Seroma prevention after modified radical mastectomy.

The most common mastectomy-associated complication is seroma formation. Seromas can be associated with other more serious complications such as skin flap necrosis, delayed wound healing, infection, and lymphedema. The flap tacking procedure that closes the axillary fossa dead space and tacks the mastectomy flaps to the chest wall has been suggested as one potential technique to reduce the incidence of postmastectomy seromas. This institution-wide study of modified radical mastectomies demonstrated a significant decrease (P < 0.0381) in the incidence of seroma when flap tacking was performed. Women who developed a seroma, compared to those who did not, averaged nearly twice as any office visits in the first 2 months after the operation. Distribution of office visits between the seroma patients and nonseroma patients was significant (P < 0.0001). When practiced by several surgeons, the flap tacking procedure 1) reduces postmastectomy seromas and 2) reduces the amount of postoperative patient office visits and care.     

乳腺癌改良根治术患者的护患互动式综合干预

目的探讨护患互动式综合干预用于乳腺癌改良根治术患者的效果。方法将170例拟行乳腺癌改良根治术患者按不同病区分为干预组和对照组各85例。干预组给予护患互动式综合干预,包括互动资料收集、互动方案初建、实施互动循环和互动效果反馈4个环节,推动患者/家属主动参与治疗护理活动;对照组给予常规护理。干预3个月评价效果。结果干预组患肢前屈、外展角度及握力显著高于对照组(P0.05,P0.01)。结论护患互动式综合干预促使患者积极参与治疗护理,可有效促进患肢功能恢复。     

乳腺癌改良根治术后皮下积液的预防措施

目的 探讨乳腺癌术后皮下积液的防治方法。方法 回顾北京友谊医院普外科2002年1月～2004年12月收治的女性乳腺癌患者312例。比较皮下引流管接持续高负压吸引组（A组）与持续低负压引流组（B组）,乳腺癌改良根治术后皮下积液的发生率。结果 A组160例患者拔管前合计引流量220～350ml,平均270ml。35例发生皮下积液,积液发生率为21．8％。同时伴皮瓣坏死5例。B组152例患者拔管前合计引流量160～250ml,平均180ml。17例发生皮下积液,积液发生率为11．2％。皮瓣坏死3例。B组与A组比较皮下积液发生率有显著性差异（P=0．011）。结论 乳腺癌改良根治术后引流管接持续低负压吸引有助于减少皮下积液的发生率。     

Early discharge after modified radical mastectomy

Thirty-nine patients underwent modified radical mastectomy and were discharged with their suction drains and sutures in place after a mean postoperative stay of 4.7 days. Drains and sutures were removed at the first office visit. There were no infections, and late seromas developed in only 21 percent of the patients. Another group of patients were hospitalized until drainage effluent from their tubes was less than 30 ml/day, at which time the drains were removed and the patients discharged. This group had a mean postoperative stay of 9.5 days, and an incidence of late seroma of 43 percent. These data suggest it is both safe and effective to discharge patients 3 to 5 days after mastectomy at considerable potential cost savings due to the reduced hospital stay.     

Axillary recurrence after modified radical mastectomy

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.     

乳腺癌改良根治术同步乳房再造患者的心理干预

目的 探讨乳癌改良根治术同步乳房再造患者的常见心理问题及其护理干预.方法 采用SCL-90自评量表和患者最关心问题调查表评估患者心理问题,针对患者最关心的问题进行心理干预,并重视家庭及社会支持等.结果 干预前后患者SCL-90评分比较及与国内常模比较,差异有统计学意义(均P＜0.01).结论 心理干预可有效缓解乳癌改良根治术同步乳房再造患者的心理问题.     

保乳术与乳房改良根治术对患者肋间臂神经的影响

目的探讨保乳术与乳房改良根治术对乳腺癌的疗效及肋间臂神经的影响。方法将2010年1月至2013年1月收治的150例乳腺癌患者按照随机数字表法分为保乳组75例和根治组75例,术后两组患者随访3年,采用SPSS22.0统计学软件包对数据进行处理,手术时间、出血量、切口长度、住院时间、生活质量评分等计量资料用(x珋±s)表示,采用成组t检验;胸肌萎缩、胸壁外形改变、感觉功能障碍、复发、远处转移、生存率及并发症发生率比较采用χ2检验,以P0.05表示差异有统计学意义。结果与根治组比较,保乳组手术时间、术中出血量、手术切口长度、住院时间均显著缩短,两组间差异具有统计学意义(P0.05);保乳组胸肌萎缩、胸壁外形改变、感觉功能障碍发生率均显著低于根治组(P0.05);术后保乳组(2.6%)上肢水肿、切口感染、皮下积液等并发症发生率均显著低于根治组(44.0%)χ2=25.814,P0.05;生活质量显著高于根治组,以上指标两组间比较差异均具有统计学意义(P0.05)。结论保乳术对乳腺癌患者创伤更小,能避免对肋间臂神经的损伤,对于满足手术适应证的患者,保乳术可以作为首选治疗方案。     

Defibrotide and heparin in the prevention of deep venous thromboses. A controlled study

Forty-one surgical patients at risk of deep venous thrombosis (DVT) were treated with defibrotide (400 mg/b.i.d./i.v.) or with heparin (5000 UI/t.i.d./s.c.). Neither DVT nor pulmonary embolism was evidenced. In the heparin group the healing rate was longer and during the first three days bleeding from the surgical wound was more pronounced. In particular one patient of the heparin group had to interrupt the treatment for haemorrhage.     

Non-tumour morbidity and mortality after modified radical mastectomy.

From 1985 to 1987 148 patients underwent mastectomy for breast cancer, of whom 91 underwent modified radical mastectomy. Of these patients (median age 60 years (range 31-86 years)), 89 have been assessed for early (< 30 days) and late (> 30 days) non-tumour morbidity and mortality. A total of 41 patients had nodal metastases. Adjunctive therapy used was tamoxifen in 70 patients and radiotherapy in 20. Overall, 47 patients (53%) developed a total of 75 complications, and there was one 30-day mortality. Of the patients, 26 developed one complication, 14 had two complications and 7 three complications. Early complications were lymphocoele/seroma (n = 22), wound infection (n = 9) and cardiopulmonary problems (five deep vein thrombosis, two pulmonary embolus (1 death), one myocardial infarct). Late complications were lymphoedema (n = 10), pectoralis major wasting (n = 6), frozen shoulder (n = 7), intercostobrachial neuralgia (n = 4), and a small number of self-limiting wound problems (n = 9). There were two late deaths (myocardial infarcts). Early complications were not related to nodal status, and late complications were related to neither nodal status nor radiotherapy. Significant morbidity is attached to radical surgery for breast cancer. Most complications are minor and self-limiting, but there are a small number of late complications which may affect quality of life.     

保留皮肤的乳腺癌改良根治术后一期乳房假体再造

目的探讨用硅胶假体植入法修复乳腺癌改良根治术后乳房缺失的疗效。方法2005年6月至11月,10例患者行保留皮肤的乳腺癌改良根治术后,同期于胸大肌后植入硅胶假体再造乳房,并根据冰冻结果决定是否保留乳头乳晕复合体。结果本组病人术后无伤口积液感染,皮肤坏死及异物反应等。10例患者美观效果均满意,其中有4例保留乳头乳晕复合体。所有病人进行术后随访。随访时间为1～6个月。未发现有远处转移和局部复发。无上肢水肿及功能障碍。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再造,具有创伤小、安全、简单、恢复快的特点;再造后乳房美观,效果满意。     

Contralateral axillary silicone lymphadenopathy after modified radical mastectomy and reconstruction

We describe a 49-year-old female patient who was diagnosed with breast cancer in her left breast. The patient underwent a modified radical mastectomy and immediate reconstruction with the placement of an expander implant. Two years later, the patient suffered a minor trauma and began to feel the softening of her reconstructed breast, and a growing palpable mass appeared in the contralateral (right) axilla. Examinations revealed the intracapsular rupture of the expander implant. Aspiration cytology from the palpable axillary mass suggested silicone lymphadenopathy. We replaced the ruptured implant, and the lymph node from the contralateral axilla was removed. Silicone lymphadenomegaly in the right axilla was verified by a postoperative histopathological review. This case represents a rare manifestation of silicone lymphadenopathy caused by altered lymphatic drainage due to previous axillary lymphadenectomy. Level of Evidence: Level V, diagnostic study.     

乳腺癌改良根治术的技术改进

乳腺癌改良根治术是当今国内外乳腺癌的主要外科治疗术式。 1999年 5月～ 2 0 0 1年 10月 ,我们对 5 1例乳腺癌的改良根治术Auchincloss术式操作方式进行了改进 ,采用开胸器牵开胸大肌间沟 ,直视下清扫 3水平 (L3)及胸肌间淋巴结的操作方法 ,取得了理想效果。1　资料和方法1.1　一般资料　 5 1例乳腺癌均为女性。年龄 35～ 6 1岁 ,中位年龄 44岁。临床分期 :I期 7例 ,Ⅱ期 31例 ,Ⅲ期 13例。1.2　方法　①均由工作 10年以上的乳腺专科医生主刀 ,按乳腺癌改良根治术Auchincloss术式 ,包括探查清扫胸肌间组织完成操作后 ,3位术者分别彻底检…     

Effects of dextran-40 on flap viability after modified radical mastectomy

BACKGROUND:

Postoperative management of patients after modified radical mastectomy has evolved over the past decades. In the early postoperative period, wound complication rates were reported to be as high as 60%. Flap necrosis after modified radical mastectomy is a common problem encountered by surgeons. Various treatment strategies have been proposed in the literature but none have addressed the use of dextran-40.

OBJECTIVE:

To determine whether dextran-40 infusion improves skin flap viability after modified radical mastectomy.

METHODS:

Twenty-eight patients who underwent modified radical mastectomy were randomly assigned to receive dextran-40 or no dextran-40 intraoperatively after flap dissection. Patients were followed prospectively over a five-year period in a community hospital. The incidence of postmastectomy skin flap necrosis and prognosis of the necrotic area after dextran-40 infusion was observed.

RESULTS:

Flap necrosis was observed in five (17.8%) patients. Hypertension and diabetes mellitus were found to be risk factors for the development of flap necrosis (P<0.05). Flap thickness and tension on the flaps were found to be related to flap necrosis. Six of seven patients with flap perfusion problems (ecchymosis or necrosis) underwent dextran-40 treatment and healed without graft replacement.

CONCLUSIONS:

Dextran-40 treatment did not affect development of flap necrosis. However, if necrosis had already developed, the necrotic area of the skin flaps improved with dextran-40 treatment.     

乳腔镜在保留乳头乳腺癌改良根治术中的应用

目的探讨乳腔镜在保留乳头乳腺癌改良根治术治疗乳腺癌的疗效。方法2003年11月至2006年8月,对30例肿块直径≤3cm、距离乳晕≥3cm的乳腺癌采用乳腔镜下行保留乳头乳腺癌改良根治术,腋窝脂肪抽吸后行乳腔镜腋窝淋巴清扫。结果手术时间120~156min,平均128.9min,手术出血量为30~100ml,平均56ml。取淋巴结6~34个,平均16个。保留的乳房形态良好,伤口小而隐蔽,所有患者对手术效果满意。术后随访2~29个月,平均16.6个月,未见局部复发。结论该术式对保护上肢功能、保持胸部良好的外观形状及提高患者的生存质量均是一种较好的手段,是一种治疗Ⅰ、Ⅱ期乳腺癌合理有效术式。     

月牙形切口在乳腺癌改良根治术中的应用

目的 探讨月牙形切口在乳腺癌改良根治术中的应用效果.方法 分析近10多年129例行乳腺癌改良根治术的乳腺癌患者的临床资料,129例均行乳腺癌改良根治术.随机分为两组:A组,51例,采用月牙形切口;B组,78例,采用Steward横切口.观察患者的切口愈合情况、腋窝淋巴结清扫的数目、肩关节功能恢复满意度.结结果 A组月切口Ⅰ期愈合率90.2%(46/51),B组75.6%(59/78)(P＜0.05);患侧肩关节功能恢复满意度A组96.1%(49/51),B组84.6%(66/78)(P＜0.05).结论 月牙形切口张力低,愈合好,暴露满意,对肩关节的功能影响小,是乳腺癌改良根治术的一种理想切口.     

腹壁下动脉穿支皮瓣在双侧乳腺癌改良根治术后乳房再造中的应用

目的 总结采用腹壁下动脉穿支游离皮瓣再造双侧乳房的经验。方法 2004年6月至2005年5月,对3例双侧乳房改良根治术后的患者,应用DIEP皮瓣行二期乳房再造术。结果 3例患者6个皮瓣均成活。随访3个月以上,双侧再造乳房双侧对称,外形满意。未见腹壁疝和腹壁膨出发生。结论 选用DIEP皮瓣游离移植再造乳房,是乳腺癌改良根治术后恢复双侧乳房外形的一种理想方法。     

保留相关功能神经的改良乳腺癌根治术

目的探讨改良乳腺癌根治术保留胸前神经及肋间臂神经的方法及临床意义。方法选择Ⅰ、Ⅱ期乳腺癌患者 87例 ,随机分为两组 ,A组 5 2例 ,采用经胸大肌前入路清扫腋窝淋巴结 ,保留胸小肌、胸前神经及肋间神经。B组 (对照组 ) 35例 ,经胸大肌入路清扫腋窝淋巴结 ,切除胸小肌 ,切断肋间臂神经 ,观察随访两组术后情况。结果术后重度胸大肌萎缩 :A组 ,0例 ,B组 2 8例(80 % ) ,2组比较 ,差异有显著性 (χ2 =6 1 34,P <0 0 1)。腋窝及患侧上肢感觉异常 ,A组 3例(5 8% ) ,B组 31例 (88 6 % ) ,2组比较 ,差异有显著性 (χ2 =6 2 2 4 ,P <0 0 1)。结论保留胸前神经及肋间臂神经的改良乳腺癌根治术能够有效地防止胸大肌萎缩和患侧腋窝上肢感觉障碍的发生率。