应用邻近扩张皮瓣修复T4期局部晚期乳腺癌术中大面积软组织缺损的临床研究

目的在皮肤累及较大的局部晚期乳腺癌根治术中应用邻近扩张皮瓣修复胸壁大面积缺损,减少术后并发症,降低局部复发率。方法 64例新辅助化疗完全缓解(complete remission,CR)、部分缓解(partial remission,PR)的患者,在新辅助化疗同期行患侧乳房周围皮下扩张器置入术,并持续液压扩张皮肤至化疗结束,行乳腺癌根治术同期取扩张器,推进扩张皮瓣修复创面。37例同期游离植皮修复患者为对照组。结果 64例采用扩张皮瓣的患者术后伤口全部一期愈合,术后放疗未出现皮肤放射性溃疡,随访3年局部复发率明显低于游离植皮组。结论对于新辅助化疗有效的T4期乳腺癌患者,根治术中应用邻近扩张皮瓣修复可减少皮瓣坏死和放射性溃疡的发生,降低局部复发率。     

邻近扩张皮瓣对局部晚期乳腺癌术中胸壁软组织缺损的修复

目的 探讨局部晚期乳腺癌术中胸壁软组织缺损的修复方法.以减少创伤和肿瘤局部种植的风险.方法 在有效的新辅助化疗前提下,于化疗期间沿患侧乳房周围埋植扩张器并逐渐扩张皮瓣,为根治术中的胸壁缺损提供修复用的软组织,观察效果,并与既往开展的转移肌皮瓣修复相比较.结果 9例患者皮瓣扩张提供的组织量充足,扩张顺利.扩张的皮瓣可有效覆盖创面并一期愈合.患者对术后放疗耐受性好.短期随访无胸壁复发者,避免了转移皮瓣可能出现的供区肿瘤种植.结论 局部邻近扩张皮瓣是肿瘤切除术后修复胸壁软组织大面积缺损安全、创伤小的有效方法.     

局部晚期乳腺癌临床分析

我院 1996年 2月至 2 0 0 0年 8月收治晚期乳腺癌 5 3例 ,采取合理的综合治疗 ,取得了较好的疗效 ,报道如下。一、临床资料1.一般资料 :本组 5 3例 ,均为女性 ,术前经针吸细胞学明确诊断 ,年龄 3 2～68岁 ,中位年龄 46岁。2 .临床特征 :5 3例病人 ,原发肿瘤为 :Ｔ3 (>5ｃｍ ) 3 2例 ,Ｔ42 1例 (皮肤桔皮样变 13例 ,卫星结节 3例 ,炎性乳癌 5例 )。区域淋巴结 :Ｎ0 2例 ,Ｎ12 0例 ,Ｎ2(融合淋巴结 ) 2 9例 ,Ｎ3 (胸骨旁淋巴结 )2例。肿瘤分期 :Ⅲａ期 3 2例 ,Ⅲｂ期 2 1例。3 .治疗方案 :所有病人术前行ＶＭＦ或ＥＭＦ方案化疗一疗程 ,然后行…     

皮瓣固定在乳腺癌根治术中的应用

皮瓣坏死是乳腺癌根治术后常见的并发症 ,我们采用皮钉固定的办法预防皮瓣坏死 ,疗效满意 ,报告如下。1　临床资料乳腺癌 17例 ,男 1例 ,女 16例 ,年龄 2 8～ 74岁。均采用乳腺癌根治术 ,其中纵行梭形切口 12例 ,横行梭形切口 5例。2　手术操作要点腋窝淋巴结清扫、冲洗创面后 ,放置 2根引流管 ,术后接负压持续吸引 ,间断缝合切口 ,于切口两侧距切口约 3～ 4ｃｍ处 ,用左手示、中指将皮瓣固定于相应的肋骨表面 ,尽量使皮瓣向切口方向推移 ,以减轻切口张力 ,用 1号丝线自固定处皮肤进针 ,缝至肋骨骨膜上再出针 ,在两线间放置一约 3ｃｍ× 0 .…     

原发局部晚期乳腺癌的治疗

目的：分析女性原发局部晚期乳腺癌治疗结果及预后，以确定更完善的治疗。方法：对１４７例进行回顾性研究，对治疗及多种因素与预后的相关性进行分析。结果：与预后相关的因素为腋淋巴结转移（Ｐ＜０．０５），治疗失败的原因是血行转移（Ｐ＜０．０５）。单纯手术治疗５年及１０年生存率分别为２６．７％、２０．０％，综合治疗５年及１０年生存率分别为５２．６％、４７．７％（Ｐ＜０．０１）。结论：应采用综合治疗     

局部皮瓣在乳腺癌保乳术后一期修复中的应用

目的 观察应用局部皮瓣修复保乳术后乳房缺损的临床疗效。方法 2004年7月至2013年1月,对9例早期乳腺癌患者保乳手术所遗留的乳房缺损进行即刻修复,采用外侧胸背筋膜皮瓣7例,胸腹壁皮瓣2例,观察皮瓣成活情况、并发症和术后美观效果。结果 术后外观评价8例为优,1例为良。1例患者出现皮瓣局部坏死,经保守治疗愈合。1例患者出现皮瓣供区感染,口服抗菌素治疗,未影响手术效果。术后平均随访22个月,未见局部复发病例。结论 应用局部皮瓣修复保乳术后乳房部分缺损,手术效果好,并发症少,可扩大肿瘤周围的切除范围,降低肿瘤局部复发风险。     

邻近延迟扩张皮瓣在躯干四肢创面修复的应用

目的 总结邻近延迟扩张皮瓣在躯干四肢创面修复中的应用方法及效果。方法 2003年4月至2008年7月期间,应用邻近延迟扩张皮瓣的方法修复8例躯干及四肢骨外露创面,每例患者共需要2～3次皮瓣延迟手术,修复缺损的供区可直接缝合。结果 8例患者围手术期无扩张器外露及皮瓣血运障碍等并发症,皮瓣转移修复术后全部皮瓣成活,伤口愈合良好。结论 在某些特殊条件下的躯干四肢缺损区域,在难以应用局部皮瓣、带蒂皮瓣或扩张皮瓣修复时,合理应用邻近延迟扩张皮瓣的方法修复以上缺损区,有效解决了皮瓣转移的长宽比值、旋转半径及皮瓣成活面积,而达到良好的修复效果。     

乳腺癌根治术后皮瓣坏死的简易处理

目的 探讨乳腺癌根治或改良根治术后大块皮瓣坏死的理想处理方法。方法 1998～2002年我院乳腺外科行乳腺根治或改良根治365例,较大范围皮瓣坏死(≥3×3cm)40例(11％),进行简单清创后直接将坏死皮瓣切除缝合。结果 40例病人中39例经过坏死皮瓣切除缝合后成功(97.5％),其中 2例术后皮瓣再次坏死,行再次上述手术而治愈。1例病人再坏死皮瓣小而浅,经过数次换药后迅速愈合。结论 就乳腺癌根治或改良根治术后较大皮瓣发生坏死而言,局部坏死皮瓣切除加立即缝合是一种经济、简单、实用的方法。     

皮瓣鱼网式打孔在乳腺癌根治术创面覆盖中的应用

目的 探讨皮瓣鱼网式打孔在乳腺癌根治术后创面覆盖中的应用。方法 对80例妇性乳腺癌患者行乳腺癌根治术或改良根治术，而后在皮瓣上、下缘予以鱼网式打孔，常规缝合创面。结果 全部病例均未植皮，有15例在术后2－5天内有皮瓣血供不良，其余65例均无皮瓣坏死，创面愈合良好。结论 皮瓣鱼网式打孔可有效地减小皮瓣缝合张力，减少皮瓣坏死的并发症，可应用于乳腺癌根治术的创面覆盖。     

不可手术的局部晚期乳腺癌的治疗

<正>局部晚期乳腺癌的分期评估为临床ⅢA(T3N1M0除外)、ⅢB或ⅢC期。对于表现为不可手术的、非炎性乳腺癌的局部晚期乳腺癌患者,标准的治疗是以蒽环类为基础±紫杉类的化疗方案作为术前初始治疗。术前化疗获得临床效果后的局部治疗包括:(1)全乳切除+Ⅰ/Ⅱ级腋窝淋巴结清扫,联合或不联合延迟乳房重建;(2)肿块切除+Ⅰ/Ⅱ级腋窝淋巴结清扫。     

New challenges in multimodal workout of locally advanced breast cancer

The term “locally advanced breast cancer” (LABC) encompasses a heterogeneous group of breast neoplasms that represent an extremely variable percentage of newly diagnosed breast cancers (4–90%, depending of world regions). These cancers may have different clinical and biological characteristics that can be managed by primary surgery or neoadjuvant integrated treatments. In this paper we review the updated guidelines and discuss most recently reported evidence related to LABC multidisciplinary workout, in order to maximize results of combined systemic therapies, modern surgical procedures and radiotherapy.     

局部晚期乳腺癌术前介入化疗近期疗效观察

【摘要】目的评价术前介入化疗治疗局部晚期乳腺癌的近期疗效。方法选取我科2010年2月至2016年1月期间经空心针穿刺活检病理证实的局部晚期乳腺癌患者共13例,全部采用Seldinger’s方法,局麻后经股动脉穿刺,将导管选择至肿瘤主要供血动脉,灌注化疗药物,方案为法玛新100 mg,丝裂霉素10 mg,氟尿嘧啶1000 mg,奥沙利铂150 mg,随后选择性栓塞供血动脉。结果CR2例,PR10例,SD1例,有效率（CR+PR）为92.3%,患者获益率（CR+PR+SD）为100%。13例患者均获得根治性切除。结论术前介入化疗是提高局部晚期乳腺癌手术切除率有效安全的方法。     

长春瑞滨和表阿霉素联合新辅助化疗方案治疗局部晚期乳腺癌的临床研究

目的评估长春瑞滨和表阿霉素的联合新辅助化疗方案在局部晚期乳腺癌治疗中的临床疗效和毒性反应.方法2001年9月至2004年12月,158例经空芯针活检组织学诊断证实的局部晚期乳腺癌患者在术前接受新辅助化疗,方案为长春瑞滨25 mg/m^2（第1、8天）,表阿霉素60mg/m^2（第1天）,每3周为1个疗程共3个疗程.结果原发病灶临床有效率为81.6%,其中23.4%（37/158）达到临床完全缓解（cCR）,58.2%（92/158）达到临床部分缓解;疾病稳定（SD）16.5%（26/158）,疾病进展（PD）1.9%（3/158）.病理完全缓解29例（18.3%）,其中15例术后标本未见肿瘤残留,14例仅残留原位癌组织.68例新辅助化疗前区域淋巴结细针穿刺活检阳性的病例,化疗后18例（26.5%）手术标本中未见区域淋巴结转移.最常见的毒性反应包括中性粒细胞减少症、脱发和恶心呕吐,共有111例患者（70.3%）发生3～4度中性粒细胞减少症.无因新辅助化疗引起的败血症和死亡病例.结论长春瑞滨和表阿霉素的联合新辅助化疗方案在局部晚期乳腺癌治疗中疗效显著且耐受性良好.     

Phase II open-label study of bevacizumab combined with neoadjuvant anthracycline and taxane therapy for locally advanced breast cancer

BackgroundNeoadjuvant anthracycline- and taxane-based chemotherapy is frequently administered in breast cancer. Pathological complete response (pCR) rates vary according to clinical disease stage and biology of breast cancer. The critical role of angiogenesis in the progression of breast cancer, together with significantly improved efficacy when bevacizumab is combined with chemotherapy in the metastatic setting, provides a strong rationale for evaluating the integration of bevacizumab into neoadjuvant chemotherapy regimens.MethodsA single-arm, multicentre, phase II, open-label study evaluated four 3-weekly cycles of FEC (5-fluorouracil 600 mg/m², epirubicin 90 mg/m² and cyclophosphamide 600 mg/m²) followed by 12 cycles of weekly paclitaxel (80 mg/m²) in combination with bevacizumab 10 mg/kg every 2 weeks as neoadjuvant therapy for HER2-negative stage III locally advanced or inflammatory breast carcinoma. The primary endpoint was pCR rate.ResultsPlanned treatment was completed in 49 of the 56 enrolled patients. In the intent-to-treat population, the pCR rate was 21% and the clinical response rate was 59%. Breast-conserving surgery was achieved in 34% of patients. In the subgroup of 15 patients with triple-negative disease, the pCR rate was 47%. Grade 3 adverse events in ≥5% of patients were neutropenia, leucopenia, asthenia, and rash. One case each of hypertensive retinopathy and post-operative wound complication, both after treatment completion, were considered probably related to bevacizumab. There were no treatment-related deaths and no cardiac function abnormalities.ConclusionsThis study indicates that FEC followed by weekly paclitaxel with bevacizumab is an active neoadjuvant regimen for locally advanced breast cancer, with no major safety concerns.Clinical trial registrationNCT00559845.     

Pattern of care in locally advanced breast cancer: Focus on local therapy

Background and MethodsThe optimal treatment of locally advanced breast cancer (LABC) remains undetermined. We analyzed factors influencing local therapy in LABC in a pooled material including three large clinical series.ResultsOf a total of 787 patients, local therapy was given in 604, surgery in 184, radiotherapy in 69, and a combination thereof in 351. The use of local therapy was related to younger age, lower clinical T and N stage, no skin involvement and no progression during induction chemotherapy. The use of surgery was related to younger age, lower clinical T and N stage, no clinical skin involvement and response to induction chemotherapy. The use of postoperative radiotherapy was correlated with larger tumor size, higher number of positive lymph nodes, positive surgical margin, extracapsular lymph node extension, lymphatic vessel invasion and skin involvement.ConclusionsThe most frequent local therapy in LABC remains a combination of surgery and radiotherapy. Clinical and pathological characteristics influence the type of local treatment.     

直肠癌新辅助放化疗后病理完全缓解的相关研究进展

局部晚期直肠癌标准的治疗方案为术前新辅助放化疗加手术的综合治疗。研究显示,直肠癌患者术前放化疗后达病理完全缓解者预后较好。尽管对这些患者的后续治疗方案有较大分歧,但已倾向于保守治疗而非根治性手术治疗。本文就局部晚期直肠癌术前新辅助放化疗后病理完全缓解的预后及预测等相关研究进展作一简要综述。     

Optimal treatment of locally advanced prostate cancer

The treatment of clinically locally advanced prostate cancer (cT3–4) is subject to controversies. Patients with lymph node metastases as well as patients with overstaged localized and thus curable disease fall into this category. Radical prostatectomy, external beam radiotherapy and early or deferred hormonal therapy are possible treatment options. Multimodal treatment (i.e., a combination of these options) is frequently used. After radical prostatectomy, Gleason score-adjusted disease-specific survival does not differ meaningfully between the tumor stages pT2 and pT3–4. In the case of lymph node metastases after radical prostatectomy, but not in node-negative disease, adjuvant hormonal treatment seems to improve survival. Adjuvant radiotherapy may improve biochemical and local control in locally advanced prostate cancer, a survival benefit has, however, not yet been proven. External beam radiotherapy alone provides unfavourable survival rates in locally advanced prostate cancer. Adjuvant hormonal treatment may improve outcome in this setting. When no curative treatment is chosen, early hormonal treatment seems to provide modest benefit compared with deferred therapy.     

腹腔镜手术联合术中放射治疗局部进展期直肠癌的回顾性研究

目的:分析腹腔镜手术联合移动式直线加速器术中放射治疗(intraoperative radiotherapy,IORT)对局部迸展期直肠癌(locally advanced rectal cancer,LARC)的疗效.方法:回顾性分析我院2012年1月至2016年1月应用腹腔镜手术联合IORT治疗的22例LARC病人...     

Rational use of trastuzumab in metastatic and locally advanced breast cancer: implications of recent research

The management of HER2-positive metastatic breast cancer, a disease renowned for its aggressive natural history, has been revolutionized by the introduction of trastuzumab. Indeed, outcomes for patients with HER2-positive advanced breast cancer are now equivalent to, if not better than, those of their HER2-negative counterparts. Since the pivotal registration trial, a wealth of new clinical data has emerged regarding the use of trastuzumab in a variety of clinical contexts - adding to the evidence but also highlighting areas of uncertainly and debate. These include the optimal partner chemotherapy(ies) to trastuzumab; the effectiveness of combining trastuzumab with endocrine therapy; the benefits of continuing trastuzumab after progression on a trastuzumab-containing regimen; and the role of trastuzumab in locally advanced and inflammatory breast cancer. In this paper we review major clinical trials addressing these questions, clinical recommendations that can be made as a result, and the strength of evidence that supports them. Finally, we identify areas of ongoing uncertainty, and propose recommendations for future research in this field.