老年乳腺癌203例外科治疗分析

目的评价老年妇女乳腺癌的手术效果，并重视其外科问题。方法分析并复查２０３例临床和随访资料。结果本组２０３例女性患者均进行手术。以改良根治术为主共９６例，占４７％；根治术５２例；扩大根治术５例；全乳切除术３９例；姑息性手术６例；电化疗术５例。本组术后３年、５年生存率分别为７７．２％和６８．２％。合并症７１％，术后并发症发生率１６．３％，术后死亡率１．５％。结论（１）老年乳腺癌经手术可改善生活质量，并有较高生存率，高龄并非是手术禁忌证。（２）内外科配合，重视并处理好合并症和术后并发症。（３）对每个患者应采取合适的术式和麻醉方法，术后精心护理。     

青年和老年乳腺癌改良根治术患者术后并发症对比

现阶段在我国乳腺癌治疗包括手术治疗、辅助化学治疗、内分泌治疗、放射治疗及生物治疗,其中手术治疗为主要治疗手段之一且以改良根治术为主.乳腺癌改良根治术范围相对较广,创伤大,而老年患者心肺及各器官功能减退,对手术及麻醉耐受相对较差[1],术后极易出现各种并发症,由于老年生理功能减退,且多合并基础疾病,手术风险较大.本文通过对行乳腺癌改良根治术的老年和青年女性患者并发症进行回顾性分析,来探讨其围术期护理及术后并发症防治.     

老年乳腺癌的流行病学研究及其对行根治性手术治疗患者生存期的影响

目的探讨老年乳腺癌的流行病学特征及其对行根治性手术治疗患者生存期的影响。方法选择老年乳腺癌患者150例,收集其一般资料进行老年乳腺癌流行病学研究。给予患者传统根治术或改良根治术治疗,对所有患者进行术后5年随访,统计老年乳腺癌患者根治性手术治疗后5年生存情况。结果老年乳腺癌患者均为女性;65~70岁为老年乳腺癌高发病年龄段占52.67%;肿瘤多为单结节病灶且以浸润性导管癌为主;患者TNM分期多为Ⅱ期;Luminal A为老年乳腺癌主要分子分型占69.33%;临床老年乳腺癌发病率有升高趋势。患者行根治性手术治疗后5年回访率100.00%,术后3年生存率为76.67%,术后5年患者生存率为61.33%;乳腺癌肿瘤病理、TNM分期和分子分型会影响行根治性手术治疗后患者生存期(P0.05)。结论老年乳腺癌临床发病率有上升趋势且多为浸润性导管癌,肿瘤生物学行为好,老年乳腺癌患者预后水平较好。乳腺癌肿瘤病理、TNM分期和分子分型是老年乳腺癌患者根治性手术治疗后生存期的影响因素。     

老年女性乳腺癌72例临床分析

目的探讨老年乳腺癌患者临床特点、手术方式及术后综合治疗选择,探讨老年乳腺癌外科治疗的最佳方案。方法对华东医院自2004年1月至2008年12月收治的72例≥65岁乳腺癌患者的临床资料进行回顾性分析。所有患者均行手术治疗,行乳腺癌改良根治术61例,乳房单纯切除术8例,乳房象限切除术3例。术后行化疗45例,放疗12例,行内分泌治疗患者58例。结果所有患者均顺利度过围手术期。出现皮下积液15例,切口感染2例。无一例出现严重并发症或原有并发症加剧。结论老年乳腺癌患者的治疗应以外科手术为主,辅以化疗和内分泌治疗。年龄并非是手术禁忌证,但应重视并处理好并存疾病。     

乳腺癌改良根治术中保留肋间臂神经的临床价值

目的探讨观察乳腺癌改良根治术中保留肋间臂神经（ICBN）的临床价值。方法将60例拟行乳腺癌改良根治术的乳腺癌患者随机分为实验组（32例）和对照组（28例）。实验组术中保留ICBN,对照组切除ICBN。观察两组上臂内侧感觉功能。结果实验组术后1、3、12个月发生上肢感觉障碍分别为5（15.6%）、2（6.3%）、1例（3.1%）,对照组分别为19（67.9%）、15（53.6%）、11例（39.3%）,两组感觉障碍发生率比较,P均〈0.01,两组术后并发症发生率及癌复发率相比,P〉0.05。结论乳腺癌改良根治术中保留ICBN可明显减少术侧上臂内侧感觉障碍发生率,提高患者的生活质量,且不增加手术并发症的发生率和肿瘤复发率。     

手术治疗老年女性乳腺癌患者的临床特征、术后治疗情况、预后及其影响因素分析

目的分析手术治疗的老年女性乳腺癌患者的临床特征、术后治疗情况、预后以及影响预后的相关因素。方法回顾性分析我院收治的399例65岁以上手术治疗的老年女性乳腺癌患者的临床资料,分析其临床特征、术后治疗情况和预后,对影响老年女性乳腺癌患者预后的因素进行多因素Logistic回归分析。结果老年乳腺癌患者多为65～70岁,单纯左、右乳患病居多,双侧乳患病较少,肿瘤直径多数为2～5 cm,65. 16%无淋巴结转移,分期多属Ⅰ期或Ⅱa期,以浸润性导管癌较为常见,分子类型多为Luminal A型或Luminal B HER-2(-)型。手术治疗后大部分患者能接受辅助治疗(放疗、化疗、内分泌治疗),患者的1年、3年和5年的无病生存率分别为96. 23%、92. 48%和86. 59%,总生存率分别为96. 99%、90. 65%和85. 47%。多因素Logistic回归分析结果显示,肿瘤大小、淋巴结转移、TNM分期、分子分型是影响患者预后的独立因素。结论手术治疗的老年女性乳腺癌病理类型以浸润性导管癌为主,手术治疗后大部分患者能接受辅助治疗,预后较好。肿瘤大小、淋巴结转移、TNM分期、分子分型是影响手术治疗老年女性乳腺癌患者预后的独立因素。     

老年女性乳腺癌127例分析

目的探讨老年女性乳腺癌的临床特点及其治疗方案。方法回顾性分析了1982年8月至2003年8月收治的老年女性乳腺癌的临床资料。结果127例患者中，114例手术治疗，其中95例在全麻或硬膜外麻醉下行乳腺癌根治术、改良根治及单纯乳腺切除术，l9例行肿瘤局部切除术。9例单纯放疗，4例单纯化疗。12例于术后6个月至5年时局部复发，36例在随访4个月至6年时出现肺、肝、骨及脑转移，35例在随访8个月至5年7个月时死于本病，9例死于其他疾病。3、5、10年生存率分别为93．7％、59．3％、58．1％。结论老年女性乳腺癌的l临床治疗应以外科手术为主，内分泌治疗等为辅的综合治疗方案。     

保乳术联合前哨淋巴结活检在老年乳腺癌患者治疗中的应用价值

目的探讨在老年乳腺癌患者治疗中应用保乳术联合前哨淋巴结活检的临床价值。方法随机选取86例老年乳腺癌患者,参照随机数字表法分为两组,每组43例。观察组采用保乳术联合前哨淋巴结活检治疗,对照组行传统根治术治疗,对两组患者的手术基本情况、术后并发症以及美容效果满意度等指标进行对比。结果观察组的围术期各指标显著优于对照组,且并发症发生率为4.65%,低于对照组的20.93%(P0.05)。组间术后美容效果满意度比较,观察组的60.47%明显高于对照组的30.23%(P0.05)。结论在严格把握适应证的基础上,采用保乳术联合前哨淋巴结活检治疗老年乳腺癌患者具有显著效果,可促进术后快速恢复,降低术后并发症,能取得令人满意的美容效果。     

老年维吾尔族女性乳腺癌临床病理特征分析

目的 探讨老年维吾尔族女性乳腺癌临床病理特征.方法 收集自2000年至2007年住院手术治疗的老年维吾尔族女性乳腺癌患者30例,回顾性分析其临床及病理特征,同时与非老年组维吾尔族乳腺癌患者60例作对照.结果 30例老年维吾尔族乳腺癌与非老年组相比,肿瘤部位、病理类型、淋巴结转移及免疫组化无明显差异,但在TNM分期肿块体积,病程方面有差异.结论 老年维吾尔族乳腺癌有其特殊的临床及病理特点,发现较晚,应重视普查筛检和早期诊断,多采取改良根治术及辅助内分泌治疗.     

老年伴心血管病乳腺癌简化根治术护理

目的分析老年伴心血管病乳腺癌简化根治术护理方法。方法选取2013年1月~2015年6月我院收治的老年伴心血管病乳腺癌简化根治术治疗患者120例作为研究对象,随机分为研究组和对照组,各60例。研究组患者给予综合护理干预,而对照组给予常规护理干预,对比两组患者术后并发症发生情况以及护理满意度。结果研究组术后发生并发症的人数显著低于对照组,且研究组护理满意度高达95%,而对照组满意度仅为70%,研究组显著高于对照组,差异有统计学意义(P0.05)。结论对于老年伴心血管病乳腺癌简化根治术患者实施综合护理干预,能有效减少并发症发生情况,提高患者护理满意度,临床具有重要价值,值得进行广泛推广应用。     

乳腺癌改良根治术后皮下积液的预防与处理

目的探讨乳腺癌改良根治术后皮下积液的预防和治疗方法。方法回顾性分析该院2005．01～2010-06156例行乳腺癌改良根治术病例的临床资料,分析皮下积液的发生率及原因。结果156例中12例发生皮下积液,发生率为7．69％。所有病例经穿刺抽液、局部置管持续负压引流后均愈合出院。结论乳腺癌术后皮下积液由多种原因引起,唯有术前、术中及术后合理有效地处理,才能最大限度地减少该并发症的发生。     

Current Status of Breast Reconstruction in Southern China: A 15 Year,Single Institutional Experience of 20,551 Breast Cancer Patients

The study of this study is to assess the current status and trend of the application of breast reconstruction in China.A retrospective review of all patients who had received surgical treatment for breast cancer in the Fudan University Shanghai Cancer Center between January 1999 and June 2014 was performed. The clinicopathological and epidemiological parameters and the follow-up information of each patient were collected.A total of 20,551 patients with 20,974 surgeries were identified. Of those, the rates of patients received mastectomy, breast conserving therapy, and breast reconstruction were 81.2% (17,040 cases), 15.3% (3216 cases), and 3.4% (718 cases), respectively. Skin-sparing mastectomy with autologous breast reconstruction was algate the dominant option for breast reconstruction although a rapid growth in the application of prosthetic reconstructions was observed in recent years. The rates of complications that required reoperation in patients reconstructed with latissimus dorsi myocutaneous flap, pedicled transverse rectus abdominis myocutaneous flap, free flaps, and prosthesis were 1.2%, 8.5%, 11.4%, and 10.5%, respectively, while the revision rates were 0.7%, 6.1 %, 5.3%, and 2.3%, respectively. Multiple regression analysis confirmed that types of surgery did not affect the disease-free survival of breast cancer patients.Skin-sparing mastectomy with breast reconstruction is oncologically safe while achieving satisfactory aesthetic outcomes. Autologous reconstruction remains the most commonly used technique while there is a rapid increase of prosthetic reconstruction in recent years. The low demand for breast aesthetics among Chinese women, defects of healthcare system, and the limited availability of recourses impeded the development of breast reconstruction techniques in China.     

Radical mastectomy in the aged female.

Of 142 female patients over age 75 at The New York Hospital-Cornell Medical Center, 58 underwent radical mastectomy and 40 simple mastectomy for primary breast cancer. After five years, 19 per cent of the radical mastectomy group were cancer-free compared with 35 per cent of the simple mastectomy group. The gross five-year survival rates were 50 per cent and 47 per cent respectively. In the radical mastectomy group, when the axillary nodes did not show cancer at the time of operation, there have been no known recurrences and 70 per cent of the patients have survived at least five years. There was no surgical mortality. These findings support the view that until more controlled data are available, radical mastectomy is still the preferred therapy for primary breast cancer.     

乳腺癌术后专用胸带的研制及临床应用

目的　探讨减少乳腺癌术后皮下积液、感染、皮瓣坏死发生的有效措施。方法　自行研制了一种乳腺癌术后专用胸带 (下称专用胸带 ) ;将 80例乳腺癌术后患者随机分为观察组和对照组各 4 0例 ,前者术后使用专用胸带 ,后者使用普通胸带。观察两组术后引流量、拔管时间及并发症的发生情况。结果　观察组与对照组比较 ,引流量减少 ,置管时间缩短 (P<0 .0 1) ,且并发症发生率降低 (P<0 .0 5 )。结论　专用胸带在减少术后引流量、缩短置管时间及降低并发症发生率方面优于普通胸带 ,值得推广应用     

A population-based study of bilateral prophylactic mastectomy efficacy in women at elevated risk for breast cancer in community practices

BACKGROUND: Findings from several studies suggest that bilateral prophylactic mastectomy reduces breast cancer incidence by 90% or more, but the studies used highly selected patients from referral centers, and the comparison groups were not population based. We studied the efficacy of bilateral prophylactic mastectomy in women with elevated breast cancer risk cared for in community practices. METHODS: We conducted a retrospective case-cohort study of women aged 18 to 80 years with 1 or more breast cancer risk factors (family history of breast cancer, history of atypical hyperplasia, or > or =1 breast biopsies with benign findings). Using computerized data and medical records, we identified 276 women with bilateral prophylactic mastectomy and a stratified random sample of 196 women representing an underlying cohort of 666 800 women with elevated breast cancer risk without prophylactic mastectomy, and then we determined who developed breast cancer. RESULTS: Breast cancer developed in 1 woman (0.4%) after bilateral prophylactic mastectomy vs 26 800 women (4.0%) without prophylactic mastectomy. Stratifying by birth year, the hazard ratio for breast cancer occurrence after bilateral prophylactic mastectomy was 0.005 (95% confidence interval, 0.001-0.044). No woman with bilateral prophylactic mastectomy died of breast cancer vs a calculated 0.2% of women without prophylactic mastectomy. CONCLUSIONS: Bilateral prophylactic mastectomy reduced breast cancer incidence in women at elevated risk for breast cancer cared for in community-based practices. However, the absolute risk of breast cancer incidence and death in women who did not undergo the procedure in these settings was relatively low.     

A randomised trial of mastectomy only versus tamoxifen for treating elderly patients with operable primary breast cancer—Final results at 20-year follow-up

A recent Cochrane review of trials involving elderly women with operable primary breast cancer showed no significant difference in overall survival between surgery (±adjuvant tamoxifen) and primary endocrine therapy using tamoxifen. We report the final results of a randomised pilot trial comparing primary tamoxifen and wedge mastectomy as initial treatment in this population.One hundred and thirty-one women >70 years with early operable primary breast cancer (<5 cm), unselected for oestrogen receptor (ER), entered the trial in 1982–1987. Sixty-eight patients were allocated to tamoxifen only and 67 to wedge mastectomy only, as primary treatment.At 20 years of follow-up, the median time to local failure was significantly shorter in the tamoxifen arm though approximately one-fifth of patients in this group did not develop local failure requiring mastectomy. There was no difference in regional recurrence, distant metastases or overall survival between the mastectomy and tamoxifen arms.In this small study, primary endocrine therapy achieved local control in 30% of those surviving at 5 years and 20% at 10 years, unselected for ER. The primary therapy used did not significantly affect regional recurrence, incidence of distant metastases or overall survival. Primary endocrine therapy should certainly be considered in those patients with ER positive tumours and who are unfit (based on life expectancy) for or refuse surgery.     

Music intervention improves the physical and mental status for patients with breast cancer: A protocol of randomized controlled trial

Background:Breast cancer is the most familiar cancer and the major cause of the cancer death in women worldwide. The breast cancer patients may suffer from severe mental and physical trauma. At present, there are few studies on the music therapy for patients with breast cancer. The objective of our paper is to assess the effect of music intervention on mental and physical state of breast cancer patients.Methods:The experiment will be implemented from June 2021 to June 2022 at Jinan Central Hospital. The experiment was granted through the Research Ethics Committee of Jinan Central Hospital (no.08847765). The inclusion criteria requires that the age of female patients ranges from 25 to 65 years old, and the pathological diagnosis of breast cancer requires radical mastectomy (containing extensive radical mastectomy and modified radical mastectomy). Patients who do not like to listen to music or have severe debilitating diseases or are allergic to the sound will be excluded. Patients in the intervention group are given music intervention, and in control group, patients do not receive any information about the music therapy in the period of this study. The primary outcome is quality of life, psychological distress. The secondary outcomes are the heart rate, blood pressure, as well as Visual Analog Scale (VAS).Results:Table 1 will illustrate the postoperative outcomes after music interventions between groups.Conclusion:Music intervention can improve the mental and physical health of the breast cancer patients.Trial registration:This study protocol was registered in Research Registry (researchregistry6168).     

Management of colorectal cancer in elderly patients over 80 years old

AIM: The incidence of colorectal cancer is increasing. Surgery and chemotherapy for elderly patients are also increasing. We evaluated the characteristics of elderly colorectal cancer to clarify issues related to surgical therapy for elderly patients. METHOD: We studied 67 patients (38 men, 29 women) over 80 years old on whom we operated for colorectal cancer from 1990 to 2004. We compared them with 130 patients aged from 70 to 74 who were operated on in the same period, examining clinicopathological factors, operative methods, preoperative morbidity, postoperative complications, chemotherapy and postoperative survival ratio. RESULTS: In the elderly patients aged over 80, the rate of Dukes' B was high, whereas the rate of Dukes' A was high in patients aged from 70 to 74. No significant differences were observed in operative methods for colon cancer but Hartmann's operation and transanal local excision were frequent for rectal cancer in patients aged over 80. The rate of lymph node dissection was low in patients aged over 80 with rectal cancer. A significant difference was observed in lymph node dissection of rectal cancer between patients aged over 80 and those aged from 70 to 74, but there was no significant difference in curative ratio. Preoperative morbidity were recognized in 76% of patients aged over 80. Postoperative complications occurred in 51% of patients aged over 80. There were many cases showing delirium, but no differences in other complications between patients aged over 80 and those aged from 70 to 74. There was no operative mortality in patients aged over 80. CONCLUSION: Even elderly patients can anticipate safe operations without postoperative complications or decreased quality of life, if the appropriate operative procedure is selected with regard to their general condition.