乳腺癌保留乳头乳晕改良根治术的临床应用价值

目的 探讨保留乳头乳晕的改良根治术在乳腺癌治疗中的可行性、肿瘤的根治性和美容效果.方法 选择初治乳腺癌患者96例,其中保留乳头乳晕的改良根治术(NSM)组共35例,改良根治术(MRM)组共61例.对两组患者术后并发症、外观评价、局部复发及远处转移情况进行比较.结果 术后并发症NSM组和MRM组差异无统计学意义(x2=3.140,P=0.061);外观评价NSM组优于MRM组(x2=82.786,P=0.000);随访48～ 84个月,平均随访63个月,两组患者均无局部复发,NSM组发生远处转移2例(5.7％),MRM组远处转移3例(4.9％),两组远处转移率差异无统计学意义(x2=0.029,P=0.866).结论 保留乳头乳晕的改良根治术可以获得与改良根治术相同的治疗效果,术前患者容易接受,术后美容效果好,值得广泛推广.     

保留乳头乳晕复合体的改良根治术对早期乳腺癌的疗效研究

目的探讨保留乳头乳晕复合体(nipple-areolar complex,NAC)的乳腺癌改良根治术对早期乳腺癌的临床疗效。方法选取40例行保留NAC改良根治术和40例行传统改良根治术的早期乳腺癌患者,按1∶1比例进行配对回顾性研究。结果保留NAC组中位随访时间为48个月,传统改良根治组为50个月。保留NAC组5年局部区域复发率为5.0%,传统改良根治组为7.5%,两者比较差异无统计学意义(P=0.673)。保留NAC组5年远处转移率为10.0%,传统改良根治组为7.5%,两者比较差异无统计学意义(P=0.557)。保留NAC组和传统改良根治组5年总生存率分别为96.0%和98.2%,差异无统计学意义(P=0.589);两组5年无瘤生存率分别为91.7%和92.3%,差异无统计学意义(P=0.612)。结论严格把握适应症基础上,保留NAC改良根治术对早期乳腺癌的疗效与传统改良根治术疗效相近,但可达到患者乳房重建的美容效果和提高患者术后生活质量。     

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。     

保留乳头乳晕的乳腺癌改良根治术治疗乳腺癌的安全性

保留乳头乳晕的乳腺癌改良根治术（NSM）作为乳腺外科的一种术式,因其保留了患者的乳头乳晕复合体（NAC）,对患者术后的美容效果或者术后重建外观美容有极为重要的意义。然而,其临床应用仍存在一些值得探讨的争议点。近年来国内外出现了一些与NSM安全性相关的热点问题,如NSM术前筛选标准、NAC受侵情况、NSM术后并发症及处理方法等。     

早期乳腺癌保留乳头乳晕复合体改良根治并一期乳房重建

目的探讨保留乳头乳晕复合体（nipple—areolarcomplex,NAC）并一期乳房重建术治疗早期乳腺癌的可行性、安全性、肿瘤根治性和美容效果。方法2006年1月至2009年12月收治早期乳腺癌28例,12例接受保留NAC的改良根治术并一期乳房重建（观察组）,16例为不保留NAC的一期乳房重建（对照组）,比较分析两组的局部区域复发率、远处转移率及再造乳房形态。结果随访时间为36～48个月,28例均未发现肿瘤局部复发或远处转移,重建乳房外形满意,观察组乳头乳晕区皮肤无坏死,再造乳房无明显萎缩,质地柔软,乳头感觉存在。结论在严格把握适应证的基础上行保留NAC改良根治并一期乳房重建术治疗早期乳腺癌是安全和可行的,重建后的乳房美容效果更满意。     

保留乳头乳晕的改良根治术和重建荟萃分析

目的探讨保留乳头乳晕复合体的乳腺切除及乳房即刻重建手术在中国的临床应用情况,以及对预后的影响。方法检索Pub Med、中国知网、维普、万方数据库中关于保留乳头乳晕复合体和乳房重建相关的文献,没有时间和语言限制。对符合入选标准的文献进行质量评价与荟萃分析。结果共有16篇随机对照试验纳入分析。11篇研究分析得出乳腺癌改良根治术后进行Ⅰ期重建术增加了术后并发症,但差异没有统计学意义(P=0.106),4篇文献分析结果显示保留乳头乳晕复合体后增加了术后并发症(P=0.026)。5篇研究分析显示乳腺癌改良根治术后进行Ⅰ期重建术并没有增加局部复发的概率(P=0.735),3篇研究提示乳腺癌改良根治术后进行Ⅰ期重建术并没有增加远处转移的概率(P=0.905),3篇文献显示保留乳头乳晕复合体后增加了远处转移的概率,但差异没有统计学意义(P=0.523)。7篇研究证实乳腺癌改良根治术后进行Ⅰ期重建术加强了患者对外观的满意度(P=0.000)。结论保留乳头乳晕复合体的乳腺癌改良根治术+Ⅰ期重建术并不增加术后并发症、局部复发和远期转移的发生,却增强了术后满意度,可以作为早期年轻乳腺癌患者的首选术式。     

保留乳头乳晕复合体乳腺癌根治术的肿瘤学风险及适应证

保留乳头乳晕复合体（nipple—areolacomplex，NAC）的乳腺癌改良根治术是在保留胸肌的改良根治术的基础上，进一步保留乳头、乳晕，其具有保乳手术良好的效果，同时又达到改良根治术的较低的复发率，可望作为Ⅰ、Ⅱ期乳腺癌手术治疗的常规选择术式。该术式的缺陷在于保留NAC带来的残留癌的风险，因此术前结合NAC浸润相关因素，准确预测NAC受累风险，从而制定恰当的手术适应证是关键。本文就保留NAC的乳腺癌改良根治术的肿瘤学风险及适应证进行综述：     

乳腺癌改良根治术同期假体植入重建乳房

目的探讨乳腺癌行改良根治术后，同期硅胶假体植入重建乳房的可行性。方法2005年6月至2006年9月，对20例Ⅰ、Ⅱ期乳腺癌患者行保留皮肤的乳腺癌改良根治术后，同期于胸大、小肌间植入硅胶假体重建乳房，并根据冰冻切片检查结果决定是否保留乳头乳晕复合体。结果20例患者客观评价效果优良和尚好者达95％，主观评价效果优良和尚好者达100％。其中有6例保留乳头乳晕复合体。术后随访3～18个月，所有病例均无局部复发和远处转移，无明显术后并发症。结论保留皮肤的乳腺癌改良根治术后用硅胶假体行一期乳房重建，能达到满意的乳房美容效果，是治疗早期乳腺癌安全可行的方法。     

保留皮肤的青年乳腺癌改良根治术后即刻乳房再造与改良根治术的比较分析

目的:比较保留皮肤的乳腺癌改良根治术后即刻乳房再造与改良根治术对青年患者的疗效,并对乳房再造患者的预后因素进行分析。方法:回顾性分析柳州市人民医院2008年7 月至2014年6 月收治并行保留皮肤的乳腺癌改良根治术后即刻乳房再造组（60例）与改良根治术组（68例）的青年乳腺癌患者临床病理资料,比较两组间局部复发、无瘤生存及总生存,并分析年龄、肿瘤大小、是否保留乳头乳晕等因素对乳房再造患者生存的影响。结果:所有病例随访15～88个月,中位时间51个月。即刻乳房再造组局部复发3 例,远处转移8 例,死亡5 例,3 年无瘤生存率91.7% ,5 年无瘤生存率81.7% ,总生存率91.7%;改良根治术组局部复发2 例,远处转移9 例,死亡5 例,3 年无瘤生存率94.1 % ,5 年无瘤生存率83.8% ,总生存率92.6% ,两组比较均差异无统计学意义（均P > 0.05）。 即刻乳房再造组患者预后分析显示,淋巴结转移及雌孕激素受体阴性与无瘤生存率、总生存率相关（均P <0.05）。 结论:青年乳腺癌患者保留皮肤的改良根治术后即刻乳房再造组与改良根治术组在局部复发及远期生存方面无显著性差异,对于早期青年乳腺癌患者是安全的,保留乳头乳晕并未增加肿瘤复发风险,淋巴结转移及雌孕激素受体阴性是影响预后的主要因素。      

保留乳头乳晕改良根治术同期TRAM瓣乳房重建治疗早期乳腺癌的临床研究

目的:探讨临床早期乳腺癌(Ⅰ、ⅡA期)保留乳头乳晕复合体(nipple-areolar complex, NAC)的乳腺癌改良根治术同期应用下腹部横行腹直肌肌皮瓣(TRAM)转移乳房重建的可行性.方法: 26例临床早期乳腺癌患者行保留乳头乳晕的改良根治术同时应用下腹部横行腹直肌肌皮瓣转移乳房重建.结果: 26例均获成功,除1例患者出现部分皮瓣血运欠佳外,其余均无并发症.所有患者均获随访,随访时间10～58个月(平均26个月),重建乳房效果良好,均无癌局部复发或远处转移.结论: 临床早期乳腺癌保留乳头乳晕的改良根治术同期应用下腹部横行腹直肌肌皮瓣转移乳房重建安全可行,可同时满足肿瘤治疗和形体美两方面的要求,提高了患者的生活质量.     

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。     

Mastectomy Versus Conservative Surgery

Women with early breast cancer were offered the choice of a mastectom lurnpectomy plus radiotherapy, or entry in a trial in which the alrdcation to either type of treatment was randomized. Few women chose the trial, and most were relieved that a choice was available. Othel patients, for whom it was decided that a mastectomy was the only viable treatment on medical grounds, were offered breast reconstruction whenever it was technically feasible. Psychosocial adaptation was measured using tests of anxiety, depression, marital adjustment, body satisfaction, self-esteem, sociability, and life change. Tests were given before surgery at intervals up to one year afterward. The degree of concern the women felt about the disease, their appearance, and the treatment was also assessed. The major difference among the groups was in the degree of concern about appearance. Women who rated high in this regard (the younger patients) tended to choose conservative surgery or reconstruction when a mastectomy was necessary. Generally, the adjustment to treatment was good in all the groups, despite some anxiety when the patients were in the hospital for surgery. Tailoring the treatment to each woman's preference resulted in low psychological morbidity.     

Implant-sparing Mastectomy: An Alternative for Women Undergoing Mastectomy With Retropectoral Implants

IntroductionImplant-sparing mastectomy (ISM) is a skin-sparing mastectomy that preserves a retropectoral implant and potentially eliminates the need for tissue expansion or complex reconstruction. This study aimed to determine oncologic and surgical outcomes and reconstructive patterns in patients undergoing ISM.Patients and MethodsA single-institution, retrospective review of patients undergoing ISM from 2006 to 2018 was performed. Patient/tumor characteristics, stage, adjuvant therapy use, 90-day complication rates, reconstruction type, and disease recurrence were collected.ResultsA total of 121 ISMs in 73 women were performed. Seventy (57.9%) ISMs were for breast cancer (BC) treatment and 51 (42.1%) for prophylaxis. Among BC cases, 72.3% were cT1/cT2 and 73.8% were cN0; 72.3% received systemic therapy and 33.8% received radiation therapy. There were 3 deaths owing to BC at the median follow-up of 35 months. Among 5 recurrences, only 1 was local. There was no BC identified after prophylactic ISM. Total 90-day complication rate per ISM was 15.7%. Rates were 0.8% for both seroma and wound infection, 2.5% for wound dehiscence, 3.3% for hematoma, and 8.2% for skin necrosis. The majority (72.6%) of patients required only implant exchange for reconstruction. Overall use of autologous reconstruction was low (12.3%); 77.8% of flaps were performed in patients receiving radiation therapy.ConclusionISM is a unique approach for patients pursuing mastectomy for BC treatment or prevention with equivalent oncologic outcomes and complication rates to mastectomy with reconstruction. Reconstruction for the majority was markedly simplified by elimination of tissue expansion while maintaining a low rate of flap reconstruction.     

The Male Role and Mastectomy

To explore the psychosocial aspects of men's reactions and adjustments to mastectomy, this study used in-depth interviews with 24 husbands and clinical observations of a multisession men's support group as well as a test and retest analysis of questionnaire data. Sex role theory was used to explain how factors related to the male role complicate men's adjustment. Husbands placed a high priority on their wives' adjustment but kept their own feelings at bay. Men's adoption of a "protective guardian" role during their wives' hospitalization fostered denial and later blocked communication between spouses. Repeated-measures analysis of the questionnaire data indicated that support group members became significantly more communicative with spouses about mastectomy issues than did control group members. These quantitative findings parallel clinical observations.     

保留乳头乳晕的乳房切除术肿瘤学安全性

摘 要：随着乳腺癌患者对形态要求增高及外科技术的发展,保留乳头乳晕的乳房切除术联合Ⅰ期或Ⅱ期乳房重建,可最大限度地切除肿瘤并维持乳房外观。但是,其安全性一直广受争议,手术适应证也未完全明确,亟须进一步探讨。     

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.

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.