Assessing the Effect of Lifetime Contralateral Breast Cancer Risk on the Selection of Contralateral Prophylactic Mastectomy for Unilateral Breast Cancer

Introduction

Contralateral prophylactic mastectomy (CPM) rates are rising, with fear implicated as a contributing factor. This study used a contralateral breast cancer (CBC) risk stratification tool to assess whether the selection of CPM is reflective of future CBC risk.

乳腺癌改良根治术后皮瓣坏死的预防探讨

[目的]探讨预防乳腺癌改良根治术后皮瓣的缺血坏死。[方法]对85例乳腺癌根治术后患者术中、术后应用横形切口、手术刀锐性分离、双套管引流、皮瓣的多点缝合以及PGE1脂微球的应用等方法。[结果]85例中仅有2例发生皮瓣坏死，坏死率仅为2．4％，而对照组坏死率为21．0％，两者差异有显著性。[结论]在乳腺癌根治术的术中、术后应用横形切口、手术刀锐性分离皮瓣、双管引流、皮瓣的多点缝合PGE1脂微球的应用等方法预防皮瓣坏死，效果显著．缩短了愈合时间，并发症少。     

The Effect of Receptor Status on Mastectomy and Contralateral Prophylactic Mastectomy Rates in Early Stage Invasive Breast Carcinoma

Background

There is an established relationship between hormone receptor (HR; estrogen and/or progesterone receptors) status, HER2 status, and locoregional recurrence. The purpose of this study was to analyze how HR and HER2 receptor status have influenced the surgical management trends among patients with early stage breast cancer.

乳腺癌改良根治术手术技巧对皮下积液的预防

目的探讨乳腺癌改良根治术手术技巧对皮下积液的预防。方法回顾性分析行乳腺癌改良根治术（Auchincloss术式）的乳腺癌患者418例,术中依据乳腺淋巴回流行淋巴管结扎,同时腋窝侧只留置一条皮下引流管行负压吸引,术后无需任何形式加压包扎。结果418例中仅12例出现术后皮下积液〉10天,发生率约为2.9%,所有积液患者在术后两周内〈14天拔除引流管。结论乳腺癌改良根治术术中依据乳腺淋巴回流行淋巴管结扎,是1种有效的预防皮下积液的手术方法,术后无需任何形式加压包扎且皮下只需留置腋窝侧一条负压吸引管。     

抗扁管、弹力绷带在乳腺癌术后的应用价值

 引言乳腺癌根治术后早期皮下积液、皮瓣坏死不仅影响患者经济、情绪,也影响术后化疗、放疗。1993～2 0 0 2年我们共行乳腺癌根治术5 30例,发生切口并发症187例(35 % )。我们采用不同的方法予以处理,现将治疗方法及结果报告如下:1　资料与方法1.1　临床资料　本组5 30例,年龄31～79岁,平均4 7岁,见表1。表1　5 30例乳腺癌患者临床资料临床资料例数A组B组临床分期5 30 2 912 39　I 2 0 2 10 894　II 2 75 14 912 6　III 5 33419病理分类　浸润型导管癌312 16 4 14 8　浸润型小叶癌884 939　单纯癌794 4 35　髓样癌2 82 0 8　粘液腺癌17 10 7　其它6 4 2手术切口　横切口314 16 6 14 8　纵切口2 16 12 5 911.2　抗扁管结构　抗扁管为硅胶制成,质软,内有5条突起小槽贯穿整条引流管,受压时突起小槽起支撑作用而不影响引流,引流管每隔2～3cm开有小孔,接口处硅胶材料增厚使引流口与皮肤固定不漏气。1.3　引流管的放置　内侧管位于胸骨旁,外侧管位于腋窝。两管各接负压瓶术后持续负压吸引,引流...     

星状神经节阻滞在防治乳腺癌术后皮下积液中的应用

目的: 评价星状神经节阻滞(SGB)对乳腺癌改良根治术后常见并发症皮下积液的防治效果。 方法: 215例乳腺癌改良根治术患者按照随机临床试验设计分为2组,对照组108例给予临床常规局部加压包扎法进行治疗,干预组107例在上述传统治疗措施基础上合并实施星状神经节阻滞(SGB);治疗效果的评价指标主要包括:置引流管时间、平均日引流量、皮下积液率、皮瓣坏死率、切口I期愈合率。 结果 :对照组和干预组平均置引流管时间分别为9.8和7.3d,平均日引流量分别为170ml和144ml,皮下积液的发生率分别为31%和13%,皮瓣坏死率分别为12%和4%,切口I期愈合率分别为67%和82%,经统计学检验,以上差别均具有显著性意义(P<0.05)。 结论: 对于本次乳腺癌改良根治术后皮下积液的干预研究发现,较临床上传统的单纯局部加压包扎法这种治疗手段相比,星状神经节阻滞联合疗法在防治皮下积液及皮瓣坏死方面表现出更佳的效果,能够促进乳腺癌改良根治术后患者皮下积液尽早得以治愈。     

乳腺癌改良根治术后皮下积液的发生原因与防治

目的探讨乳腺癌改良根治术后皮下积液产生的原因及防治方法。方法 80例乳腺癌改良根治术患者经积极治疗基础疾病,注意手术技巧及合理的引流、护理,以预防皮下积液发生。结果 80例乳腺癌患者中13例发生皮下积液(16.3%),9例经反复穿刺抽液,2例经调整引流管位置,2例经重新置管、负压引流,加压包扎等治疗,2周内治愈。结论采取综合预防和治疗措施明显降低了皮下积液的发生率,提高了患者的生活质量。     

The Endocrine Prevention of Breast Cancer

A clear explanation for the high incidence of breast cancer in modern women is now possible. The risk of breast cancer rises steeply from menarche until menopause. Associated with the reproductive process, the ovary, including the corpus luteum, produces substantial amounts of estrogen and progesterone, both of which induce growth of the breast epithelium. This sex-steroid-driven breast epithelial cell proliferation increases the risk of carcinogenesis by accelerating the occurrence of somatic genetic errors. Postmenopausally, as there is little cell proliferation, the breast epithelium is more “resistant” to mutagenic effects, and breast cancer risk rises at a low rate. Unfortunately, the genetic errors accumulated during the premenopausal period are not lost following menopause, and breast cancer risk remains high. Sex-steroid antagonists, such as tamoxifen, may reduce breast cancer incidence both by blocking breast epithelial cell proliferation and by direct antitumor effects on clinically occult breast cancers. The rationale for a contraceptive designed to reduce breast cell proliferation by decreasing premenopausal sex-steroid exposure is presented.     

Breast Cancer Prevention

Although screening recommendations have been long established, more than 40 000 women died of breast cancer in the US in the year 2001. Risk factors for developing breast cancer have been identified, leading to the possibility of breast cancer prevention. Adjuvant tamoxifen for 5 years decreases the incidence of contralateral breast cancer by 50%. This finding and the favorable safety profile of tamoxifen led to the NSABP P-1 trial, which demonstrated a 50% reduction of breast cancer in a high-risk population. The benefit was seen only in estrogen receptor (ER)-positive breast cancers, but was seen in all age groups. Furthermore, tamoxifen was found to reduce the overall rate of osteoporotic fractures. Endometrial cancer in the tamoxifen arm of the NSABP P-l trial was increased 3- to 4-fold in women >50 years, similar to the increased risk seen with adjuvant tamoxifen therapy. Other agents that are currently under study for breast cancer chemoprevention include raloxifene and retinoids. The STAR trial is under way and compares raloxifene to tamoxifen for breast cancer chemoprevention in high-risk women. Tamoxifen is currently the only agent approved by the US Food and Drug Administration (FDA) for chemoprevention in breast cancer but has not produced a survival advantage to date.     

Long-Term Psychological Sequelae of Mastectomy and Breast Conserving Treatment for Breast Cancer

Psychiatric and psychosocial adaptation to two types of treatment for primary breast cancer, modified radical mastectomy and partial mastectomy with radiotherapy, was studied five years after the primary treatment. 102 consecutive patients with pT1NOMO breast cancer were invited to follow-up which was done by standardized questionnaires. Nineteen women declined the invitation and 25 others were not included for various reasons, leaving 58 to complete the interviews. 30% of the women reported accentuated mental symptoms compared to the state before treatment, with no significant difference between the two treatment groups. Psychiatric state, marital adjustment and fear of cancer recurrence were also similar in the two groups. However, breast conserving treatment seems to preserve the woman's female identity and acceptance of body configuration. We conclude that breast conservation does not in itself prevent mental sequelae after treatment for primary breast cancer. Selective psychoprophylactic programs and reorganization of the postoperative follow-up should be tried to diminish unwanted psychological reactions.     

乳腺癌术后皮瓣坏死的原因分析与防治

全文对两组不同方法和术后处理的乳腺癌手术后皮瓣坏死情况进行了分析，对皮瓣坏死的防治提出了几点看法。     

Evaluation of the Learning Curve in Robotic Nipple-sparing Mastectomy for Breast Cancer

BackgroundThis study discusses the preliminary results of robotic nipple sparing mastectomy (R-NSM) in patients with breast cancer and analyzes the learning curve of the same surgeon in a single medical center.Patients and MethodPatients with breast cancer from a single center who received R-NSM between 2018 to 2020 were recruited for clinical and pathologic tumor characteristics including family history, grade, type of tumor, treatment, and outcome. The learning curve for R-NSM was analyzed by using cumulative sum (CUSUM).ResultsA total of 85 R-NSM procedures from 78 patients were evaluated. In the CUSUM plot analysis of the learning curve, a significant decrease in time for mastectomy, reconstruction, and total operation appeared in the 22nd, 23rd, and 26th procedures, respectively. Patients’ body weight, gel implant size, and specimen weight had significant correlations with the time for mastectomy. Four (5.6%) patients had nipple partial ischemia, and 1 (1.4%) had total nipple necrosis. The mean follow-up was 11.4 ± 6.2 months; only 1 patient showed recurrence.ConclusionRobotic breast surgery is a feasible method with good cosmetic outcome under suitable patient selection. Oncologic safety is not a reason to stop its development.     

24例保留乳头乳晕乳腺癌术后即刻乳房重建的临床经验

目的:探讨保留乳头、乳晕及部分乳房皮肤的乳腺癌改良根治术后即刻采用不同的方法乳房重建的可行性。方法:筛选出病理符合要求的24例早期乳腺癌患者,行保留乳头、乳晕及部分皮肤的改良根治术,根据患者的要求,结合其身体、心理、经济等状况,特别是乳房的大小和需要切除的尺寸,选择适合该患者的手术方式即刻行乳房重建,采用硅胶充填假体置入乳房重建9 例,腹直肌肌皮瓣乳房重建3 例,背阔肌肌皮瓣和硅胶填充假体联合重建12例。术后根据客观标准和主观标准评价重建效果。结果:24例乳腺癌患者术后即刻乳房再造术后外观良好,双侧乳房基本对称。客观评价效果优良和尚好者23例（95.83%）,主观评价优良和尚好者24例（100%）,1 例术后部分乳头坏死、脱落。1 例术后出现血肿,于术后3 个月消失。术后给予常规化疗,随访5～48个月,除1 例患者术后2 年死于原发性肝癌,均无局部复发或远处转移。结论:对于早期乳腺癌行保留乳头、乳晕及部分乳房皮肤的乳腺癌改良根治术后即刻采用不同方法乳房再造,具有经济、整形效果好、显著减少患者乳房缺失造成的心理影响、提高生存质量等优点。术后不影响乳腺癌的辅助治疗和远期疗效,能同时满足肿瘤治疗和形体美容两个方面的要求,正逐渐被广大乳腺癌患者所接受。      

Stewart横切口在乳腺癌改良根治术中的应用价值

目的探讨Stewart横切口在乳腺癌改良根治术中的应用价值。方法 269例行改良根治术的乳腺癌患者中,横切口组124例采用Stewart横梭形切口行改良根治术,纵切口组145例采用传统的纵切梭形切口行改良根治术,比较两组患者的术后并发症和预后。结果横切口组患者术后1期愈合率为83.87%,皮瓣轻度坏死5例（4.03%）,1、3、5年生存率分别为94.35%、70.37%、65.00%;纵切口组患者术后切口1期愈合率为79.31%,皮瓣坏死12例（8.28%）,1、3、5年生存率分别为93.80%、69.6%、65.21%。结论乳腺癌改良根治术横切口皮瓣坏死率低于纵切口,切口类型的选择不影响乳腺癌患者的生存率。     

早期乳腺癌改良根治术与保乳手术的疗效比较

目的比较改良根治术与保乳手术治疗对早期乳腺癌的临床疗效。方法按照手术方式将155例乳腺癌患者分为保乳组(40例)和改良组(115例),保乳组行保乳手术+术后放、化疗,改良组行改良根治术+术后化疗,比较两组患者1、3、5年生存率、局部复发率以及远处转移率。结果保乳组死亡1例,改良组死亡4例,死亡原因均为非乳腺癌原因;保乳组2例发生远处转移,其中1例为肺转移,1例为骨(脊柱)转移,术后生活质量未受明显影响;改良组6例发生远处转移,其中4例为肺转移,2例为骨转移,术后生活质量未受明显影响;两组患者1、3、5年生存率、局部复发率、远处转移率比较,差异无统计学意义(P>0.05)。结论保乳手术+术后放、化疗对早期乳腺癌的远期疗效与改良根治术+术后化疗相近,但保乳手术创伤小、术后恢复时间短、能够保留乳房的美观外形,临床应用价值更高。     

保留乳头乳晕的乳腺癌改良根治术与传统乳腺癌改良根治术的临床疗效对比

[目的]探讨保留乳头乳晕复合体的乳腺癌改良根治术(NSM)与传统乳腺癌改良根治术(MRM)的疗效及术后并发症.[方法]收集上海市第一人民医院宝山分院2008年1月至2011年6月间接受保留乳头乳晕复合体(NAC)乳腺癌改良根治手术的31例患者资料,与62例同期乳腺癌改良根治术患者按照1:2进行配对研究.比较两组的局部区域淋巴结复发率、远处转移率、总生存率及术后并发症情况.[结果]NSM组和MRM组的中位随访时间分别为28个月和29个月.NSM组和MRM组的腋窝淋巴结复发率分别为6.65％和3.23％,两组比较无统计学差异(P=0.598).NSM组与MRM组的锁骨上淋巴结转移率和远处转移率均为3.23％,两组锁骨上淋巴结转移率和肿瘤远处转移率经比较无统计学差异(P值均为1.000).两组生存率分别为96.77％和98.39％,经比较无统计学差异(P=1.000).两组的NAC坏死、皮瓣坏死、切口裂开、皮下积液和上肢淋巴水肿等并发症发生率,经比较无统计学差异(P＞0.05).[结论]保留乳头乳晕复合体的乳腺癌改良根治术在严格入组条件和手术操作的情况下,可以与传统乳腺癌改良根治术达到相同的治疗效果.     

乳腺癌防治工作浅谈

该文介绍了近年来乳腺癌领域几个热点问题如普查，定位活检，保乳治疗，前哨淋巴结活检，综合治疗和乳房重建的研究进展。