妊娠期及哺乳期乳腺癌8例临床分析

目的探讨妊娠期哺乳期乳腺癌的诊断和治疗方法。方法回顾分析1997年至2007年共收治8例妊娠期哺乳期乳腺癌的临床资料,对其诊断、治疗分析总结。其中3例妊娠期、5例哺乳期乳腺癌,并与同期收治的普通乳腺癌患者在诊断、治疗方法、5年生存率等方面进行比较。结果妊娠期及哺乳期乳腺癌患者治疗后5年生存率与肿瘤分期、治疗时妊娠和哺乳时间、病程、手术方式、病理类型、肿瘤分化程度、有无肿瘤复发转移和雌激素受体状况均有明显关系。提示妊娠期及哺乳期乳腺癌患者的预后比普通乳腺癌差,二者5年生存率分别为50％（4／8）和75．8％（801／1056）,但在相同分期和年龄的患者,其生存率无明显差别。结论妊娠期及哺乳期乳腺癌应提高早期诊断率,一旦确诊应积极采取以根治性手术为主的综合治疗,不仅缩短疗程,还能提高生存率;终止妊娠及终止哺乳应列为常规综合治疗之一;治疗后近期再次妊娠可能影响预后。     

妊娠期抗菌药物的选择

妊娠期用药是关系到母体及胎儿二者安全的重要问题,据统计几乎所有的孕妇要应用2-5种药物,尤其抗菌药物占首位。胎儿发生先天性异常的占2％左右,而60％以上与不安全用药有关。根据药物的药代动力学及理化性质等,可将抗菌药物分为:(1)妊娠期忌用;(2)妊娠期某阶段忌用及(3)妊娠期可以使用的三大类。     

妊娠期哺乳期乳腺癌诊治分析

目的分析妊娠期及哺乳期乳腺癌的诊断、治疗和预后。方法通过10例临床资料分析,结合有关文献。结果妊娠期乳腺癌在终止妊娠后5年生存率为25%,哺乳期乳腺癌的5年生存率为66.7%。治疗原则同一般乳腺癌,依据临床分期、妊娠周数及患者对胎儿的需要程度。结论妊娠期乳腺癌临床表现与普通乳腺癌相同,但临床诊断更晚,妊娠期乳腺癌5年生存率差,终止妊娠并不能提高患者生存率;确诊主要靠细胞学穿刺或活检。     

乳腺癌患者围手术期护理

1临床资料 2005年4月至2008年6月本院外科手术治疗乳腺癌82例,年龄32—84岁,平均48．8岁。行乳腺癌改良根治术16例,约占19．5％;乳腺癌根治术43例,约占53．8％;乳腺癌扩大根治术4例,约占4．9％;全乳房切除术10例,约占12．2％;保留乳房的乳腺癌切除术9例,约占11％。     

妊娠期高血压疾病的治疗

妊娠期高血压疾病是产科特有而常见的并发症，欧美人群的发病率约为6％～10％，我l司妊娠期高血压疾病约占总数的5．6％～9．4％。妊娠期高血压疾病严重威胁母婴健康，     

妊娠期哮喘患者疾病管理及用药情况的调查分析

目的了解妊娠期哮喘患者哮喘控制及药物使用的情况,分析妊娠期哮喘控制不佳的原因。方法通过对41例诊断为哮喘的妊娠期女性进行问卷调查,收集其目前哮喘控制水平、药物使用情况、吸入装置与吸入技巧、用药依从性、对疾病和药物的认识、影响哮喘控制的因素等情况,根据答题结果分析。结果根据哮喘控制问卷评分,"良好控制"占39.0%;"部分控制"+"未控制"占61.0%。在妊娠期间,34.1%患者有过至少1次因哮喘急性发作门/急诊就诊或入院治疗。20.0%患者能正确吸入药物,52.6%患者用药依从性较好。39%患者认为吸入激素对胎儿危害会大于哮喘,61.0%患者分不清楚缓解药和控制药。影响哮喘控制原因中,48%患者担忧激素会对胎儿影响,无患者选择经济因素。结论妊娠期哮喘控制欠佳,药师参与妊娠哮喘患者管理有望提高其控制水平。     

妊娠期用药对胎儿的影响

据统计，92％孕妇在妊娠期至少用过一种药物，早在60年代初即发现药物可引起胚胎畸形，如反应停（Lllalidornide）引起海豹样略形。所以近年来，围产期用药对胎儿的影响成为人们十分关注的问题。药物是用以预防、治疗及诊断疾病的物质，若用药不当，胎儿有致死、致畸、致发育不良等影响。1．对胎儿的影响：孕妇服用的药物几乎都能通过胎盘进入船儿体内，其影响主要与用药时胎龄、药物性质、剂量、疗程长短、胎盘的内在因素及胎儿遇传素质有关。受精后2周内受精卵分裂，胚泡植入并形成二胚层，但船儿胎盘间血流循环尚未建立，药物对胚胎儿无…     

妊娠期乳腺癌在诊断和手术、化疗、放疗综合治疗方面的特殊性探讨

目的对妊娠期乳腺癌的诊断、手术、放疗、化疗等综合治疗方面的特殊性进行探讨。方法回顾性分析自2000年5月～2007年5月期间某院收治的妊娠期乳腺癌患者11例,其中属于妊娠期的有5例,分娩后1年内的有6例。对7例患者实施了乳房保留治疗,4例实施改良根治术,且所有患者在术后进行放疗,有8例接受了化疗。结果11例患者通过钼靶检查中有9例以及6例B超检查都发现了阳性。由于诊断时期较晚,因此其肿瘤Ⅰ期、Ⅱ期、Ⅲ期例数为2例、5例、4例。对所有患者进行随访发现,有9例无病生存,有2例在结束治疗2年后出现局部复发或者转移。结论妊娠期乳腺癌的误诊是较为常见的,因此在诊断时,要重视妊娠、哺乳等时期对乳房的检查以及超声检查的作用。在治疗时要坚持兼顾疾病迫切性和胎儿安全性的原则。研究表明在允许开展化疗及放疗的综合治疗前提下,进行乳房保留治疗是治疗妊娠期乳腺癌的可行方法。     

妊娠相关性乳腺癌的化疗安全性评价

妊娠相关性乳腺癌因其特殊的生理改变以及治疗可能对胎儿产生影响等因素,在药物治疗上具有一定的复杂性和特殊性.2020年5月,中华医学会外科学分会乳腺外科学组发布妊娠相关性乳腺癌临床诊治专家共识(2020版),推荐蒽环类、紫杉烷类、环磷酰胺、铂类作为妊娠期乳腺癌的治疗药物,但未对其安全性进行分析,也未推荐可行的治疗方案.本...     

乳腺癌的药物治疗进展

乳腺癌是危害女性健康最常见的恶性肿瘤之一，全世界每年约有120万妇女发生乳腺癌，发病率为10％～15％，并以每年0．2％～8％的幅度上升。药物治疗是乳腺癌治疗的主要手段，包括细胞毒性化疗药物、内分泌治疗药物、分子靶向治疗药物。现将乳腺癌的药物治疗进展综述如下。     

以乳房脓肿起病误诊为哺乳期乳腺炎的乳房结核1例

乳房结核,是乳房的一种慢性特殊性感染,由结核分枝杆菌引起,本病少见,但并不是非常罕见,有报道称南非、印度等国家发病率较高,约占乳腺疾病的4.5%,欧美等发达国家发病率较低,发病率约占乳腺疾病的0.5%～1.0%,国内发病率约占乳腺疾病的1.5% ～2.8%,常见于20～40岁妇女,因其临床症状多样,诊断缺乏特异性,各种检查的方法都有其局限性,文献报道其误诊率可达57.0%～80.0%,详细的查体及完善的辅助检查可以帮助临床医生诊断此疾病,从而避免误诊、漏诊。为了提高对乳房结核这种疾病的认识,本文拟结合文献回顾威海市中心医院乳腺外科1例乳房结核患者的临床资料。     

三氧化二砷联合用药治疗乳腺癌的研究进展

乳腺癌是女性发病率最高的恶性肿瘤之一。药物治疗和放射疗法是乳腺癌临床治疗的主要手段,但仍存在副作用大,肿瘤易耐药等问题。三氧化二砷是治疗急性早幼粒细胞白血病的一线用药,其也可联合多种药物对乳腺癌等实体瘤产生良好疗效,并在一定程度上缓解临床治疗弊端。本文综述三氧化二砷联合化疗药、激素类药、营养补充剂类药、中药等多种药物或放射疗法对乳腺癌的研究进展,为乳腺癌联合用药研究提供新思路。     

妊娠哺乳期乳腺癌8例临床分析

目的探讨妊娠哺乳期乳腺癌的临床特点、诊断和治疗。方法分析我院2001—2008年收治的8例妊娠哺乳期乳腺癌患者的临床资料。结果8例妊娠哺乳期乳腺癌患者平均年龄是30．5岁,主要临床表现为乳腺肿物,经手术病理确诊,从出现症状到临床确诊的时间2～5个月。6例患者Ⅱ期,2例Ⅳ期。患者行乳腺癌手术治疗,并辅以化疗、放疗及内分泌治疗。结论妊娠哺乳期乳腺癌发病年龄轻,临床表现和诊断方法与一般乳腺癌相同。治疗原则与普通乳腺癌相同,但需考虑胎儿因素。     

9家肿瘤专科医院激素类抗肿瘤药应用情况及处方合理性分析

目的:了解9家肿瘤专科医院激素类抗肿瘤药的应用情况及处方合理性。方法:计算9家三级甲等肿瘤专科医院2010-2012年激素类抗肿瘤药的用药频度(DDDs),进行排序、评价用量变化,依据药品说明书等资料分析2012年度处方单次剂量、用药频次、给药途径合理性。结果:他莫昔芬、来曲唑、阿那曲唑DDDs依次居乳腺癌内分泌治疗药物的前3位,比卡鲁胺、氟他胺、雌莫司汀DDDs依次居前列腺癌内分泌治疗药物的前3位。他莫昔芬、来曲唑、阿那曲唑、依西美坦、甲地孕酮、比卡鲁胺的用量呈上升趋势。此类药物给药途径合理性率均为100%。黄体生成素释放激素(LHRH)类似物单次剂量、给药频次合理率最高,分别在98%¹00%与98%100%与98%⁹9%之间;乳腺癌内分泌治疗药物次之,单次剂量与给药频率合理率分别在93%99%之间;乳腺癌内分泌治疗药物次之,单次剂量与给药频率合理率分别在93%¹00%与89%100%与89%¹00%之间;前列腺癌治疗药物单次剂量、给药频次合理率较低,分别在83%100%之间;前列腺癌治疗药物单次剂量、给药频次合理率较低,分别在83%⁹7%与69%97%与69%⁸8%之间。结论:9家肿瘤专科医院2010-2012年度激素类抗肿瘤药使用总体合理。前列腺癌内分泌治疗药物处方合格率较低,主要表现为单次剂量、给药频次不合理,需加强对其处方的审查。     

Treatment of pregnancy-associated breast cancer

Background: In primary breast cancer three therapeutic components-cytotoxic, endocrine and targeted antibody therapy-have led to a significant reduction in breast cancer mortality. In pregnancy associated breast cancer the right therapeutic choice is still under discussion while incidence is increasing. With an incidence of 1/3,000 to 1/10,000 pregnancies, pregnancy-associated breast cancer is the most common solid tumor in pregnancy after cervical carcinoma. Objective: This article reviews the evidence base for the use of various treatment modalities in patients with pregnancy-associated breast cancer. Methods: Medline review, searching for articles including years 2000 through 2008 was performed. Search was conducted for the terms “pregnancy” and “breast cancer”. Cross references up to the second level were taken into account if of interest for this review. Results: Loco-regional therapy of pregnancy-associated breast cancer follows the general guidelines for breast cancer therapy in principle. Radiation of the breast and/or chest wall is usually not performed during pregnancy. Chemotherapy is indicated for the majority of patients with pregnancy-associated breast cancer. After the first trimester, anthracycline-based chemotherapy is regarded as the treatment standard in pregnancy. Folate antagonists such as methotrexate are strictly contraindicated as they are the main cause of fetal malformations. Adjuvant endocrine therapy with anti-estrogens during pregnancy is contraindicated. Data on targeted biological treatment, particularly for HER2/neu positive tumors during pregnancy are scarce and this treatment should be postponed until after delivery. Conclusion: This article summarizes the special features of the diagnosis and primary therapy of pregnancy-associated breast cancer with particular emphasis on cytotoxic therapy.     

乳腺癌194例临床分析

目的分析194例乳腺癌综合治疗的疗效,探讨乳腺癌治疗后影响其生存、复发、转移及预后的因素。方法对1998年6月至2008年6月在本院治疗满5年全部乳腺癌患者进行回顾性随访,将临床资料结果进行总结分析。结果本组乳腺癌5年生存率为53．09％,生存率较低与延误诊治时机、肿块分期、病理类型、腋淋巴结转移、胸肌转移、激素受体以及综合治疗情况等诸多因素有关。结论乳腺癌5年生存率虽然仅为53．09％,但如果能早期发现,早期诊断,早期进行以手术、化疗及内分泌治疗为主的综合治疗,乳腺癌生存率还可提高。     

Safety issues surrounding the use of aromatase inhibitors in breast cancer

Third generation aromatase inhibitors (AIs) are now established therapy in advanced oestrogen receptor (ER)-positive breast cancer. As the use of AIs expands to include adjuvant treatment of early breast cancer and breast cancer prevention, tolerability and effects on other organs such as bone will become as important as the antitumour properties of the drugs. In direct comparisons with tamoxifen, AIs have a better toxicity profile with fewer patients stopping therapy because of drug-related side effects. There is a lower incidence of thromboembolic events and vaginal bleeding compared with tamoxifen. Although published information about the side effects of AIs is scarce, it is likely that they will have adverse effects on bone and possibly also on lipid metabolism. Subprotocols of ongoing adjuvant trials are investigating these effects. It is likely that the choice of which third generation AI to use will be largely determined by its tolerability and safety profile, since it is likely that the currently available drugs have similar efficacy.     

Breast cancer management: quality-of-life and cost considerations

The purpose of this article was to provide a literature-based extensive overview of the quality-of-life and cost issues posed by the management of breast cancer. Incidence and mortality rates vary widely in different countries. Breast cancer accounts approximately for one-fifth of all deaths in women aged 40-50 years. The 1994-1998 incidence rate in the US population was on average 114.3 per 100 000 women. Treatment options include surgery, radiotherapy and drug therapy (cytotoxic and endocrine drugs). All treatment options affect patients' health-related quality of life (HR-QOL) in various ways. The use of cytotoxic agents has a particularly large HR-QOL impact. HR-QOL questionnaires are complex tools, not routinely used in breast cancer trials.Worldwide, around 10 million individuals develop cancer each year; this figure is expected to increase to 15 million in 2020. For all cancers, the total economic burden of this disease worldwide was projected by the authors to be in the range of $US 300-400 billion in 2001 (about $US 100-140 billion as direct costs and the remainder as indirect costs [morbidity and mortality]). According to the National Institute of Health (NIH), the total cost of cancer was estimated at $US 156.7 billion in 2001 in US ($US 56.4 billion as direct costs, $US 15.6 as indirect morbidity costs, and $US 84.7 billion as indirect mortality costs). Based on limited information, in the US, breast cancer can be projected to account for about one-fifth/one-fourth of the total cost of cancer. Breast cancer treatment costs are higher in the US than in other developed countries. Both direct and indirect costs are dependent on disease stage. The per-patient costs for initial care in 1992 were estimated at $US 10 813, for continuing care at $US 1084 and for terminal care at $US 17 886. Stage-specific costs provide information for cost-effectiveness analyses of cancer-control initiatives, such as screening programmes. Economic studies on breast cancer are heterogeneous, and the cost estimates made are not easily generalisable. The cost of treatment for breast cancer in developing countries is < or =5% of that in developed regions.     

依维莫司联合氟维司群用于激素受体阳性晚期乳腺癌的研究进展

乳腺癌是一种经典的激素依赖性肿瘤,内分泌治疗是激素受体阳性［HR（+）］/人表皮生长因子 2 阴性 ［HER-2（-）］晚期乳腺癌的主要治疗方法。传统的内分泌药物,如他莫昔芬、芳香化酶抑制剂（AI）和氟维司群已被 广泛应用于晚期（局部晚期或转移）绝经后患者。然而,对于这种亚型的乳腺癌患者,在引入靶向药物,如人哺乳动 物雷帕霉素位点（mTOR）抑制剂和细胞周期蛋白依赖性激酶4/6（CDK4/6）抑制剂后,内分泌治疗的选择已经扩大,出 现了各种靶向药物与内分泌治疗的组合。本文旨在探讨mTOR抑制剂依维莫司联合氟维司群在对AI耐药的雌激素 受体阳性［ER（+）］/HER-2（-）晚期乳腺癌中的应用。