保留乳房的改良根治术治疗早期乳腺癌的临床应用

目的　探讨保留乳房改良根治术治疗早期乳腺癌的临床应用价值。方法　回顾性分析本院 1997年 2月至 2 0 0 3年12月手术治疗的 12 8例Ⅰ、Ⅱ期乳腺癌病例。行保留乳房的改良根治术 76例 ,传统改良根治术 5 2例。术后均辅以放疗、化疗或内分泌治疗。结果　保留乳房改良根治组患者术后并发症发生率低 (P <0 .0 5 ) ,而生存率和复发率和传统改良根治组无明显差异 (P>0 0 5 )。结论　保留乳房改良根治术是治疗早期乳腺癌的合理外科方法 ,能提高乳腺癌病人的生活质量     

乳癌改良根治术术式评价

乳癌改良根治术最早由Patey在1948年提出,从70年代以来国内外普遍采用。目前许多学者都倾向对Ⅰ期乃至Ⅱ期乳癌以改良根治术为首选。本文仅就其各种不同术式结合文献试做评价。 一、术式简介;乳癌改良根治术式,最初按保留胸大、小肌情况分为两类,一类是Auchincloss术式(保留胸大肌、胸小肌);一类是Patey术式(保留胸大肌、切除胸小肌)。后来术式变化主要在于处     

72例乳癌根治术后创面的处理

目的：探讨乳癌根治术后伤口并发症的防治，以期提高创面愈合率。方法：本组72例乳癌患者，行标准根治术28例，改良根治术44例，前者行一期植皮10例。结果：术后创面一期愈合65例，延迟愈合7例，后者中感染1例、皮瓣局部坏死6例。结论：避免皮瓣张力过大、保持创面引流通畅、恰当的加压包扎是提高创面愈合率的关键因素。     

保留瓣膜及瓣下结构的二尖瓣替换术25例

25例保留二尖瓣瓣下结构的二尖瓣替换MVRP手术,与常规二尖瓣替换手术(MVR)比较,有利于术后心功能的恢复,尤其是左心室功能恢复的优点.     

探讨乳腺癌保留乳房术后放疗的临床经验及体会

目的：探究乳腺癌保留乳房术后放疗的临床疗效。方法本次研究选择对象共50例,均为2009年5月~2012年5月在我院进行全乳放疗的保留乳房手术后的乳腺癌患者,对其临床资料进行回顾性分析。结果随访发现,患者生存率为96.7%,病变复发率为5.0%;无严重放疗反应和并发症出现;乳房外观优良率为75.0%。结论乳腺癌保留乳房术后放疗的临床疗效与根治术相当,患者生存率高,病变复发率低,有利于乳房美观。     

旋股外侧血管蒂复(联)合组织瓣移植的解剖学基础

目的：为以旋股外侧血管蒂复(联)合组织瓣移植提供解剖学基础。方法：50侧成人下肢标本解剖观察旋股外侧动脉分支起始类型及其分布。结果：旋股外侧动脉分支起始主要有3型：Ⅰ型：旋股外侧动脉发升支、横支和降支占76％；Ⅱ型：升支、横支、降支由两干从股深动脉或股动脉发出占20％；Ⅲ型：升支、横支、降支单独从股深动脉或股动脉发m占4％。升支恒定分支分布于阔筋膜张肌和髂嵴前外侧部；横支分支分布于股外侧肌上部和大转子前外侧部；降支分支分布于股外侧肌和股前外侧部皮肤。结论：76％可以旋股外侧血管为蒂形成：①升支阔筋膜张肌皮瓣和／或髂骨瓣；②横支大转子骨瓣或骨膜瓣；③降支股前外侧皮瓣。20％则可以升支和横支或横支和降支共十形成相应两个组织瓣：     

Ⅰ期腺体筋膜组织瓣成型术联合乳房病损切除治疗肉芽肿小叶性乳腺炎患者的疗效评价

目的:分析Ⅰ期腺体筋膜组织瓣成型术联合乳房病损切除(以下简称"联合术")治疗肉芽肿小叶性乳腺炎(Granulomatous lobular mastitis,GLM)患者的疗效.方法:选取2017年4月～2020年4月我院收治的85例GLM患者作为研究对象,依照手术方案不同分为对照组(n=42)和观察组(n=43).对...     

乳癌远处转移或术后复发患者血清CYFRA21-1水平的观察

本文对 52例乳癌远处转移及 39例乳癌术后复发患者的血清CYFRA21-1进行测定,发现CYFRA21-1对这两类患者具有较好的诊断价值。现报道如下。1　对象和方法1 1　对象1. 1. 1　对照组　41例体检正常女性,年龄 ( 24 ~62 )岁,无心、肝、肺和肾等重要器官疾病,肝肾功能正常,无乳腺     

胸壁复合组织瓣用于心脏外科小切口的解剖学研究

目的 研究以胸壁带蒂复合组织瓣修复心脏手术后胸壁缺损的可行性，并在此基础上设计出新的心脏手术小切口。方法 观察１０具尸体前胸壁深层结构的血供规律，测量胸骨外侧缘与胸廓内动脉之间的距离。结果 前胸壁学层各结构均由胸廓内动脉及在分支供血，胸廓内动脉距胸骨外侧缘的距离为１ｃｍ左右，紧挨胸骨外侧缘切开肋软骨，可以避免胸廓内动脉的损伤。以该动脉为蒂，可以保证多种前胸壁复合组织瓣有良好的血供。结论 用以胸廓内     

组织瓣移植修复术的护理

我科1994～1997年共收治各种组织瓣移植修复病例77例,通过有效治疗和护理,效果满意,报道如下。 1临床资料 男60例,女17例,年龄3.61岁,平均年龄32岁。其中20岁以下,9例;20～40岁,58例;40岁以上10例。创面长期不愈33例,创面缺损骨外露42例,2例因血管危象再次手术。     

Auchincloss乳腺癌改良根治术65例治疗体会

目的：分析行Auchincloss乳腺癌改良根治术患者的临床特点,进一步提高乳腺癌的临床诊治水平。方法回顾性分析2009年1月-2013年3月收治的行Auchincloss乳腺癌改良根治术治疗的65例女性乳腺癌患者的临床资料。临床分期I期19例,Ⅱ期32例,Ⅲ期14例;其中伴有淋巴结转移的病例29例。结果65例患者手术时间平均（164±19.54）min;手术出血量（75±23.79）ml;术中清除淋巴结14.63枚,39例患者术中保留肋间臂神经。术后发生皮瓣下积液12例（18.46%）、患肢淋巴水肿2例（3.08%）。术后随访时间为0.5~4年,无局部肿瘤复发和转移,无患者死亡。结论 Auchincloss乳腺癌改良根治术操作简单,术后并发症相对较少,并保持胸部外形饱满和肢体功能,根治效果良好,不会增加局部复发的危险。     

侧胸带蒂胸外侧动脉穿支皮瓣的解剖观察及其在保乳术乳房重建中的临床应用

目的 探讨带蒂胸外侧动脉穿支皮瓣在乳腺癌保乳术后部分乳房重建中临床应用的解剖学基础及效果。方法 (1)取新鲜成人尸体标本8具,其中男6具、女2具,年龄28~71岁,平均39.5岁。标本经股动脉灌注加入氧化铅的红色凝胶后,在上至锁骨、下至第五肋、外至腋前线、内至胸骨旁的区域内,解剖观察两侧胸外侧动脉的位置、走行、分支以及与周围血管的吻合情况,对胸外侧穿支血管的来源进行系统分型,并测量胸外侧动脉穿支起始处外径及血管蒂长度。(2)纳入湖南省肿瘤医院2015年8月—2019年2月收治的12例Ⅰ期乳腺癌患者临床资料进行回顾性分析,患者均为女性,年龄14～52岁,平均43.2岁。其中浸润性导管癌8例,浸润性小叶癌4例;均为单侧发病,肿瘤位于乳房外上区域9例、外下区域3例。12例均行保乳术,术中于肿瘤切除后应用带蒂胸外侧动脉穿支皮瓣行部分乳房重建,术后观察皮瓣成活情况及重建后的乳房外形。结果 (1)8具16侧标本中,有15侧出现胸外侧动脉,从胸大肌和背阔肌之间穿出,其起始处外径0.7~0.9 mm,平均0.80 mm;血管蒂长6.8～10.4 cm,平均8.15 cm,与胸肩峰动脉、胸廓内动脉、胸背动脉和肋间动脉形成丰富的血管吻合。15侧胸外侧动脉按照其来源分为6型,分别来自胸肩峰动脉(8/15,Ⅰ型)、腋血管(4/15,Ⅱ型)、胸背血管(2/15,Ⅲ型)、肩胛下血管(1/15,Ⅳ型)、多源型(1/15,Ⅴ型);另有1侧胸外侧动脉缺如(Ⅵ型)。(2)本组12例患者切除肿瘤及乳腺组织质量为70～95 (80.0±5.7)g,切取的侧胸带蒂胸外侧动脉穿支皮瓣长10.5～13.5 (11.2±0.4) cm、宽4.5～7.5 (6.3±0.5)cm、厚3.0～4.5 (3.4±0.4) cm。术后2例发生皮瓣脂肪液化,1例伤口裂开,经过换药治疗均愈合。12例患者术后随访6～20个月,平均11.5个月。所有皮瓣均顺利成活,重建乳房外形可,质地柔软,侧胸皮瓣供区仅遗留线性瘢痕,肩关节功能无明显异常;无一例出现乳腺癌复发。结论 胸外侧动脉穿支来源多样,解剖位置较恒定,且供血范围大,带蒂胸外侧动脉穿支皮瓣对于乳腺癌保乳术后乳房外侧区域重建是一个有价值的选择方案。     

Depression and conservative surgery for breast cancer

BACKGROUND:

Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer.

OBJECTIVE:

To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction.

METHODS:

Seventy‐five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ² test.

RESULTS:

There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ² = 9.97; p = 0.126).

CONCLUSION:

Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.     

Computerized prediction of risk for developing breast cancer based on bilateral mammographic breast tissue asymmetry

This study developed and assessed a computerized scheme to detect breast abnormalities and predict the risk of developing cancer based on bilateral mammographic tissue asymmetry. A digital mammography database of 100 randomly selected negative cases and 100 positive cases for having high-risk of developing breast cancer was established. Each case includes four images of cranio-caudal (CC) and medio-lateral oblique (MLO) views of the left and right breast. To detect bilateral mammographic tissue asymmetry, a pool of 20 computed features was assembled. A genetic algorithm was applied to select optimal features and build an artificial neural network based classifier to predict the likelihood of a test case being positive. The leave-one-case-out validation method was used to evaluate the classifier performance. Several approaches were investigated to improve the classification performance including extracting asymmetrical tissue features from either selected regions of interests or the entire segmented breast area depicted on bilateral images in one view, and the fusion of classification results from two views. The results showed that (1) using the features computed from the entire breast area, the classifier yielded the higher performance than using ROIs, and (2) using a weighted average fusion method, the classifier achieved the highest performance with the area under ROC curve of 0.781 ± 0.023. At 90% specificity, the scheme detected 58.3% of high-risk cases in which cancers developed and verified 6–18 months later. The study demonstrated the feasibility of applying a computerized scheme to detect cases with high risk of developing breast cancer based on computer-detected bilateral mammographic tissue asymmetry.     

乳腺癌根治术保留肋间臂神经对患者术后生存质量的影响

目的　对照研究乳腺癌改良根治术腋淋巴结清扫术中对肋间臂神经的保留与否,探讨该术式对患者术后生存质量的影响。 方法 在以往对I期、Il期乳腺癌患者实施乳腺癌根治术Anchincloss术式的基础上进行保留肋间臂神经改良,随机选取了 150例Ⅰ、Ⅱ期女性乳腺癌患者 ,随机均分为保留组和切除组。 结果 保留组的上臂后内侧感觉异常和疼痛等不良主诉的发生率较对照组明显降低,两者比较差异有显著性意义(P<0.01);随访期内两者的局部复发及远处转移率无统计学差异。 结论 I期、Il期乳腺癌患者行改良根治术保留肋间臂神经,减少了患者术后疼痛综合症的发生,提高了患者术后生活质量,临床应用具有可行性,值得推广应用。     

Predictors for contralateral prophylactic mastectomy in breast cancer patients

Background: In recent years, radical breast cancer surgery has been largely replaced by breast conservation treatment, due to early diagnosis and more effective adjuvant treatment. While breast conservation is mostly preferred, the trend of bilateral mastectomy has risen in the United States. The aim of this study is to determine factors influencing patients’ choice for having contralateral prophylactic mastectomy (CPM). Methods: This is a retrospective study of 373 patients diagnosed with primary invasive breast cancer who were treated by bilateral or unilateral mastectomy (BM or UM) at the Revlon/UCLA Breast Center between Jan. 2002 and Dec. 2010. In the BM group, only those with unilateral breast cancer who chose CPM were included in the analysis. Results: When compared with the UM group, the following factors were found to be associated with BM: younger age, pre-menopausal, a family history of breast/ovarian cancer, BRCA mutation, more breast biopsies, history of breast augmentation, having MRI study within 6 months before the surgery, more likely to have reconstruction and sentinel lymph node biopsy (SLNB) and fewer had neoadjuvant/adjuvant chemotherapy/radiation. When patients with bilateral breast cancer were excluded, multivariate logistic regression analysis indicated younger patients with negative nodes, SLNB as the only nodal surgery and positive family history were significant factors predicting CPM and immediate reconstruction using tissue expanders or implants. Conclusion: Younger age, lower TN stage, requiring only SLNB and high risk family history predict contralateral prophylactic mastectomy. Tissue expander/implant-based reconstructions were more frequently chosen by patients with BM.     

保乳手术与改良根治术治疗早期乳腺癌的临床疗效比较

目的观察保乳术与改良根治术治疗早期乳腺癌的临床疗效。方法 80例早期乳腺癌患者按手术方法分为2组,保乳组采用保乳术,根治组采用乳腺癌改良根治术,比较2种手术方式的临床疗效。结果保乳组手术时间、术中出血量、平均引流量、住院时间、并发症的发生率明显低于根治组,保乳组乳房外形评价优良率明显高于根治组(P0.05)。但是保乳组患者术后局部复发率、远处转移率、3年及5年生存率与根治组比较没有明显差异(P0.05)。结论保乳手术治疗早期乳腺癌疗效满意,值得推广应用。     

膝上外侧动脉穿支皮瓣逆行修复膝关节周围软组织缺损的临床观察

目的 探讨膝上外侧动脉穿支皮瓣逆行修复膝关节周围软组织缺损的应用特点。 方法 回顾性分析2012年2月—2014年10月唐山市第二医院手外科收治的12例膝关节周围软组织缺损患者的临床资料,其中男9例、女3例,年龄22～46岁;左侧7例,右侧5例。均合并肌腱、韧带和/或骨关节外露,皮肤、软组织缺损范围4 cm×5.5 cm~12 cm×6 cm。均采用膝上外侧动脉穿支皮瓣逆行修复创面。结果 术后12例皮瓣全部成活,创面均Ⅰ期愈合。12例均获得随访,随访时间10～21个月,平均17.5个月。末次随访皮瓣外形佳,质地柔软,弹性好,皮瓣感觉S₂～S₃,两点辨别觉8～11 mm,平均10.3 mm。膝关节功能按照Lysholm膝关节评分系统评定:优7例,良4例,可1例,优良率为11/12。结论 膝上外侧动脉穿支皮瓣能有效修复膝关节周围软组织缺损,供区副损伤小,疗效满意,可为一种较好的方法。     

穿支皮瓣修复小腿及足踝部软组织缺损

目的探讨应用穿支皮瓣修复小腿及足踝部软组织缺损的临床效果。方法在1998年2月至2008年6月间海口市人民医院应用胫后动脉内踝上穿支皮瓣8例和腓动脉外踝上穿支皮瓣7例分别修复小腿及足踝部组织缺损。结果术后12例穿支皮瓣全部成活,2例皮瓣发生边缘或表皮坏死,经换药后治愈,1例皮瓣坏死达1/2,经换药后再次植皮修复治愈,随访2月～4年,皮瓣外观良好,足踝部功能恢复,行走正常。结论内踝上或外踝上穿支皮瓣修复小腿及足踝部皮肤软组织缺损效果良好。