乳腺癌保乳治疗43例诊治体会

探讨乳腺癌保乳治疗的诊治体会及相关问题。行保乳手术治疗的乳腺癌患者43例,采用肿瘤局部扩大切除或象限切除,以及腋淋巴结清除,术后辅以放疗、化疗或术前新辅助治疗等。无复发、无淋巴结转移、无远处转移、无死亡病例;乳腺皮肤微小变化,形状与健侧乳腺相似,手感好;少数因局部放疗后皮肤手感及弹性欠佳。保乳手术和传统手术相比,保乳手术既可以在生存中获益,同时又能保持完美的体态,术后并发症少,无伤口感染,无皮瓣坏死、皮下积液,患者心理状态良好,生存质量较高。     

Ⅰ期乳腺癌保乳手术治疗的探讨

目的探讨保乳手术在I期乳腺癌治疗中的临床应用。方法对116例I期乳腺癌患者实施了保乳手术,术后辅以规范的综合治疗。结果116例患者保乳手术过程顺利,近期乳房外形保持良好。术后随访12～24个月,无局部复发,远处转移和死亡。结论保乳手术治疗Ⅰ期乳腺癌疗效满意,手术前全面细致地检查,有助于手术适应证的准确判定,术前、术后配合规范的综合治疗,是保乳手术疗效的可靠保证。     

32例乳腺癌乳腔镜保乳手术的护理

目的:乳腔镜保乳手术在乳腺癌腋窝淋巴结清扫中的应用,总结其护理措施.方法:对2008年12月～2011年12月32例乳腺癌乳腔镜保乳手术的患者的临床护理资料进行回顾性分析,并总结经验.结果:所有患者的手术成功,术后恢复良好,术后无并发症.结论:乳腔镜在保乳手术的治疗中,创口小、易愈合、疗效确切,通过重视患者的心理护理,正确熟练的护理配合,提高患者的生存质量.     

早期乳腺癌保乳手术与改良根治术远期疗效的比较

为探讨乳腺癌保乳手术与改良根治术远期疗效的差别。笔者回顾性分析了43例行保乳手术以及57例行改良根治术的乳腺癌患者的临床资料，对其5年疗效的差别作出评估。结果示保乳手术组5年生存率为 95.2%,根治术组为94.3%，差异无显著性（P>0.05）。提示保乳手术与改良根治术对于治疗早期乳腺癌的远期疗效相当，而保乳手术使患者保持良好的乳腺外观，可在早期乳腺癌的治疗中予以推广。     

人性化美容切口在乳房手术中的应用

目的：探讨人性化美容切口在乳房手术中的临床效果。方法：对1998年3月～2003年8月间429例乳腺良性病及42例乳腺癌患，分别采用色素掩饰性切口(乳晕周围弧形切口)、隐蔽性切口(乳房下皱襞切口和腋窝切口)以及Stewart横切口行肿块切除、保乳手术和乳腺癌改良根治术。结果良性病例切口全部I期愈合，伤口疤痕小，隐蔽性好。乳腺癌患伤口I期愈合37例，皮瓣部分坏死6例，均为Stewart横切口，换药后愈合；皮下积液6例，上肢活动均满意。结论：人性化美容切口既能达到治疗目的，又满足了患心理需求，是人性化治疗乳腺疾病的体现。     

弧形切口切除乳腺肿块126例分析

目的探讨弧行切口在乳腺肿瘤切除术中的应用和美容效果。方法回顾性分析采用弧行切口治疗的126例乳腺肿瘤患者病例资料。结果所有患者切口一期愈合,瘢痕不明显,美容效果好,无严重手术并发症。结论弧行切口切除乳腺肿块美容效果好,适用于所有乳腺良性肿瘤和一些早期乳腺癌的保乳术式。     

110例乳腺癌保乳综合治疗的临床观察

目的探讨乳腺癌保乳手术的临床疗效。方法对我院2002年1月-2008年12月收治的110例乳腺癌保乳手术患者临床资料进行回顾性分析。结果110例患者术后均恢复良好,随访半年～6年,无一例死亡,无一例局部复发,出现肝及肺转移2例,保乳手术后患者美容效果满意率为83．6％。结论掌握乳腺癌患者保乳的手术指征结合术后的综合治疗,可降低乳腺癌保乳术后局部复发,并取得满意的美容效果。     

微创确诊乳腺癌后保乳手术的选择

【摘要】 目的 探讨微创手术（Mammotome）确诊乳腺癌后保乳手术的特点和可行性。方法 对我院2008.4~2012.2期间654例乳腺微创手术后确诊的8例乳腺癌进行总结,探讨其保乳手术的特点。结果 7例完成保乳手术,1例完成保留乳头的根治术。保乳手术者术后均进行了化放疗及内分泌治疗,随访至今均无复发。结论 微创手术确诊的乳腺癌一般为早期乳腺癌,选择保乳手术是可行的。     

早期乳腺癌32例行保乳手术临床分析

目的总结早期乳腺癌施行保乳手术的治疗效果。方法回顾性分析32例早期乳腺癌患者实施保乳手术治疗、术后放疗、化疗和内分泌治疗的临床资料。结果随访12⁶0个月,32例患者无局部复发及远处转移.术后效果满意。结论早期乳腺癌适时实施保乳手术联合化疗、放疗和内分泌治疗,创伤小、外观恢复好、复发率低,疗效肯定。     

不同手术治疗Ⅰ～Ⅱ期乳腺癌对保留肋间臂神经的影响比较

目的探究不同手术方法治疗Ⅰ～Ⅱ期乳腺癌对保留肋间臂神经( ICBN))的疗效。 方法回顾性分析2016年1月至2018年1月72例早期乳腺癌患者,根据术式不同分为保乳组(n＝38)与根治组(n＝34),保乳组患者采取保乳手术治疗,根治组患者进行改良根治术治疗。采用SPSS19.0软件进行统计分析,围术期相关指标和术后乳腺功能评分等采用( ±s)描述,独立t检验;术后并发症发生率及术后肢体感觉情况采用χ²检验分析,P<0.05差异有统计学意义。 结果保乳组患者的手术时间、术中出血量、总引流量等围手术指标均明显少于根治组(P<0.05),淋巴结清扫数量两组差异无统计学意义(P>0.05);保乳组患者的并发症总发生率为10.5%,显著低于根治组患者的29.4%(P<0.05);保乳组患者的术后灼痛、麻木、疼痛、感觉减退等肢体感觉情况和乳腺功能评分明显好于根治组(P<0.05)。 结论保乳手术对Ⅰ～Ⅱ期乳腺癌患者的疗效良好,能有效保留患者的ICBN,改善其乳腺功能,值得临床应用。     

聚乙烯醇泡沫负压伤口疗法在脊柱结核术后反复窦道不愈合中的应用

目的评价深腔填塞聚乙烯醇（polyvinylalcohol,I）VA）泡沫行负压伤口疗法（negativepressure wound therapy,NPWI、）侄脊柱结核术后治疗窦道不愈合中的效果。方法对2008年1月一2011年1月临床收治的17例脊柱结核术后反复窦道不愈合的病例,延窦道行病灶清除联合深腔填塞PVA泡沫行NPWT,观察在院治疗效果和愈后复发情况。结果患者伤121安置PVA泡沫10—25d,平均安置15。7d,伤口完全愈合17—29d,平均21．5d。随访6～30个月,无结核病灶复发。结论NPWT是脊柱结核术后反复宾道不愈合治疗中一项重要的手段,它在促进伤121愈合、结核脓肿排空、消灭脓肿死腔等方面起到了不可忽视的作用。     

The effect of body mass index and wound irrigation on outcome after bilateral breast reduction

Thirty patients undergoing bilateral breast reduction by inferior pedicle technique were entered into a prospective, randomized study to determine the effect of unilateral saline wound irrigation and body mass index (BMI) on outcome. Each patient was assessed at 1, 4, and 8 weeks after surgery for wound dehiscence, infection, fat necrosis, and breast comfort by means of a visual analog pain score. The mean patient age was 33 years; mean weight, 67.7 kg; mean BMI, 26.3; and mean weight of breast tissue excised per patient, 1270 g. In 60 breasts there were 13 cases of minor wound breakdown, all of which had healed by 8 weeks postoperatively. Wound irrigation had no significant effect on the rate of T-junction breakdown or on postoperative pain. BMI was associated significantly with wound breakdown (BMI > 26.3, 33% wound breakdown rate; BMI < 26.3, 10% wound breakdown rate; P < 0.05, chi2 test). Patients with a high BMI are more likely to have delayed healing after breast reduction.     

游离腹壁下动脉穿支皮瓣在乳房再造中的应用

目的:探讨游离腹壁下动脉皮肤穿支(deep inferior epigastric perforator,DIEP)皮瓣在早期乳腺癌患者(Ⅰ或Ⅱ期)术后乳房再造中的临床应用。方法:对12例早期乳腺癌患者行根治术或改良根治术同期或二期应用DIEP皮瓣行乳房再造,其中乳腺癌分期I期9例,II期3例。结果:1例皮瓣出现部分坏死,1例皮瓣出现脂肪液化,经换药后愈合,其余皮瓣均成活,再造乳房外形可,弹性好,无皮瓣挛缩变形;无腹壁疝和腹壁膨出。11例获随访平均2.2年,效果均较满意,未出现乳腺癌复发病例,4例获得优,5例获得良,失访1例按良计算,2例效果差,优良率83.3%。结论:乳腺癌术后一期或二期应用DIEP皮瓣游离移植再造乳房,具有皮瓣血运良好、再造乳房外形满意、腹部供区并发症少,可同时行腹壁整形等优点,是乳腺癌术后乳房再造的理想方法之一,放化疗不影响皮瓣的成活。     

35岁以下早期乳腺癌患者保乳术和改良根治术的临床对比研究

【摘要】 目的 分析并比较35岁以下早期乳腺癌患者保乳术与改良根治术的疗效、预后和生存情况。方法 选择本院经手术治疗的早期乳腺癌患者110例作为观察对象,按接受手术方法的不同分为保乳术组61例和改良根治术组49例,对比观察两组患者的围手术期情况、外观疗效、长期疗效和生存质量情况。结果〓保乳术组患者手术时间、术中出血量和住院时间均较改良根治术组显著性减少(P<0.001),且术后并发症发生情况也较改良根治术组明显改善(P<0.05);保乳术组患者术后外观优良率较改良根治术组有显著性提高(P<0.05);两组患者3年无复发生存率和生存期比较无显著性差异(P>0.05);保乳术组患者3年后SF-36生存质量各项评分显著性高于改良根治术组(P<0.05)。结论〓对于35岁以下早期乳腺癌患者而言,保乳手术具有美容佳、创伤小、并发症少和生存质量好等优点,且能保持与传统方式相似的生存率,为临床治疗方法选择提供了一定的理论依据,但尚待多中心、大样本研究进一步证实。     

多网管解剖型置管灌洗法治疗骨折术后继发慢性骨髓炎

 目的探讨多网管解剖型置管灌洗法在骨折术后继发慢性骨髓炎治疗中的应用价值。方法回顾性分析 2006年 6月至 2008年 12月收治的骨折术后继发慢性骨髓炎患者 40例(41处)的病例资料.男 35例.女 5例;年龄 16~68岁.平均 42.7岁。对 40例(41处)采用彻底清创、闭合死腔、多网管解剖型置管灌洗引流、全身及局部应用敏感抗生素等系列疗法治疗 3~4周。术后每 3个月复查.包括切口愈合情况、X线片表现、红细胞沉降率和 C-反应蛋白。按灌洗治疗结束时炎症是否稳定及术后 6个月时炎症是否复发制定疗效评价标准.参考指标包括伤口愈合情况、全身症状、红细胞沉降率及 C-反应蛋白等。结果 按上述疗效判定标准.优 37例.切口一期愈合.术后 6个月时无复发;良 2例.切口愈合稍差.经换药治疗后愈合.术后 6个月时无复发;差 1例.窦道复发.切口未愈。 36例在术后半年行植骨内固定术.术后骨折愈合.4例未经植骨直接愈合。随访 30~50个月.平均 43.2个月.均无复发。结论多网管解剖型置管灌洗法对于骨折术后继发慢性骨髓炎的治愈率高.可操作性强.术后好管理.是一种有效的治疗方法。     

Wound healing after hand surgery in patients with systemic sclerosis--a retrospective analysis of 41 operations in 19 patients

This retrospective study evaluates the results of 41 consecutive hand and forearm operations in 19 patients with systemic sclerosis performed between 1985 and 2000. The mean age of the patients was 50 (14-84) years. Twenty-seven operations were elective and 14 were acute, carried out for skin breakdown and/or skin necrosis. One minor wound healing problem occurred in the elective group. In the acute group, seven of 14 operations healed uneventfully. Four patients had necrosis/infections after surgery, which required further surgery. Two patients had repeated wound infections. Another patient only healed after he stopped smoking. In systemic sclerosis, surgery performed electively does not seem to have increased difficulty with wound healing. Even larger operations, such as wrist arthrodesis or wrist replacement, can be performed safely. In acute cases with spontaneous skin breakdown and/or necrosis and/or critically ischaemic fingers, wound healing is more precarious and several procedures may be necessary to achieve skin healing.     

Treatment of an infected inguinal wound following vascular reconstruction with a sartorius muscle flap

Infection or breakdown of a wound in the groin is a dreaded complication in vascular surgery. On 8 patients with such impending or declared wound complications, a distally pedicaled sartorius muscle-flap was performed immediately after wound debridement, to cover the autologeous or alloplastic vascular graft. In all but one case the groin healed promptly. In 6 cases the vascular repair remained patent.     

Wound conditioning by vacuum assisted closure (V.A.C.) in postoperative infections after dorsal spine surgery

The use of vacuum assisted closure (V.A.C.) therapy in postoperative infections after dorsal spinal surgery was studied retrospectively. Successful treatment was defined as a stable healed wound that showed no signs of acute or chronic infection. The treatment of the infected back wounds consisted of repeated debridement, irrigation and open wound treatment with temporary closure by V.A.C. The instrumentation was exchanged or removed if necessary. Fifteen patients with deep subfascial infections after posterior spinal surgery were treated. The implants were exchanged in seven cases, removed completely in five cases and left without changing in one case. In two cases spinal surgery consisted of laminectomy without instrumentation. In two cases only the wound defects were closed by muscle flap, the remaining ones were closed by delayed suturing. Antibiotic treatment was necessary in all cases. Follow up was possible in 14 patients. One patient showed a new infection after treatment. The study illustrates the usefulness of V.A.C. therapy as a new alternative management for wound conditioning of complex back wounds after deep subfascial infection.     

Pott's paraplegia in patients with severely deformed dorsal or dorsolumbar spines: treatment and prognosis

STUDY DESIGN: Pott's paraplegic patients with severe spinal deformity were reviewed retrospectively after being treated with chemotherapy and/or decompressive surgery. OBJECTIVES: To determine the most appropriate treatment protocol and to predict the prognosis for Pott's paraplegics with severe spinal deformity. SETTING: Catholic University of Korea Medical Center and Moon-Kim's Institute of Orthopedic Research, Seoul, Korea from 1971 to 1996. METHOD: In this study, there were 33 patients (eight children and 25 adults), ranging from 13 to 56 years of age. They developed spinal tuberculosis at the age of 9 years (range, 2-29 years), and remained neurologically symptom free from an average of 16 years (range, 4-27 years). Four adults who responded well to treatment initially suffered relapses of paraplegia. Only six patients had previously received a full course of triple chemotherapy. Seven (two children, five adults) had healed disease, and 26 (six children, 20 adults) had active disease. Eleven cases had frequent drainage from the sinuses. Kyphoscoliosis was found in 11 patients: four children and seven adults. The remaining patients had kyphosis only. Among the 26 patients with active tuberculosis, 10 had triple chemotherapy itself and the rest had additional decompression surgery (10 anterior and six posterior). All seven patients with healed tuberculosis were subjected only to surgery (two anterior and five posterior). RESULTS: In seven patients with healed tuberculosis, surgery did not improve neurologically except in one child patient. In four patients, the severity of paralysis remained unchanged and two patients, deteriorated neurologically after surgery. In six children with active tuberculosis, there were remarkable neurological recoveries by either conservative treatment or surgical decompression. Seven adults with active tuberculosis recovered slowly, improving by one or two Frankel grades (three Frankel C, three D, one E). In 11 out of 13 surgically treated adults with active disease, paralysis that had persisted for less than 3 months gradually improved by one or two Frankel grades. One Frankel A and one Frankel B paraplegic patients who had paralysis that had lasted through 6 months did not recover after surgery. CONCLUSION: The neurological recovery of Pott's paraplegics with severe spinal deformity resulted in three different outcomes: (1) severe deformity is different from moderate and mild deformities; (2) patients with healed tuberculosis had poorer prognosis than patients with active tuberculosis; (3) children had better prognosis than adults. Furthermore, patients with paralysis persisting over 6 months did not recover neurologically after surgery.     

金玉夫膏在整形术后伤口不愈合修复中的应用

目的 探究金玉夫膏在整形术后伤口不愈合修复中的应用效果。方法 选取2016年6月-2022年12月 我院门诊处理的18例整形术后伤口不愈合患者作为研究对象,均采用金玉夫膏进行局部换药,1次/d,直至愈合, 记录伤口愈合时间,观察愈合后的瘢痕增生、皮肤色泽和质地情况,统计患者满意度。结果 18例伤口全部愈 合,愈合时间5~15 d;随访6~12个月,所有伤口愈合良好,外观平整,不臃肿,局部无明显压痛和增生性瘢痕, 愈合皮肤柔软,有弹性,色素沉着不明显;瘢痕评价均为轻度;色泽分级显效16例,有效2例;质地分 级均为显效;患者满意17例,较满意1例,满意度为100.00%。结论 金玉夫膏局部换药在修复整形术后伤 口不愈合治疗中的效果确切,可缩短伤口愈合时间,且愈合过程中无明显不良反应,患者满意度较高。