乳腺癌的保乳治疗

乳腺癌是女性最常见恶性肿瘤之一,其发病率呈逐年上升趋势.在中国,这种上升趋势更为明显,乳腺癌的发病率已升至女性恶性肿瘤的第一或第二位,严重危害广大妇女的身心健康.     

乳腺癌保乳手术治疗148例分析

目的研究乳腺癌保乳治疗方法的选择,探讨保乳手术适应证及疗效. 方法回顾分析1996年1月～2003年10月我院接受保乳治疗的148例乳腺癌临床资料.0期5例,Ⅰ期85例,Ⅱ期55例,Ⅲ期3例.手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫.术后常规行辅助放疗、化疗和内分泌治疗. 结果手术标本石蜡病理检查各切缘均无癌浸润.经过54个月中位随访期(范围2～84个月),局部复发率为2.7%(4/148),其中乳腺3例,腋窝1例;远处转移率3.4%(5/148),手术至远处转移间期6～43个月,转移部位分别为肺、肝、脑膜和骨,其中3例死亡.对保乳综合治疗结束后满1年的108例患者进行乳房外形的评估,优32.4%(35/108),良49.1%(53/108),差18.5%(20/108). 结论对早期乳腺癌及部分经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意.规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键.保乳手术后大部分患者乳房外形良好.     

乳腺癌保乳手术治疗的相关问题

乳腺癌发病呈逐年上升的趋势，该如何治疗是我们研究的重点。保乳手术自1924年产生以来，经过不断的研究、完善，现已成为欧美国家患者首选的术式。我国起步较晚，各家医院开展情况的各不相同，对保乳手术的有关问题还缺乏统一认识，现就相关问题讨论如下。     

乳腺癌保乳手术的体会

目的　总结和探讨乳腺癌保乳手术保持乳房良好外形 ,在术前、术中和术后应注意的问题。方法　 3 7例患者接受了乳腺癌保乳手术。术后从乳头外观、双乳头水平差距、双乳头距同侧腋前线垂直距离之差距和瘢痕对乳房外形影响等四个方面的量化标准 ,评估保留乳房的外形美观效果。四项指标积分≥ 2 1分为优 ,13～ 2 0分为良 ,<13分为差。结果　术后保留乳房外形优良者 3 0例 ( 81.1% ) ,乳房外形较差者 7例 ( 18.9% )。常见问题是因切口瘢痕致乳房变形、乳头歪斜、乳头不自然挺立 ,以及与对侧乳头水平高度差距明显。结论　术前认真设计手术切口、术中注意术区皮瓣和保留乳腺组织的彻底游离以及切除、缝合技巧 ,术后切口包扎时注意避免压迫乳头等 ,将有助于保持保留乳房的外形美观效果     

乳腺癌保乳整复手术

保乳整复手术是乳腺癌治疗中的一个基本组成部分。这种治疗方式可以切除大量的乳腺组织,提高美容效果,在使患者满意的同时保持良好的肿瘤学切除原则,减少再切除术和乳腺切除率,并有助于辅助放射治疗计划。 我们复习了近年来各种不同保乳整复手术,并描述了在切除乳腺内不同位置肿瘤的技术应用以及选择不同技术时所考虑患者相关的具体因素。最后,对于这种外科手术类型的肿瘤学安全性的证据及并发症进行了讨论。     

乳腺癌保乳手术治疗体会

目的总结乳腺癌施行保留乳房的根治术的治疗效果。方法回顾性分析2003年8月～2007年12月我科开展的52例保乳手术的乳腺癌患者的临床资料。术后均行联合化疗、放疗、内分泌治疗。结果本组52例均获得随访,随访时是2个月-4年。51例均未发现有局部复发及远处转移,1例出现局部复发并肺转移。除1例因乳房过小术后外形欠美观外,其余51例保乳术后的乳房外形基本满意。结论乳腺癌行保乳手术并联合放、化疗可达到与传统根治手术相同的近期效果,并具有患者心理打击小、美容效果好的优点。     

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。     

乳腺癌保乳手术32例临床分析

目前,乳腺癌的发病率已上升至女性肿瘤中的第二位,有逐年上升且年轻化趋势,在某些地区已达女性恶性肿瘤的首位。随着肿瘤病理学等基础学科的进步,外科医生对乳腺癌的认识也发生了深刻的变化,乳腺癌治疗已由单一手术治疗发展成为全身综合性治疗。乳腺癌保乳手术合并放化疗已日渐成为对早期乳腺癌最多采用的治疗方法。我省处于高原地区,保乳手术开展较晚,我院2007年1月至2010年7月共实施保乳手术32例,报告如下。     

乳腺癌保乳治疗的共识与争议

乳腺癌的治疗强调在局部控制基础上的综合治疗。越来越多的临床实践证明扩大乳腺癌手术无生存获益。手术范围日益缩小,从100多年前的扩大根治术逐渐过渡到改良根治术和更微创的保乳手术。乳腺癌腋窝处理也从传统的淋巴结清扫术,过渡到部分早期病人可仅接受前哨淋巴结活检术,降低了上肢淋巴结水肿、感觉和运动障碍等并发症发生率。基于安全有效的长期随访结果,原发肿瘤切缘阴性的保乳手术加术后全乳放疗是大多数早     

早期乳腺癌保乳手术52例分析

目的评估早期乳腺癌保乳综合治疗的疗效。方法2000年3月～2005年9月，我院对52例Ⅰ期及部分Ⅱ期（肿瘤≤3cm，单发病灶）乳腺癌行局部广泛切除术，全腋窝淋巴结清扫术联合术后放疗，并辅以化疗（CMF或CEF方案）、内分泌治疗（口服三苯氧胺）。结果术后病理提示个切缘无癌细胞浸润。美容效果优良率达86．5％（45／52）。50例随访10～36个月（中位时间16个月），未见局部复发与远处转移。结论选择部分Ⅰ～Ⅱ期乳腺癌病例行保乳手术治疗，乳房外形及临床疗效满意，而且可以提高生活质量。     

Treatment of Recurrent Breast Cancer Following Breast Conserving Surgery

Patients with isolated ipsilateral breast cancer recurrence face completion mastectomy in the majority of cases. Selected patients may derive good outcomes from repeat breast conservation surgery and indeed repeat irradiation may be employed using one of many different modalities. Tumor biology rather than salvage surgery method is likely to influence outcome. Patients with isolated breast tumor recurrence are treated in the majority of cases with completion mastectomy, when for selected patients there exists little evidence that more radical surgery provides better outcomes in terms of further recurrence and overall survival, than repeated breast conserving surgery. Literature search identifying articles addressing the issue of repeat breast conserving surgery for ipsilateral breast tumor recurrence, and repeat radiotherapy (search terms include: repeat breast conserving surgery, salvage mastectomy, salvage breast conserving surgery, salvage radiotherapy, reirradiation). Thirty‐five articles discussed the outcomes of repeat breast conserving surgery versus salvage mastectomy, methods of repeat breast irradiation, repeat sentinel lymph node biopsy and related factors. Repeat breast conserving surgery may represent a safe and feasible treatment method for isolated ipsilateral breast tumor recurrence.     

预见性护理对乳腺癌整形保乳术患者乳房美观度的影响

目的 观察预见性护理应用于乳腺癌整形保乳术后对患者乳房美观度的影响。方法 选择2022年 5月-2023年2月于我院行乳腺癌整形保乳术的44例患者为研究对象,采用随机数字表法分为对照组和研究 组,每组22例。对照组给予常规护理,研究组给予预见性护理,比较两组乳房美观度、乳房美容效果及心 理状况。结果 研究组乳头纵向移位距离、乳头横向移位距离、乳房凹陷程度、瘢痕增生、乳房对称性评 分均高于对照组（P＜0.05）;研究组乳房美容优良率为90.91%,高于对照组的59.09%（P＜0.05）;研究组 护理后HAMD评分、HAMA评分均低于对照组（P＜0.05）。结论 为乳腺癌整形保乳术后患者提供预见性 护理能有效改善乳房美容度,提升乳房美容效果,有利于调节患者的不良情绪,值得临床应用。     

Breast Conserving Surgery after Primary Chemotherapy in Locally Advanced Breast Cancer

Purpose: Primary chemotherapy is being given in the treatment of locally advanced breast cancers (LABC), but a major concern is local recurrence after therapy. The aim of this study was to assess the role of breast conserving surgery (BCS) in patients with locally advanced breast cancer.

Material and Methods: Twenty-eight patients, presenting LABC (T any, N 012, M0) were treated with primary chemotherapy comprising of cyclophosphamide, doxorubicin and fluorouracil and then BCS followed by radiotherapy were examined between the years 1992-2002 retrospectively. Before neoadjuvant chemotherapy, seven patients (25%) were Stage IIB, 19 patients (68%) Stage IIIA and two patients (7%) Stage IiIB. Survival times and curves were established according to the Kaplan-Meier method and compared by means of the log-rank test. The chi-square test and log rank test were performed for univariate statistical analysis of each prognostic factor. P values in multivariate analysis were carried out by the Cox’s proportional hazards regression model. All p values were two-sided in tests and p values < 0.05 were considered significant.

Results: Clinical down staging was obtained in 25 (89%) of patients. Three (11%) patients had complete clinical response, 22 (78%) patients with partial response and 3 (11%) had stable disease. The primary tumour could not be palpated after chemotherapy in 6 (21%) of 28 patients presenting with palpable mass, therefore needle localization was performed for BCS. Median follow-up was 51.9 months (ranging 10 to 118 months). Local recurrence was detected in 4 (14%) patients. Distant metastasis developed in 5 (18%) patients. Three of the patients died of distant metastases and two of them are alive at 49 months. Five-year survival rate was 66%. Statistically, there were no significant factors in terms of local recurrence. Histological grade and menopause status were significantly associated with overall survival (p = 0.018) and nuclear grade was the one significant factor on distant disease-free survival in univariate analysis (p = 0.006). In multivariate analysis, there were no significant factors in terms of overall and distant disease-free survival Conclusions: Negative margin is more important than the clinical and histological parameters, such as pretreatment stage, clinical response rate, ER and PR in terms of local recurrence. BCS can be performed safely by achieving free surgical margin in patients who have small sized tumour and with either N2 axillary involvement or skin invasion.     

加速康复外科护理在乳腺癌保乳手术中的应用效果

目的 分析加速康复外科护理在乳腺癌保乳手术中的应用效果。方法 选取2021年1月-12月于 我院行保乳手术的70例乳腺癌患者作为研究对象,随机分成对照组和观察组,各35例。对照组和观察组 分别实施常规护理和加速康复外科护理,比较两组护理效果、不良情绪、生活质量及并发症发生情况。 结果 观察组护理总有效率为97.14%,高于对照组的68.57%,差异有统计学意义（P＜0.05）;观察组干预 后SAS和SDS评分低于对照组,差异有统计学意义（P＜0.05）;观察组情感功能、心理状态、身体功能和 社会功能各项评分均优于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为2.86%,低于对 照组的28.57%,差异有统计学意义（P＜0.05）。结论 加速康复外科护理应用于乳腺癌保乳手术中效果理 想,能够缓解患者不良情绪,提升生活质量,降低并发症发生率。     

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。     

肿瘤整形技术对早期乳腺癌保乳手术患者美容效果及预后的影响

探讨对早期乳腺癌患者应用乳腺肿瘤整形保乳术治疗对其术后乳房美观度及预后的影响。方法 选取我院2019年3月-2021年6月收治的60例早期乳腺癌患者为研究对象,随机分为对照组和观察组,每组30例。对照组采用常规保乳术治疗,观察组采用乳腺肿瘤整形保乳术治疗,比较两组术后乳房美观度和预后状况。结果 观察组术后乳房美观优良率为96.67%,高于对照组的73.33%（P＜0.05）;两组治疗1年后均无复发和远处转移,生存率均为100.00%;两组治疗2年后生存率、复发率及远处转移率比较,差异无统计学意义（P ＞0.05）。结论 乳腺肿瘤整形保乳术在早期乳腺癌患者中的应用效果确切,可提升患者的术后乳房美观度,且预后状况较好,不会增加复发率及远处转移率。     

Other Primary Malignancies in Breast Cancer Patients Treated with Breast Conserving Surgery and Radiation Therapy

Background

Our purpose was to examine the incidence and impact on survival of other primary malignancies (OPM) outside of the breast in breast cancer patients and to identify risk factors associated with OPM.

Methods

Patients with stage 0–III breast cancer treated with breast conserving therapy at our center from 1979 to 2007 were included. Risk factors were compared between patients with/without OPM. Logistic regression was used to identify factors that were associated with OPM. Standardized incidence ratios (SIRs) were calculated.

Results

Among 4,198 patients in this study, 276 (6.6 %) developed an OPM after breast cancer treatment. Patients with OPM were older and had a higher proportion of stage 0/I disease and contralateral breast cancer compared with those without OPM. In a multivariate analysis, older patients, those with contralateral breast cancer, and those who did not receive chemotherapy or hormone therapy were more likely to develop OPM after breast cancer. Patients without OPM had better overall survival. The SIR for all OPM sites combined after a first primary breast cancer was 2.91 (95 % confidence interval: 2.57–3.24). Significantly elevated risks were seen for numerous cancer sites, with SIRs ranging from 1.84 for lung cancer to 5.69 for ovarian cancer.

Conclusions

Our study shows that breast cancer patients have an increased risk of developing OPM over the general population. The use of systemic therapy was not associated with increased risk of OPM. In addition to screening for a contralateral breast cancer and recurrences, breast cancer survivors should undergo screening for other malignancies.     

DCE-MRI 在乳腺肿瘤保乳术中的应用价值

目的 分析并讨论DCE-MRI在乳腺肿瘤保乳术中的应用价值。方法 随机选取我院2021年 5月-2023年5月收治的70例乳腺肿瘤患者,所有患者均采取保乳术治疗。依据临床诊断方式差异将其分为 FFDM组与DCE-MRI组,FFDM组采取FFDM进行检查,DCE-MRI组采取DCE-MRI进行检查,在病理检测 结果的基础上比较两组乳腺肿瘤良恶鉴别率以及两种检查方式的临床灵敏度及特异度。结果 DCE-MRI组 良、恶性鉴别准确率高于FFDM组（P＜0.05）;DCE-MRI组临床灵敏度及特异度高于FFDM组（P＜0.05）。 结论 在乳腺肿瘤保乳术中采取DCE-MRI具有很高的诊断率、临床灵敏度及特异度,能够有效评估患者 的治疗效果,因此具有很高的临床应用价值。