乳腺癌改良根治术与Halsted根治术的疗效比较

本文复习了我院７２例改良根治术治疗的乳腺癌患者，与同时期Ｈａｌｓｔｅｄ要治术７３例作比较，ＭＲＭ组５年，１０年生存率分别为８１．０４％和５０．５９％，ＲＭ组分别为７５．５７％和５５．３３％，经统计学处理，两级无显著性差异（Ｐ〉０．０５）。同时对腋淋巴结清除数目与局部复发率分别进行比较，两组也无显著差异，作者认为可手术的乳腺癌，除非肿瘤累及胸大肌或腋淋巴结转移较大而影响手术操作外，ＭＲＭ为可行术式。     

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Kodama法改良根治术的临床应用研究

探讨对腋淋巴结阳性乳腺癌患者行Kodama术式的应用临床及意义。方法:322例乳腺癌患者,154例临床腋淋巴结阳性乳腺癌患者采用Kodama术式,168例行常规Auchinclos改良根治术式,对两组情况进行比较,同时随访观察患者的预后情况。结果:两组患者手术时间差异无统计学意义,行改进术式患者腋下清扫淋巴结总数及L3组淋巴结数较常规术式多,两组差异有统计学意义,Kodama术式组患者5年无瘤生存率为58.9%,常规术式组患者5年无瘤生存率为51.1%,两组差异无统计学意义。结论:对临床腋淋巴结阳性乳腺癌患者行全腋下淋巴结清扫具有一定的临床应用价值,采用Kodama术式有利于对L3组淋巴结的清扫。      

乳腺癌根治术后放射治疗的评价

为了评价乳腺癌根治术后辅助放射治疗的作用，本文分析了院１９８７－１９９０年４９７例乳腺癌根治术后放疗的疗效，并与我院前期（１９６３－１９７７年）单纯手术组比较，总５年生存率无显著性差异（Ｐ〉０．０５），而腋淋巴结（４－６只）阳性组５年生存率有显著性差异（Ｐ〈０．０５），认为放疗应用恰当可提高腋淋巴结转移者的５年生存率。本组中Ⅲ期患者术后辅助加了化、放疗、与术后辅加放疗者比较，可提高５年生存率，但无     

乳腺癌根治术后放射治疗的评价

为了评价乳腺癌根治术后辅助放射治疗的作用，本文分析了我院1987～1990年497例乳腺癌根治术后放疗的疗效，并与我院前期（1903～1977年）单纯手术组比较，总5年生存率无显著性差异（P＞0．05），而腋淋巴结（4-6只）阳性组5年生存率有显著性差异（P＜0．05），认为放疗应用恰当可提高腋淋巴结转移者的5年生存率。本组中Ⅲ期患者术后辅助加了化、放疗，与术后输加放疗者比较，可提高5年生存率，但无显著性差异。     

保乳手术与改良根治术治疗早期乳腺癌的临床效果

目的观察保乳手术与改良根治术治疗早期乳腺癌的临床效果。方法选取2009年2月至2011年9月间收治的早期乳腺癌且接受手术治疗的128例患者,其中保乳手术治疗56例(保乳手术组),改良根治术72例(改良根治术组),对两组患者的手术时间、出血量、切口长度和住院时间、术后乳房美容效果进行比较,对患者进行门诊随访3年后,比较两组患者术后3年的随访结果,包括生存率、并发症率、腋淋巴结复发及远处转移。结果保乳手术组患者的手术时间及住院时间均短于改良根治术组,保乳手术组的出血量少于改良根治术组,切口长度小于改良根治术组,差异均有统计学意义(P<0.05)。两组患者的术后美容优良率、生存率、并发症发生率、局部复发率、腋淋巴结复发率及远处转移率的差异均无统计学意义(P>0.05)。结论保乳手术与改良根治术治疗早期乳腺癌的远期效果相当,然而保乳手术较改良根治术的手术时间及住院时间更短、切口长度更小、术中出血量更少。     

乳房切除并腋淋巴结清除术与根治术对Ⅰ、Ⅱ期乳腺癌疗效的比较

目的比较乳房切除并腋淋巴结清除与根治术对Ⅰ、Ⅱ期乳腺癌的疗效.方法192例Ⅰ、Ⅱ期乳腺癌随机分两组:乳房切除并腋淋巴结清除(MAD组,95例);根治术组(RM组,97例).MAD组腋窝淋巴结清除范围是腋下群或加腋中群淋巴结.RM组采用Halsted根治术或仿根治术Ⅱ式.结果MAD组和RM组5年生存率分别为92%和91.8%;无病生存率分别为92%和90%.局部复发率:MAD组和RM组分别为3.2%和3.1%,患侧上肢肿胀发生率:MAD组为3%;RM组为7.2%.结论对Ⅰ、Ⅱ期乳腺癌采用乳房切除并腋淋巴结清除术的疗效与根治术同,且能改善病人的生存质量.     

乳腺癌根治术后胸壁放射治疗的价值

目的：探讨乳腺癌根治术后胸壁放射治疗的价值。方法：临床资料完整的乳腺癌根治术后放射治疗病例74例，其中Ⅱa期31例，Ⅱb期25例，Ⅲa期9例，Ⅲb期5例，Ⅳ期4例，合并胸壁放射治疗者36例（照射组），未合并胸壁放射治疗者38例（未照射组）。淋巴引流区和胸壁放射治疗剂量分别为DT40－53Gy,4.0-5.5周完成，DT35－52Gy，3．5－5．3周完成，多数患者放射治疗前后合并化疗，比较分析两组胸壁复发率，区域淋巴结复发率，远地转移率及生存率。结果：胸壁照射组和未照射组3年胸壁复发率分别为8．3％，10．5％，区域淋巴结复发率分别为11．1％，13．2％，远地转移率分别为22．2％，23．7％，经X^2检验无差异，P值分别为0．747、0．788、0．881。两组2、3年生存率分别为91．7％和89．2％，85．8％和86．1％，腋窝淋巴结阳性病例两组2、3年生存率分别为84．2％和81．8％、72．95和77．1％，经Logrank检验均无显著差异，P值分别为0．663、0．919。中晚期病例（临床Ⅲ期以上）胸壁照射与否及不同剂量胸壁照射的生存率曲线经Logrank检验也均无差异，P值分别为0．449，0．764。结论：研究未得出乳腺癌根治术后胸壁放射治疗有利降低局部区域复发率，远地转移率及提高生存率的结果，胸壁放射治疗的价值及后射治疗靶后的个体化确定需要更多的随机研究来证实。     

保留乳头乳晕复合体的改良根治术治疗早期乳腺癌患者疗效分析

背景与目的：保留乳头乳晕复合体（nipple—areolar complex,NAG）对乳腺癌患者乳房重建的美容效果和术后生活质量有重要意义。但保留NAC改良根治术治疗早期（Ⅰ、Ⅱa期）乳腺癌的肿瘤学风险一直存在着争论。本研究比较保留NAC的改良根治术与传统改良根治性手术治疗早期乳腺癌疗效。方法：在1998年1月～2003年12月间在我院接受手术的早期乳腺癌患者中,根据发病年龄、腋窝淋巴结状态、激素受体情况、肿块大小和Her-2／neu的表达状态5个变量对42例接受保留NAC改良根治术患者和84例接受传统改良根治术患者的按1：2比例进行配对的回顾性队列研究。比较两组的局部区域复发率、远处转移率、总生存率和无瘤生存率。结果：保留NAC组中位随访时间为48个月,传统改良根治组为44个月。保留NAC组5年局部区域复发率为2．44％,传统改良根治组3．21％,两者差异无统计学意义（P=0．771）。保留NAC组5年远处转移率为5．64％,传统改良根治组为4．30％,两者差异无统计学意义（P=0．654）。保留NAC组和传统改良根治组5年总生存率分别为96．00％和98．18％,差异无统计学意义（P=0．694）;5年无瘤生存率分别为91．67％和92．26％,差异无统计学意义（P=0．597）。结论：在严格把握适应症基础上行保留NAC改良根治术治疗早期乳腺癌可以和传统的改良根治术取得相似的治疗效果,但可以增强患者乳房重建的美容效果和提高术后生活质量。     

临床腋淋巴结阳性乳腺癌患者行全腋窝淋巴结清扫的应用探讨

背景与目的:临床腋淋巴结阳性乳腺癌患者常规行全腋窝淋巴结清扫,本研究探讨改良根治术时采用改进L3组淋巴结清扫方式的临床应用及意义.方法:322例临床腋淋巴结阳性的乳腺癌患者中,154例采用改进的L3组淋巴结清扫方式,168例行常规Auchinclos改良根治术,对两种手术方式所用时间和术后不良反应进行比较,同时随访观察患者的无病生存率.结果:两种手术方式所用手术时间、术后不良反应差异无统计学意义(P＞0.05),行改进术式患者腋下淋巴结总数及L3组淋巴结数较常规术式多,两组差异有统计学意义(P＜0.05),L3组淋巴结未转移患者5年无病生存率为68.6％,L3组淋巴结转移患者5年无病生存率为35.7％,差异有统计学意义(P＜0.05).结论:对临床腋淋巴结阳性乳腺癌患者行L3组淋巴结清扫具有一定的临床应用价值,采用改进的淋巴结清扫方式,便于L3组淋巴结的清扫.     

乳腺癌根治术与改良根治术对患侧肩关节功能的影响

目的比较乳腺癌根治术(RM)与改良根治术(MRM)对患侧肩关节功能的影响。方法RM组140例，MRM组60例，手术后1个月测量患侧肩关节的活动度，计算其相应的肩关节功能损坏程度。结果RM组术后1个月患侧肩关节功能损坏程度：屈曲49．8％，外展67．8％，内旋6．9％；MRM组后肩关节功能损坏程度：屈曲20．6％，外展42．5％，内旋3．4％。结论MRM组后患侧肩关节屈曲、外展、内旋功能损坏程度明显轻于RM组。     

New trends in the surgical treatment of primary breast cancer in the Florence District: 1979-1985

The authors report on a consecutive series of 1979 TIS-T1A-T2A-T3A breast cancer cases surgically treated from 1979 to 1985. The study investigates the impact of recent reports on conservative surgery and of a national treatment protocol for breast cancer, encouraging the use of modified radical mastectomy (MRM) and quadrantectomy, axillary dissection and breast irradiation (QUART) as alternatives to Halsted's radical mastectomy (RM). RM frequency dropped from 52% to 8% in TIS-T1A and from 82% to 20% in T2A-T3A cases in the study period, in favor of MRM and of QUART, which increased from 10% to 54% in TIS-T1A cases. Although surgical choices differ widely according to individual surgeons, a definite trend towards more conservative surgery is evident, which demonstrates how the national treatment protocol has affected current surgical practice.     

乳腺癌改良根治术217例随访分析

Modified radical mastectomy (MRM) was performed in two hundred and seventeen patients with operable breast cancer during 1972-1982. Having been followed for 5 to 10 years, the results were compared with those of radical mastectomy (RM) during the same period. There was no significant difference in 5 and 10 year survival rates between the two groups. MRM had the advantages of insignificant deformity, better function and easy breast reconstruction in comparison with RM. The authors believe that MRM should be recommended as the treatment of choice for breast cancer.     

Surgical treatment of breast cancer in elderly women--analysis of 244 patients

From April 1964 to December 1981, 244 patients, women over 60 years old, with unilateral breast cancer were treated by surgery in our hospital. In this series, 15 patients (6.1%) had Stage I, 131 (53.6%) Stage II, 82 (33.6%) Stage III and 16 (6.6%) unstaged lesions. Of these patients, 3 were treated by extended radical mastectomy (ERM), 140 by standard radical mastectomy (SRM), 49 by modified radical mastectomy (MRM) and 52 by total mastectomy (TM). Except 52 cases by TM, axillary lymph node metastasis rate in 192 patients of this series was 49.3%. The 5- and 10-year survival rates were 33.3% in ERM group, 53.4% and 39.5% in SRM group, 70.8% and 48.5% in MRM group, and 73.4% and 55.3% in TM group, respectively. The overall 5-and 10-year survival rates were 62.1% and 45.6%. In Stage I, II patients, the 5-and 10-year survival rates of TM group were much higher than those of SRM and MRM groups (P less than 0.01), but in Stage III, the 5- and 10-year survival rates of MRM group were higher than those of other groups (P less than 0.05). Noticeably, the 5- and 10-year survival rates of SRM group in Stage I approximately III were not satisfactory. Our data show that the postoperative radiotherapy or chemotherapy was ineffective in elderly patients with breast cancer.     

隐匿性乳腺癌的诊断和治疗

目的分析隐匿性乳腺癌的诊断、治疗及其预后情况,总结其诊断及治疗经验。方法回顾性分析47例隐匿性乳腺癌的诊断治疗方法以及各种方法治疗的效果。结果23例患者接受了同侧乳腺改良根治术,18例患者仅行同侧腋窝淋巴结清扫术,6例患者在腋窝淋巴结活检证实为隐匿性乳腺癌后未行进一步手术治疗。行改良根治术组与仅行腋窝清扫组两者间总生存率差异无显著性(P=0.646),但后者复发率(33.3%,6/18)明显高于前者(8.7%,2/23),两者无病生存率比较差异有显著性(P=0.008)。结论腋窝淋巴结活检及免疫组化分析对隐匿性乳腺癌的诊断具有重要意义,治疗方式首选改良根治术并辅以化放疗综合治疗。     

乳腺癌根治术中两种不同皮瓣处理方法的临床研究

目的探讨保留真皮下毛细血管网对乳腺癌改良根治术后皮瓣存活的保护作用。方法12例乳腺癌患者采用保留真皮下毛细血管网皮瓣（A组）和12例采用真皮全层皮瓣（B组）比较术后皮瓣情况。结果皮下积液A组5例,B组8例;切口皮缘起水泡A组5例,B组9例,两组比较差异均无统计学意义,P〉0．05。A组无1例发生皮瓣坏死,B组5例;术后住院天数A组较B组短,两组比较差异均有统计学意义,P〈0．05。皮瓣坏死的发生与皮下积液及皮缘水泡相关。结论保留真皮下毛细血管网可减少乳腺癌改良根治术后皮瓣坏死的发生。     

Is it useful to remove internal mammary nodes in operable breast cancer?

From September 1963 to January 1968, 243 patients with operable breast cancer were included in a randomized trial designed to compare classical radical mastectomy (RM) alone to extended mastectomy (EM), i.e. RM plus internal mammary dissection. One hundred and seventeen patients underwent RM, and 126 EM. After a mean follow-up time of 20 years, no significant differences were observed between the two treatment groups for overall survival, for the relapse-free survival rates, nor for distant metastasis, or locoregional recurrence rates. From a regression model, significant interactions were found between risk of death, EM, and both nodal status and site of the tumour. When compared to RM, EM significantly decreased the risk of death for patients with internal or medial tumour and positive axillary nodes (P = 0.05). No beneficial effect of EM was observed for any of the other patients; on the contrary, EM seemed to increase the risk of death for the patients with external tumour and negative axillary nodes (P = 0.07).     

Conservative Surgery Plus Axillary Radiotherapy vs. Modified Radical Mastectomy in Patients With Stage I Breast Cancer

BackgroundThe objective of this study was to explore the effect of conservative surgery plus postoperative axillary radiotherapy without axillary lymph node dissection vs. modified radical mastectomy in patients with stage I breast cancer.Patients and MethodsIn this study, 186 patients with stage I breast cancer were enrolled. Among them, 98 patients underwent breast-conserving surgery without axillary node dissection. From the first day after surgery, each of them received 6 cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy, and thereafter radical radiotherapy for 5 to 6 weeks. Eighty-eight patients received modified radical mastectomy with postoperative chemotherapy and radiotherapy. The clinical data of these 186 patients were analyzed.ResultsThere was no significant difference (P > .05) in local recurrence and survival rates between the conservative plus axillary radiotherapy group and the modified radical mastectomy group, although a significantly greater incidence of upper limb dysfunction and edema were observed in the modified mastectomy group (P < .05).ConclusionThe efficacy of conservative surgery plus axillary radiotherapy alone is superior to that of axillary node dissection for stage I breast cancer patients.     

Mastectomy Only Versus Radical Mastectomy and Postoperative Radiotherapy in Node Negative, Resectable Breast Cancer a randomized trial

Patients with clinically node negative resectable breast cancer were randomized to either mastectomy only or radical mastectomy and radiotherapy, and followed for 15-20 years. During follow-up axillary metastases occurred with the same frequency after mastectomy as was initially observed in the group that underwent axillary dissection. There was no significant survival difference between the two groups. When adjusting the treatment effect for differences in age, tumour size, lymph node metastases, and histology, the outcome after radical mastectomy plus irradiation was significantly inferior. Comedo carcinoma proved also in this study to carry a poor prognosis.     

Oncoplastic Breast Conserving Surgery with Nipple-areolar Preservation for Centrally Located Breast Cancer: a Retrospective Cohort Study

A compariosn was made of survival outcomes of oncoplastic breast conserving therapy (oBCT) with nippleareolar (NAC) preservation in women with centrally located breast cancer (CLBC) undergoing modified radical mastectomy (MRM) in China in a matched retrospective cohort study. We used a database including patients who received oBCT (n=91) or MRM (n=182) from 2003 to 2013 in our hospital. Matching was conducted according to five variables: age at diagnosis, axillary lymph node status, hormone receptor status, human epidermal growth factor-like receptor 2 status (HER-2) and tumor stage. The match ratio was 1:2. Median follow-up times for the oBCT and MRM groups were 83 and 81 months, respectively. There were no significant differences in 87-month overall, local, or distant recurrence-free survival between patients with oBCT and MRM (89%vs.90%; 93%vs.95%; 91%vs.92%;). For appropriate breast cancer patients, oBCT for CLBC is oncologically safe, oncoplastic techniques improving cosmetic outcomes.