医院普外科收治的84例早期乳腺癌患者的资料.根据手术方法分为保乳手术组和改良根治组,各42例.比较2组患者的基线资料、术中情况和术后临床指标.统计随访1 a期间的复发率、转移率.末次随访依据FACT-B量表评估患者的生存...     

早期乳腺癌保乳手术与改良根治术的对比研究

目的探讨保乳手术与改良根治术对早期乳腺癌的治疗效果。方法回顾性分析86例早期乳腺癌患者的临床资料,比较两组患者术后生存率、复发率、转移率及焦虑和对美容效果的满意度。结果改良根治术和保乳手术后患者的3、5、10年生存率、复发率和转移率差异无统计学意义,而保乳手术组患者术后1年的焦虑情况显著低于改良根治术组,美容效果显著优于改良根治术组。结论保乳手术能够取得与改良根治术相似的治疗效果和远期疗效,且能够满足女性形体美的要求,患者的满意度高,值得临床推广应用。     

比较改良根治术和保乳术治疗早期乳腺癌患者的效果

目的比较改良根治术和保乳术治疗早期乳腺癌患者的效果。方法选取2014-09-2018-09间收治的308例早期乳腺癌患者的病历资料进行回顾性分析。结果保乳组的手术时间、切口长度、术中出血量、引流量以及术后住院时间、生活质量评分等指标,均优于改良根治组,差异有统计学意义(P<0.05)。2组术后1 a的复发率、转移率、生存率及并发症发生率差异无统计学意义(P>0.05)。结论对早期乳腺癌患者采用保乳术,可获得与改良根治术相同的效果,且创伤小、恢复快、对患者生理功能及美观影响较小。     

早期乳腺癌保乳手术64例临床效果观察

目的对早期乳腺癌保乳手术的方法和效果进行探讨。方法选择32例接受保乳手术的早期乳腺癌患者为观察组,选择同期行改良根治术的32例早期乳腺癌患者为对照组。比较2组患者的近期效果、术后3 a存活率和对乳房外观的满意度。结果观察组手术时间、术中出血量、术后住院时间及对乳房外观的满意度均优于对照组,差异有统计学意义(P0.05)。术后随访3 a,观察组31例患者无病生存(96.8%),1例患者在术后2 a局部复发,接受改良根治术,存活至今。对照组32例患者均无病生存(100.0%),2组差异无统计学意义(P0.05)。结论在严格掌握手术适应证的前提下,对早期乳腺癌患者实施保乳手术,创伤小、患者术后恢复快,远期效果好,且能保留患者乳房完整形态,改善患者术后生活质量。     

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.     

综合保乳治疗浸润性乳腺癌

乳腺癌治疗方法是随着对乳腺癌生物学特性认识的不断加深而步步更新的。从1894年William Halsted的“乳腺癌是局部进展疾病”的理论，到现在广为接受Fiher的“乳腺癌是全身性疾病”的理论。每一次乳腺癌生物学理论的完善都推动着乳腺癌治疗方式的巨大变化。目前．乳腺癌的治疗已经从Halsted根治术、扩大根治术等乳腺癌的单一局部手术治疗发展到现在的综合保乳治疗。     

保乳手术与改良根治术治疗早期乳腺癌的临床比较

目的比较保乳手术与改良根治术的优势。方法采用前瞻性研究方法,选择2016年10月~2018年12月就诊于本院并接受相应治疗的早期乳腺癌作为研究对象,将患者分为保乳组(n=36)和改良根治组(n=36),观察记录手术相关指标、术后并发症;生活质量并对比分析。结果两组患者基线特征的差异没有统计学意义(P0.05)。保乳组在手术时间、手术出血量、引流量、住院时间、乳房美观性优于改良根治组,比较有统计学意义。两组患者的功能量表评分相比无差异(P0.05),在比较两组疲劳、呕吐、疼痛、失眠、财政困难、乳房症状、脱发症状发生率,差异具有统计学意义(P0.05)。两组经济条件、复发恐惧、形象影响、生育愿望相比存在统计学意义(P0.05),保乳组对复发的恐惧高于根治组(P0.05)。结论保乳手术在治疗早期乳腺癌的手术选择方面具有优势,这符合以往的研究报告。     

乳腺癌的保乳治疗

乳腺癌是女性最常见恶性肿瘤之一,其发病率呈逐年上升趋势.在中国,这种上升趋势更为明显,乳腺癌的发病率已升至女性恶性肿瘤的第一或第二位,严重危害广大妇女的身心健康.     

早期乳腺癌36例行保乳手术治疗体会

目的 总结早期乳腺癌施行保留乳房的根治术的治疗效果。方法 分析2002年1月～2005年12月我科选择开展的保乳手术的36例乳腺癌Ⅰ、Ⅱa患者的近期治疗效果。结果 本组患者均行保留乳房的乳腺癌根治术，术后联合化疗、放疗、内分泌治疗均获得较满意的效果。结论 早期乳腺癌行保乳手术联合放、化疗可达到与传统根治手术相同的近期效果，并具有患者心理打击小、美容效果好的优点。     

隐匿性乳腺癌12例临床分析

目的 探讨隐匿性乳腺癌(occult breast cancer,OBC)的诊断、治疗和愈后.方法 回顾分析首都医科大学附属大兴区人民医院与首都医科大学附属北京同仁医院1995年6月～2006年6月共12例OBC临床资料.结果 本组OBC共12例女性患者,平均年龄52.7岁,均单侧发病,绝经前4例,绝经后8例;左侧病变1O例,右侧病变2例,占同期诊治各型乳腺癌患者0.5%(12/2385);12例均以腋下肿块为首发症状;10例行腋下肿块切除活检证实淋巴结转移性腺癌,2例术前行细针穿刺检查为淋巴结转移性腺癌;12例中3例行淋巴结转移性腺癌的雌激素受体(estrogen receptor,ER)测定,均为阳性;10例术前行乳腺X线钼靶照相检查,2例可见有细小钙化灶,不除外乳腺癌;11例行乳腺B超检查、10例行近红外线扫描,均未发现乳腺内病灶;10例术前胸片、腹部B超,5例胸腹部CT及全身骨扫描和2例胃镜检查未发现全身其他部位病变;10例行乳腺癌改良根治术,1例行乳腺癌根治术,1例患者行姑息手术;9例术后病理检查发现乳腺原发病灶,浸润性导管癌6例、导管内癌3例;术后均予以放射治疗和化疗;3例雌激素受体阳性患者化疗后接受口服三苯氧胺内分泌治疗;随访3～10年,11例均生存且未见复发或转移,1例死亡,其中5例已生存5年以上,5年生存率为41.66%(5/12).结论 OBC是临床较为少见的特殊类型乳腺癌之一;左侧乳腺多见,比一般原发癌浸润能力强,早期即出现腋窝淋巴结肿大或远处转移;对肿大淋巴结进行细针穿刺细胞学检查或切除行组织学检查有助于诊断;乳腺癌改良根治术为常用治疗方法.     

A new method of modified radical mastectomy for breast cancer

We have developed a new type of modified radical mastectomy, the method and clinical results of which are reported herein. In this operation, axillary dissection is performed by the following two approaches. Firstly, the axillary contents are dissected from the highest possible subclavicular point to the pectoralis minor muscle, after partially cutting the sternocostal origin of the pectoralis major muscle. The second approach is from the posterior aspect of the pectoralis minor muscle to the lateral portion of the latissimus dorsi muscle. Parasternal dissection can also be performed for stage II and IIIa cancers with a central or medial tumor. After lymph node dissection, the detached edge of the sternocostal origin of the pectoralis major muscle is resutured to cover the parasternal region. Thus, complete dissection of the axillary nodes is performed whilst preserving the pectoralis major and pectoralis minor muscles. Good clinical results were achieved with respect to radicality, cosmetic effects and function in 28 patients with stage I, II and IIIa breast cancers who were followed up for between 5 to 8 years. This new operation may therefore be adopted for the majority of patients with Stage I, II, or IIIa cancers, unless massive infiltration into the pectoralis major muscle has occurred. Preservation of both the pectoralis major and pectoralis minor muscles results in a good cosmetic appearance, good functioning of the arm and easy reconstruction of the breast following mastectomy.     

保乳手术与改良根治术治疗乳腺癌的体会

【摘要】 目的 探讨保乳手术与改良根治术治疗乳腺癌的临床效果。方法 对我院从2005年1月到2007年6月期间乳腺癌治疗的临床资料进行回顾性分析。选择60名经手术治疗的乳腺癌患者,分为观察组和对照组,每组各30例,对照组给予改良根治术治疗,观察组给予保乳手术治疗,随访5年观察临床效果。 结果 观察组患者在手术时间、住院时间、术中出血量及并发症发生率方面明显优于对照组(P<0.05)。两组5年生存率比较差异无统计学意义(P>0.05)。结论 保乳手术治疗乳腺癌的效果确切,优点多,临床医师应根据患者的适应证合理应用。     

Patterns of breast reconstruction in patients diagnosed with inflammatory breast cancer: The Dana‐Farber Cancer Institute's Inflammatory Breast Cancer Program experience

Inflammatory breast cancer (IBC) exhibits dermal lymphatic involvement at presentation, and thus, the standard surgical approach is a nonskin‐sparing modified radical mastectomy (MRM) without breast reconstruction (BR). In this study, we evaluated immediate and delayed BR receipt and its outcomes in IBC. Using an IRB‐approved database, we retrospectively evaluated stage III IBC patients who received trimodality therapy (preoperative systemic therapy, followed by MRM and postmastectomy chest wall/regional nodal radiation). Patients with an insufficient response to preoperative systemic therapy and/or who required preoperative radiotherapy were excluded. BR receipt, timing, and morbidity were evaluated. Among 240 stage III IBC patients diagnosed between 1997 and 2016, 40 (17%) underwent BR. Thirteen (33%) had immediate, and 27 (67%) had delayed BR. Four patients had complications (1 [8%] immediate BR and 3 [11%] delayed BR); only 1 BR (delayed) was unsuccessful. From the MRM date, the median time to recurrence was 35 months (<1‐212) and median overall survival was 87 months (<1‐212). In this cohort of stage III IBC patients, only 11% pursued delayed BR following trimodality therapy, possibly attributable to the observed high recurrence rates hindering BR. Further studies addressing BR outcomes in IBC are needed for better counseling patients regarding their reconstructive options.     

Accelerated partial breast irradiation—Redefining the treatment target for women with early stage breast cancer

Following breast conserving surgery, the standard of care has been to deliver adjuvant radiation therapy directed to the whole breast (WBI) over a period of 3‐7 weeks. Over the past decade, increasing data have supported the concept that treatment to the whole breast may not be required in selected patients, allowing for the emergence of partial breast irradiation (PBI). Multiple randomized trials with 5‐10 years of follow‐up have been published documenting the safety and efficacy associated with PBI using multiple techniques. Questions that remain to be answered include (a) what is the optimal PBI technique for each clinical scenario, (b) are there additional patients that can be effectively managed with PBI approaches, and (c) are there different techniques/dose schedules that allow for further reduction in treatment duration and/or toxicities? Partial breast irradiation represents a standard approach for appropriately selected patients. PBI provides comparable clinical outcomes to WBI while allowing for a reduction in the duration treatment and the potential for reduced toxicities. Future studies may also help to better define which patients require no radiation, PBI, hypofractionated WBI or conventional WBI, based upon patient, clinical, pathologic features as well as potentially using tumor genetics.     

乳腺癌保乳手术切缘问题

尽管外科医生普遍认为保乳手术切缘应该是没有肿瘤细胞的干净切缘,而肿瘤残留将可能增加局部复发概率,甚至增加病死率;但是由于保乳手术在各个国家地区的做法不同及切缘评估方法的差异,至今无保乳手术中有关安全切缘宽度的共识或指南。保乳手术应该保证切缘无瘤,否则肿瘤的残留将使得一个根治性的手术人为转变成为姑息手术及活检手术;将随后的辅助治疗人为转变成为解救治疗。