预防乳腺癌术后皮瓣坏死的体会

本文阐述了对乳腺癌手术皮瓣的分离,引流方法及皮肤的缝合改进及体会。手术57例与同期对照组95例乳腺癌病人比较,其皮瓣坏死率从52.63％降至8.77％。     

防治乳腺癌改良根治术后皮瓣坏死的临床研究

目的：探讨防治乳腺癌改良根治术后大块皮瓣坏死的理想方法.方法：对558例乳腺癌改良根治术者采取术前切口设计、皮瓣避免张力缝合、适当的皮瓣厚度、合理使用电刀、行腋下和胸骨旁双管负压引流及合适包扎等措施.结果：558例中仅有32例发生小范围皮瓣坏死,坏死率约6%.结论：术前切口设计、适当韵皮瓣厚度、合理使用电刀、皮瓣无张力缝合、有效引流及合适包扎是预防皮瓣坏死较好的方法.     

防治乳腺癌改良根治术后皮瓣坏死的临床研究

目的:探讨防治乳腺癌改良根治术后大块皮瓣坏死的理想方法.方法:对558例乳腺癌改良根治术者采取术前切口设计、皮瓣避免张力缝合、适当的皮瓣厚度、合理使用电刀、行腋下和胸骨旁双管负压引流及合适包扎等措施.结果:558例中仅有32例发生小范围皮瓣坏死,坏死率约6%.结论:术前切口设计、适当韵皮瓣厚度、合理使用电刀、皮瓣无张力缝合、有效引流及合适包扎是预防皮瓣坏死较好的方法.     

20例乳腺癌术后皮瓣坏死原因分析

 目的　分析乳腺癌术后皮瓣坏死原因。方法　对实施乳腺癌手术的320例患者中出现瓣坏死的20例的临床分期、术式、肿块部位进行分析,并对皮瓣坏死原因归纳总结。结果与结论乳腺癌术后皮瓣坏死与临床分期、术式、肿块部位没有关系,主要与手术操作、术后处理及患者的个体状况有关。     

防止乳腺癌术后皮瓣坏死的体会

防止乳腺癌术后皮瓣坏死的体会江西省肿瘤医院马行天，吴毓东皮瓣坏死是乳腺癌术后常见的并发症，尤其是在目前，由于手术操作者无瘤观念的增强，多采用电刀分离皮瓣，更易出现这一皮瓣坏死的并发症。针对这个并发症的预防问题，我们于１９９０年１０月～１９９３年３月，...     

改良湿性疗法于乳腺癌改良根治术后皮瓣坏死的应用

目的探讨改良湿性疗法治疗乳腺癌改良根治术后创面皮瓣坏死的效果。方法 2006年9月至2011年9月,对18例乳腺癌改良根治术后皮瓣坏死患者,应用改良式湿性疗法进行伤口护理。结果 18例患者伤口均痊愈。结论改良湿性疗法能加速乳腺癌术后皮瓣坏死伤口的愈合,避免了植皮手术,不影响患者的后续治疗。     

合并糖尿病乳腺癌改良根治术后皮瓣坏死处理方法的探讨

目的探讨合并糖尿病乳腺癌患者改良根治术后皮瓣坏死的处理方法。方法本组共54例,35例为2003年1月至2005年12月收治,设为对照组,采用传统改良根治术;19例为2006年1月至2007年5月收治,设为研究组,采用改进方法。结果研究组皮瓣坏死率为10．5％,对照组皮瓣坏死率为45．7％,研究组皮瓣坏死率明显低于对照组。结论采用改进方法后,合并糖尿病的乳腺癌患者皮瓣坏死率明显下降。     

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。     

降低乳腺癌术后皮瓣坏死发生率的体会

皮瓣坏死是乳腺癌根治术后最常见并发症,国外文献报导其发生率为10％～60％,国内报导为51％～71％。我科91年12月以前为37.5％。我们于1992年1月～1994年11月针对皮瓣坏死率高的原因采取了一系列改进措施,手术176例,皮瓣坏死率控制在4.5％,现报告如下。     

654-2预防乳癌术后皮瓣坏死临床观察(附614例)

目的:通过对本院614例乳腺癌患者的术后临床观察,寻找预防术后皮瓣坏死的措施。方法:将患者随机分为实验组40例,对照组48例,实验组术后当天即静脉用654-2 10-20mg,连用3-7天。并推广运用于526例乳腺癌患者。结果:实验组皮瓣坏死4例,发病率为10%,对照组发生17例,发生率35.4%,差异有显著性(P<0.01)。实验组皮下积液的发生率为25%,对照组发生率为45.8%,有显著性差异(P<0.05)。推广阶段皮肤坏死发生率明显低于相关报道。结论:乳腺癌术后应用654-2可改善皮瓣血运,减少皮瓣坏死及皮下积液的发生。     

应用新型胸带预防乳腺癌术后皮瓣坏死的探讨简

目的：探讨新型胸带（专利名称：一种用于乳腺癌根治手术后的胸带;专利号：ZL201020276986．2）对于乳腺癌术后皮瓣坏死的预防作用。方法：采用回顾性分析,选取行乳腺癌根治术的女性患者163例,随机分成两组,其中93例作为实验组,术后使用新型胸带加压包扎切口;70例作为对照组,术后使用多头胸带加压包扎切口。埘比皮瓣坏死率及坏死程度。结果：实验组皮瓣坏死率明显低于对照组,差异有统计学意义（P〈0．05）。实验组中、重度皮瓣坏死率明显低于对照组,差异有统计学意义（P〈0.05）。结论：新型胸带町有效降低乳腺癌术后皮瓣坏死率,减轻其坏死程度,值得临床推广。     

腹腔镜下获取带蒂大网膜瓣在乳腺癌术后乳房重建中的应用价值

大网膜具有较强的吸收功能和覆盖填充作用,因此可以应用于乳房切除后的乳房重建。但由于开腹获取大网膜对腹部有较大的创伤,且大网膜较小的体积难以填充较大的乳房,使其在临床上的应用受到了限制。笔者重点介绍通过腹腔镜技术获取大网膜从而减小供区创伤,以及乳房体积较大时采用大网膜联合假体置入完成乳房重建的方法。     

乳腺癌保乳手术患者进行带蒂背阔肌肌瓣修复的效果分析

目的 探讨乳腺癌保乳手术患者进行带蒂背阔肌肌瓣修复的效果.方法 将90例行保乳手术的乳腺癌患者按治疗方法不同分为无瘢痕组46例和传统组44例.无瘢痕组行保乳术后即时无瘢痕带蒂背阔肌肌瓣修复术,传统组行保乳术后传统修复术.比较两组患者手术情况、临床治疗效果、乳房外观及乳房美容效果,评估患者满意度及术后不良反应发生情况.结果 无瘢痕组患者手术时间、住院时间均短于对照组,乳房美容效果优良率高于传统组,腹泻、呕吐发生率均低于传统组,满意度高于传统组,差异均有统计学意义(P﹤0.05).两组患者客观缓解率、术后乳房与胸骨上窝距离、乳房与正中线距离及复发情况比较,差异均无统计学意义(P﹥0.05).结论 应用无瘢痕带蒂背阔肌肌瓣修复与传统带蒂背阔肌肌瓣修复对乳腺癌保乳术后患者的治疗效果相当,但无瘢痕带蒂背阔肌肌瓣修复可提高乳房美容效果,缩短手术及住院时间,提升术后满意度.     

乳腺癌术后皮瓣坏死及皮下积液的预防

目的:探讨预防乳腺癌术后皮瓣坏死及皮下积液发生的方法。方法:2006年10月-2011年10月我院280例乳腺癌患者行乳腺癌改良根治术,切口均采用Stewart横切口,A组75例采用手术刀加电刀分离皮瓣,术后单根硅胶管持续负压吸引;B组75例采用手术刀加电刀分离皮瓣,术后普通橡胶管接胃引流壶负压吸引;C组65例采用单纯电刀分离皮瓣,术后单根硅胶管持续负压吸引;D组65例采用单纯电刀分离皮瓣,术后普通橡胶管接胃引流壶负压吸引。比较各组皮瓣坏死发生率及皮下积液发生率。结果:A、B、C、D四组皮瓣坏死发生率分别为4.00%(3/75),13.33%(10/75),13.85%(9/65),29.23%(19/65),A、B,A、C,B、D,C、D两组间相较,差异有统计学意义(P<0.05)。A、B、C、D四组皮下积液发生率分别为5.33%(4/75),16.00%(12/75),18.46%(12/65),33.85%(22/65),A、B,A、C,B、D,C、D两组间相较,差异有统计学意义(P<0.05)。结论:乳腺癌手术术中应用手术刀加电刀分离皮瓣,术后采用单根硅胶管接持续负压吸引,可有效预防乳腺癌术后皮瓣坏死及皮下积液。     

Role of rectus abdominis myocutaneous flap in surgery for breast cancer

Rectus abdominis myocutaneous flap has been used in four different therapeutic situations after mastectomy for breast cancer. These include (1) to obtain skin cover after radical mastectomy with liberal skin sacrifice for locally advanced cancer in 14 cases, (2) for skin cover to obtain primary wound healing in 10 cases treated by preoperative radiotherapy, (3) for delayed breast reconstruction in three patients and (4) for immediate postmastectomy breast reconstruction in 25 patients. Prosthesis was not used for breast reconstruction. The operative morbidity was minimal but 1-2 units of extra blood transfusion was required. Administration of adjuvant treatment, including chemotherapy and radiotherapy was not affected. Reconstruction was satisfactory.     

Surgical resection for elderly patient with skin invasion of breast cancer

We report a locally advanced elderly breast carcinoma with skin invasion. The patient was a 96-year-old woman who had a breast lump. The palpable tumor was 3 .5 cm in diameter. Ultrasonography revealed a low echoic mass. A core needle biopsy for the breast tumor led to a diagnosis of an invasive ductal carcinoma positive for estrogen receptor and progesteron receptor, and negative for HER2/neu protein expression. She underwent a tumorectomy including the cancer invasive skin by local anesthesia. Because her respiratory function was unbearable to perform a muscle-preserving mastectomy with general anesthesia. The surgical margins of the resected specimen were negative. The clinicopathological stage, according to the UICC-pTNM classification, was Stage III C (T4b, N0, M0). After the operation, she was administered aromatase inhibitor. The patient has been well and remained disease-free during a follow-up period of 3 years. The surgical excision with local anesthesia was useful for locally advanced super senior breast cancer patients who were impossible to perform general anesthesia by various kinds of factors.     

Local recurrence after conservative surgery for breast cancer

The advent of limited operative therapy for breast cancer has produced both good cosmetic results and local recurrence. In our department we treated 38 cases with conservation surgery for early stage breast cancers between February 1988 and October 1994, and local recurrence occurred in 2. PATIENT 1. A 56-year-old-woman had a 1 x 0.8 cm tumor in the C region of the left breast. A quadrantectomy with axillary dissection (level 2) was performed as the margin of the nipple side was negative, followed by entire breast irradiation (50 Gy). Approximately four years after the first operation she developed a local recurrence in the CD region of the breast. A salvage mastectomy with subclavicular lymph node dissection was performed. After the second operation she appears to be healthy. PATINENT 2. A 54-year-old-woman noticed a 1 cm tumor located in the EAC region of the left breast. Excisional biopsy showed solid-tubular carcinoma. The distance between the nipple and the tumor was only 0.7 cm. A wide excision with axillary dissection (level 2) was performed as the margin of the nipple side was negative on the frozen section. Neither irradiation of the entire breast nor the adjuvant chemotherapy could be performed. After a three and a half year follow up local recurrence beneath the operative scar was recognized, and an additional wide excision was performed. A half year has passed since the second operation, there have been no signs of recurrence and she appears to be healthy. In conclusion, we experienced two local recurrences in 38 cases of breast conservation surgery for early breast cancers. One patient had multicentric cancers with histologically different types: mucinous and noninvasive ductal carcinoma, and another had a very short distance between the nipple and the tumor and did not undergo chemotherapy or radiotherapy.