乳腺癌保乳手术32例临床分析

目前，乳腺癌的发病率已上升至女性肿瘤中的第二位，有逐年上升且年轻化趋势，在某些地区已达女性恶性肿瘤的首位。随着肿瘤病理学等基础学科的进步，外科医生对乳腺癌的认识也发生了深刻的变化，乳腺癌治疗已由单一手术治疗发展成为全身综合性治疗。乳腺癌保乳手术合并放化疗已日渐成为对早期乳腺癌最多采用的治疗方法。我省处于高原地区，保乳手术开展较晚，我院2007年1月至2010年7月共实施保乳手术32例，报告如下。     

早期乳腺癌保乳手术52例分析

目的评估早期乳腺癌保乳综合治疗的疗效。方法2000年3月～2005年9月，我院对52例Ⅰ期及部分Ⅱ期（肿瘤≤3cm，单发病灶）乳腺癌行局部广泛切除术，全腋窝淋巴结清扫术联合术后放疗，并辅以化疗（CMF或CEF方案）、内分泌治疗（口服三苯氧胺）。结果术后病理提示个切缘无癌细胞浸润。美容效果优良率达86．5％（45／52）。50例随访10～36个月（中位时间16个月），未见局部复发与远处转移。结论选择部分Ⅰ～Ⅱ期乳腺癌病例行保乳手术治疗，乳房外形及临床疗效满意，而且可以提高生活质量。     

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.     

早期乳腺癌32例行保乳手术临床分析

目的总结早期乳腺癌施行保乳手术的治疗效果。方法回顾性分析32例早期乳腺癌患者实施保乳手术治疗、术后放疗、化疗和内分泌治疗的临床资料。结果随访12⁶0个月,32例患者无局部复发及远处转移.术后效果满意。结论早期乳腺癌适时实施保乳手术联合化疗、放疗和内分泌治疗,创伤小、外观恢复好、复发率低,疗效肯定。     

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。     

乳腺癌保乳手术治疗148例分析

目的研究乳腺癌保乳治疗方法的选择,探讨保乳手术适应证及疗效. 方法回顾分析1996年1月～2003年10月我院接受保乳治疗的148例乳腺癌临床资料.0期5例,Ⅰ期85例,Ⅱ期55例,Ⅲ期3例.手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫.术后常规行辅助放疗、化疗和内分泌治疗. 结果手术标本石蜡病理检查各切缘均无癌浸润.经过54个月中位随访期(范围2～84个月),局部复发率为2.7%(4/148),其中乳腺3例,腋窝1例;远处转移率3.4%(5/148),手术至远处转移间期6～43个月,转移部位分别为肺、肝、脑膜和骨,其中3例死亡.对保乳综合治疗结束后满1年的108例患者进行乳房外形的评估,优32.4%(35/108),良49.1%(53/108),差18.5%(20/108). 结论对早期乳腺癌及部分经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意.规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.保乳手术后大部分患者乳房外形良好.     

86例早期乳腺癌的保乳手术疗效评价

目的：探讨早期乳腺癌保乳手术治疗的适应证及方法。方法：回顾性分析86例Ⅰ、Ⅱa期乳腺癌实施保乳手术及综合治疗的资料。结果：保乳术后病侧乳房外形均较好，两侧乳房基本对称，术后5年复发率为5．2％，5年生存率为96．5％。结论：早期乳腺癌的保乳手术治疗安全、疗效确切，但必须正确掌握手术指征及合理的切除范围，同时要保证术后的综合治疗及严格的随访制度。     

早期乳腺癌保乳手术20例效果分析

目的分析早期乳腺癌保乳手术疗法对女性生理、心理的影响及对提高病人生存质量的意义。方法回顾我科近4年来对20例早期乳腺癌行保乳手术治疗的临床资料。结果20例病人手术恢复顺利,仅1例腋窝有淋巴结转移灶(复发率6%),乳房外观丰满、良好。结论早期乳腺癌行保乳区段切除综合疗法治疗乳腺癌,方法简单,治愈率未降低、复发率未增加而外观更美丽,病人从生理及心理方面易接受,对提高病人综合生活质量起到良好作用。     

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。     

保留乳房的乳腺癌改良根治术治疗早期乳腺癌的临床观察

目的探讨保留乳房的乳腺癌根治术治疗早期乳腺癌的疗效。方法对22例早期乳腺癌患者行保乳手术治疗，术后并行辅助放疗、化疗等综合治疗。结果全组随访6～48个月，无局部复发和远处转移，3年生存率100％（17／17）。结论对早期乳腺癌行保乳手术疗效满意，严格掌握手术指征，规范的切除和术后放疗、化疗等综合治疗是保乳手术治疗成功的关键。     

Role of surgery in the treatment of brain metastases in patients with breast cancer

Background: Patients whose brain metastases from breast cancer are treated nonsurgically have a median length of survival ranging from 2.5 to 7.5 months, and a median time to recurrence ranging from 2 to 5 months. Patients treated with radiotherapy have a median length of survival ranging from 3 to 4 months. Those treated with chemotherapy have a median length of survival ranging from 5.5 to 7.5 months. Methods: We conducted a retrospective analysis on 63 patients treated over a 10-year period. Only patients who underwent surgery for nonrecurrent brain metastases were studied. Sixty-one patients (97%) underwent surgery within 2 weeks of diagnosis of the brain metastases. Results: The median length of survival was 16 months (95% confidence interval [CI] 11 to 22 months), and the 5-year survival rate was 17% (CI 9% to 29%). Brain metastases recurred in 27 patients at a median interval of 15 months (CI 12 to 24 months). Eleven patients had local recurrence, 10 had distal recurrence, and seven developed leptomeningeal disease. Significant prognosticators of length of survival were age (p=0.011), menopause status (p=0.10), postoperative radiotherapy (p=0.054), preoperative neurologic status (p=0.011), and preoperative systemic disease status (p=0.0003). Systemic disease status had a significant effect on the length of survival but not on the time to recurrence. Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996.     

Impact of locoregional treatment on survival in patients presented with metastatic breast carcinoma

ObjectivesIn this study, we tried to evaluate the efficacy of locoregional treatment (LRT) in patients with metastatic breast carcinoma (MBC).Materials and methodsThe medical records of 227 patients with MBC at initial presentation between April 1999 and January 2013 were retrospectively evaluated. The median age at diagnosis was 50 years (range, 27–83 years). Thirty-nine patients (17%) had no LRT. Among patients who had LRT, 2 (1%) had locoregional radiotherapy (RT) alone, 54 (29%) had surgery alone [mastectomy, n = 50; breast conserving surgery (BCS), n = 4] and 132 (70%) had surgery (mastectomy, n = 119; BCS, n = 13) followed by locoregional RT.ResultsThe median follow-up time was 35 months (range, 4–149 months). Five-year OS and PFS rates were 44% and 20%, respectively. In both univariate and multivariate analysis LRT per se did not affect OS and PFS rates. However, the 5-year OS and PFS rates were significantly higher in patients treated with locoregional RT than the ones who were not. The corresponding rates were 56% vs. 24% for OS and 27% vs. 7% for PFS (p < 0.001). Median survival was 67 months and 37 months, respectively.ConclusionOur study showed that patients with MBC who received postoperative locoregional RT may have a survival advantage compared with patients who were only treated by surgery. A phase III trial testing the role of adjuvant locoregional RT may help to distinguish patients who will benefit from adjuvant RT.     

乳腺癌保乳手术38例临床分析

目的 总结保乳手术治疗早期乳腺癌的临床经验及疗效观察.方法 回顾性分析2005年1月至2010年2月新疆石河子人民医院收治的38例临床0～IIa期、非乳晕区单发肿瘤的乳腺癌患者的临床资料.分析其近期疗效,并按Rose标准,对接受保乳手术的患者进行美容效果评价.结果 所有病例术后恢复良好,无1例出现并发症,随访未见局部复发及远处转移,患者对术后乳房外形及生活质量满意.结论 早期乳腺癌患者接受保乳手术治疗可取得满意的临床和美容效果.     

肿瘤整形技术在乳腺癌保乳手术中的临床应用

背景与目的 整形保乳手术（OBCS）是在完整切除肿瘤病变的同时,应用整形技术对乳房进行整形修复,最大限度维持患者术后乳房的自然外形,从而提高患者的生活质量。然而,OBCS属于新兴技术,其效果与安全性的临床证据仍然有限。因此,本研究通过对OBCS与传统的保乳手术（TBCS）治疗早期乳腺癌相关临床指标的比较,进一步明确OBCS的疗效与安全性。方法 回顾性分析2015年1月—2020年1月在河南省新乡市中心医院肿瘤外科行乳腺癌保乳手术226例患者的临床资料和随访记录,其中95例行OBCS（OBCS组）,131例行TBCS（TBCS组）,对两组患者在手术相关指标、术后并发症发生率、术后乳房美容效果、患者主观满意度以及远期疗效等方面进行对评价。结果 OBCS组缺损修复方式包括腺体推进法47例,乳腺组织腺蒂瓣转位法22例,下蒂倒T形5例,翼状整形9例,腹腔大网膜充填3例,部分背阔肌及周围脂肪瓣3例,背阔肌肌瓣法4例,腹直肌带蒂肌皮瓣转移法2例。TBCS组均采用肿瘤局部扩大切除、残留腺体直接缝合法。OBCS组的手术时间明显长于TBCS组［（136.8±28.5）min vs. （75.2±22.3）min,P=0.002］,但OBCS组术中切缘阳性再次扩大切除率明显低于TBCS组（3.2% vs. 11.5%,P=0.027）。OBCS组切除标本体积明显大于TBCS组［（101.3±12.9）mL vs. （67.6±9.8）mL,P=0.013］;OBCS组术后乳房美容优良率明显高于TBCS组（86.3% vs. 37.4%,P=0.000）;OBCS组患者主观满意率明显高于TBCS组（91.6% vs. 44.3%,P=0.000）。两组术中出血量、腋窝淋巴结清扫情况、术后并发症发生率、总住院时间、术后局部复发率、无瘤生存率及总生存率,差异均无统计学意义（均P>0.05）。结论 肿瘤整形技术应用于早期乳腺癌保乳手术,能够带来更佳的美容效果和更好的患者主观满意度,改善患者生活质量,且不会增加手术并发症和肿瘤复发、转移的发生风险,是值得推荐的一种临床技术。     

早期乳腺癌的保乳综合治疗疗效分析

目的　评价早期乳腺癌保乳综合治疗的疗效。方法　保乳组 92例 ,行保留乳房的肿瘤切除加腋窝淋巴结清扫术 ;对照组 60例 ,行乳癌改良根治术。术后给予放疗、全身化疗和 /或内分泌治疗。结果　平均随访 5 7个月 ,保乳组中无局部复发病例 ,3年生存率为 97.2 % ,5年生存率为 89.3 % ,远隔脏器转移率为 6.5 % ;对照组局部复发 2例 ,3年生存率为 97.5 % ,5年生存率为90 .1% ,远隔脏器转移率为 5 .0 % ,两组各指标对比无明显差异 (P >0 .0 5 )。结论　早期乳腺癌采用保乳综合疗法 ,可以达到与根治术相似的治疗效果 ,可作为首选方法     

乳腺癌根治术与保乳术对患者治疗效果的比较分析

目的 比较接受根治术或保乳术治疗的早期乳腺癌患者间的差异,为患者选择根治术或保乳术治疗乳腺癌提供合理依据.方法 回顾性分析宝鸡市第三人民医院普外科2009年1月-2012年1月收治的477例乳腺癌患者的病例资料,根据手术方法的不同,将其分为观察组(229例,48％)和对照组(248例,52％),其中观察组进行保乳术治疗,对照组进行根治术治疗,采用SPSS15.0统计学软件分析比较这两组患者复发率、术后并发症发生率、生存质量、乳房美容效果以及远期疗效等指标.结果 观察组患者的并发症发生率低于对照组(P＜0.05),但患者的l、3年内复发率与转移率与对照组相比,两组间差异无统计学意义(P＞0.05);观察组患者的生存质量与对照组相比差异具有统计学意义(P＜0.05);观察组美容效果的优良率达78.16％,明显高于对照组61.29％,差异具有统计学意义(x2=5.86,P＜0.05);两组用于衡量远期疗效的两项指标:总生存期(x2=3.154,P＞0.05)和无疾病进展生存期(x2=4.243,P＞0.05)间的差异无统计学意义.结论 在不影响患者术后复发率、转移率以及远期疗效的前提下,接受保乳术治疗的患者与接受根治术治疗的患者相比,具有并发症发生率低、美容效果好、生存质量高等显著优势.与传统根治术相比较,保乳术不失为一项明智的选择.     

Geriatric assessment tool application in treatment recommendations for older women with breast cancer

IntroductionTreatment of early breast cancer in older women is usually not guideline concordant owing to lack of routine evaluation of their potential frailty. We assessed the feasibility and impact of a self-administered geriatric assessment on the decision-making process in women aged 65 and above treated in a UK District General Hospital.MethodsOne hundred and one patients, aged 65 and above, with early stage, non-metastatic breast cancer were prospectively recruited between Dec-2018 and March-2021. Patients with metastatic breast cancer, a previous history of cancer and dementia were excluded. All patients had a geriatric assessment with a self-administered questionnaire (mycarg.org). All cases were discussed in the multidisciplinary meeting (MDT) and a pre geriatric assessment recommendations was made, based on the tumour grade, size, node status and receptor status. The findings of the assessment were later discussed in a second meeting and a further recommendation was made based on the geriatric assessment. Any change in the proposed treatment was recorded. Potential factors (age, Body Mass Index, co-morbidities, medications, instrumental activities of daily living, and basic activities of daily living, social support and psychological status) associated with a change in the treatment recommendation were compared using Pearson's Chi square tests for categorized data, and Mann Whitney U test for continuous data. A multivariate logistic regression was performed to test the association between geriatric assessment domains and change in treatment decision. The multivariate model was built using variables which were associated in the bivariate analysis with a p-value< 0.20.ResultsPatients aged less than 70 years were more likely to be diagnosed through screening programme as compared to older women (64.4% vs. 35.6%, p = 0.001).Self-administered geriatric assessment identified patients who were requiring assistance in their daily routine activities, and hence, were assessed to have higher morbidity status. A third of patients required assistance in their routine activities, with 18/101 patients requiring significant help during self-care. 90% patients were independent for Activity of Daily Living (ADL) at baseline and 34.76% for Instrumental Activity of Daily Living (IADL).Among the 101 patients evaluated, proposed change in the initial cancer treatment plan was made in 21.8% of patients after the second MDT. Omission of chemotherapy was recommended in 4 patients, omission of radiotherapy in 15 patients and omission of both chemo and radiotherapy in 2 patients. One patient was advised to omit Zolidronic acid, as she was noted to have renal impairment. No patient in this cohort had suggestion for omission of surgery or endocrine therapy. In the bivariate analysis, need for assistance for activities of daily living (ADLs), low physical performance (KPS), polypharmacy (3 or more medications), lack of social support as assessed using the Social Support: Medical Outcomes Study (MOS) Social Support Survey and high BMI (30 or more) all showed significance but on multivariate analysis only polypharmacy was significantly associated with change in the initial cancer treatment plan.ConclusionsThe results of this study of breast cancer patients aged 65 and above suggest that a self-administered geriatric assessment may influence treatment recommendations in a subset of patients. Recommendations that were influenced by the geriatric assessment mainly included those related to the significant morbidity that may have impacted the use of chemotherapy and/or radiotherapy.     

早期乳腺癌保乳手术术中放疗59例

目的 研究早期乳腺癌保乳手术术中放疗的可行性,评价术后并发症、乳房美容效果及肿瘤复发事件.方法 2007年6月至2010年12月,115例患者做保乳手术,59例(研究组)做术中放疗,同期有56例(对照组)术后做全乳放疗,在术后1个月评估切口愈合状况及并发症;术后1年比较两组乳房美容效果;术后随访肿瘤复发及死亡事件.结果 研究组切口愈合天数为13 ～22d,对照组为9 ～14d.研究组2例出现切口脂肪液化,16例有切口水肿,对照组未见切口脂肪液化、水肿;两组均未出现术后切口感染或血肿.术后1年乳房美容评价:研究组41例中优秀或好的有36例、一般或差的5例;对照组37例中优秀或好的有25例、一般或差的有12例(P=0.031).随访3～42个月(中位24个月),研究组局部复发2例(3.39％),其中1例(1.7％)死亡;对照组局部复发1例(1.8％),无死亡.结论 早期乳腺癌保乳手术术中放疗安全可靠、美容效果好、局部控制满意.