乳腺癌保乳根治术并腔镜下腋窝淋巴结廓清术应用

目的探讨乳腺癌保乳根治术并腔镜下腋窝淋巴结廓清术的效果及安全性。方法2003年8月至2006年8月在中国医科大学附属盛京医院第一微创外科住院的5例乳腺癌（年龄38～61岁,平均年龄51岁）行保乳根治术并腔镜下腋窝淋巴结廓清术患者,对其资料进行回顾分析。结果5例乳腺癌患者行保乳根治术并腔镜下腋窝淋巴结廓清术均获成功,所有切除乳腺标本经术中冰冻病理证实切缘肿瘤细胞阴性。平均手术时间150min,术中及术后均无并发症发生。结论保乳根治术并腔镜下腋窝淋巴结廓清术治疗乳腺癌能够达到良好的手术效果且更安全。     

腔镜保乳改良根治一期假体再造术在早期乳腺癌治疗中的临床应用

目的：探讨早期乳腺癌腔镜保乳改良根治及一期假体再造手术的临床方法及疗效。方法：对2009年8月～2011年8月20例行腔镜保乳改良根治及一期假体再造手术的早期乳腺癌患者的临床资料进行回顾性分析。结果：20例患者均顺利完成手术,无明显手术并发症。术后随访5—29个月,中位建议临床推广应用。随访时间为15个月,全组无局部复发和转移,美体效果满意。结论：对早期乳腺癌行腔镜保乳改良根治及一期假体再造手术,近期疗效及美体效果好,未增加乳腺癌术后复发转移机会,建议临床推广应用。     

保留肋间臂神经的乳腺癌改良根治术9例

腋淋巴结清扫术是乳腺癌手术的重要部分，若术中忽视对肋间臂神经的保护，患者术后常出现患侧上臂及腋窝的感觉障碍。我院2005年1月至2006年12月共行保留肋间臂神经的乳腺癌改良根治术9例，现将治疗情况及分析总结报告如下。     

乳腺癌保乳手术31例临床治疗探讨

目的 探讨早期乳腺癌保乳的临床治疗方法及疗效观察.方法 选择2006年2月～2009年2月收治女性乳腺癌31例,采用肿块局部广泛切除加腋淋巴结清扫或象限切除加腋淋巴结清扫术治疗,术后辅助放疗、化疗和内分泌治疗.结果 31例手术全部成功,无术后并发症.随访6～48个月,平均随访24个月.30例患者生存,总生存率为96.7%.结论 保乳手术结合术后综合治疗乳腺癌,近、远期临床疗效均满意,美容效果好,术后并发症少,无放疗后乳房纤维化、挛缩.患侧肢体活动良好,无淋巴水肿等并发症发生.     

保留肋间臂神经对乳腺癌腋窝淋巴结清扫术的感觉障碍影响的研究

目的 探讨乳腺癌手术腋窝淋巴结清扫时保留肋间臂神经(ICBN)对感觉障碍影响的研究.方法 对146例Ⅰ、Ⅱ、Ⅲa期乳腺癌患者行改良根治术的临床资料进行分析.将其随机分为两组:保留组(67例)行腋窝淋巴结清扫术时保留ICBN,对照组(79例)行腋窝清扫时常规切除ICBN.比较两组在手术时间、腋窝淋巴结清扫数量及术后上臂内侧感觉异常等情况.结果 保留组及对照组术后1、3、6个月患侧上臂内侧感觉障碍发生率分别为17.9％、74.9％,11.9％、60.7％,7.4％、59.5％,差异均有统计学意义(x2=46.78,P＜0.001;x2=36.54,P＜0.001;x2=42.80,P＜0.001).手术时间及腋窝淋巴结清扫数量差异无统计学意义(P＞0.05).术后8个月到5年期间随访无局部复发.结论 对Ⅰ、Ⅱ、Ⅲa期乳腺癌患者在行腋窝淋巴结清扫时保留ICBN可明显减少术后患侧上臂内侧感觉障碍,从而提高生活质量,不影响局部复发率.     

原发性乳腺鳞状细胞癌二例

例1女,50岁.发现左侧乳腺肿块5 d于2008年9月15日入院.体检:左乳外上象限可触及-2.0 cm × 1.5 cm肿块,质硬,无压痛,边界不清,活动尚可,乳头无溢液、无内陷,皮肤无橘皮样改变.术中冷冻切片诊断为浸润性乳腺癌,倾向于鳞状细胞癌.行左侧乳腺癌改良根治术及左腋窝淋巴结清扫.     

乳腔镜乳腺癌改良根治术的护理

乳腔镜技术在治疗乳腺良、恶性疾病中显示出较大的优势和广泛的运用前景，在乳腺癌改良根治术中的运用，具有切口小、术后并发症少、手术质量高、患者心理负担轻等优点。我科自2009年1月至2010年2月已完成20例乳腔镜乳腺癌改良根治术，现将护理体会报告如下。     

微创腔镜入路与传统入路治疗甲状腺乳头状癌的对比分析

目的:探究不同入路手术对甲状腺乳头状癌患者的疗效.方法:选取我科2018年10月至2020年10月期间收治的85例甲状腺乳头状癌患者随机分为2组.对照组42例患者接受传统颈前开放手术入路与中央淋巴结清扫术,观察组43例患者接受微创腔镜下经胸乳入路手术与中央淋巴结清扫术,对比两组患者术后指标.结果:观察组术后总缓解率大于对照组(P<0.05);炎性指标水平低于对照组(P<0.05).结论:经胸乳入路微创腔镜手术与中央淋巴结清扫术相比传统术式,可以提高术后总缓解率,降低术后炎性水平.     

改良性保乳保腋窝手术与传统保乳手术对 T1期乳腺癌患者复发的影响

目的 对比改良性保乳保腋窝手术与传统保乳手术对T1期乳腺癌患者复发的影响。方法 选取2016年3月~2018年2月我院收治的T1期乳腺癌患者98例,按照随机数字表法分为观察组和对照组,各49例。观察组行改良性保乳保腋窝手术,对照组行传统保乳手术。对比两组手术相关指标、并发症及复发转移情况。结果 观察组手术时间、术中出血量、并发症发生率均优于对照组,差异有统计学意义（P＜0.05）;随访1年后,两组均未出现复发。结论 与传统保乳手术相比,改良性保乳保腋窝手术治疗T1期乳腺癌患者不会增加患者复发率,且可有效缩短手术时间,减少术中出血量,降低并发症发生率。     

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。     

Sentinel lymph nodes for breast carcinoma: an update on current practice

Sentinel lymph node (SLN) biopsy has been established as the standard of care for axillary staging in patients with invasive breast carcinoma and clinically negative lymph nodes (cN0). Historically, all patients with a positive SLN underwent axillary lymph node dissection (ALND). The ACOSOG Z0011 trial showed that women with T1–T2 disease and cN0 who undergo breast‐conserving surgery and whole‐breast radiotherapy can safely avoid ALND. The main goal of SLN examination should be to detect all macrometastases (>2 mm). Gross sectioning of SLNs at 2‐mm intervals and microscopic examination of one haematoxylin and eosin‐stained section from each SLN block is the preferred method for pathological evaluation of SLNs. The role and timing of SLN biopsy for patients who have received neoadjuvant chemotherapy is controversial, and continues to be explored in clinical trials. SLN biopsies from patients with invasive breast carcinoma who have received neoadjuvant chemotherapy pose particular challenges for pathologists.     

Assessing second echelon lymph nodes during sentinel lymph node biopsy: can we have more accurate axillary treatment for breast cancer patients?

Sentinel lymph node biopsy (SLNB) is the standard treatment for breast cancer patients with clinically negative axilla. For patients with positive sentinel lymph nodes, axillary lymph node dissection (ALND) was required. However, approximately a half of the SLNs-positive patients were found to have clear axillary lymph nodes after ALND, indicating that they had received unnecessary ALND without therapeutic benefit. Therefore, we propose a hypothesis for solution of this clinical problem. We defined the second echelon lymph nodes (SELNs) as those nodes receiving lymphatic drainage directly from the SLNs. For patients with positive-SLNs, SELNs can be biopsy and assessed. If SELNs are negative, no more ALND was needed in these patients even if their SLNs are positive. If our hypothesis were confirmed to be true, we can tailored our axillary treatment to more breast cancer patients, avoiding unnecessary ALND and its complications.     

Prognostic Value of p53 and bcl-2 Expression in Patients Treated with Breast Conservative Therapy

Prognostic value of p53 and bcl-2 expression on treatment outcome in breast cancer patients has been extensively evaluated, but the results were inconclusive. We evaluated the prognostic significance of these molecular markers in patients treated with breast conserving surgery and radiotherapy. One hundred patients whose immunostaining of p53 and bcl-2 expression was available among 125 patients who underwent radiotherapy after breast conserving surgery and axillary lymph node dissection were enrolled into this study. Eighty-seven patients also received adjuvant chemotherapy and/or hormonal therapy. Conventional clinicopathologic variables and treatment-related factors were also considered. The 5-yr loco-regional relapse-free and distant metastasis-free survival rates were 91.7% and 90.9%, respectively. On univariate analysis, age, T stage and the absence of bcl-2 & estrogen receptor (ER) expression were associated with loco-regional relapse-free survival. When incorporating these variables into Cox proportional hazard model, only bcl-2(-)/ER(-) phenotype was an adverse prognostic factor (P=0.018). As for the distant metastasis-free survival, age, T stage, and p53 expression were significant on univariate analysis. However, p53 expression was the only prognosticator on multivariate analysis (P=0.009). A bcl-2(-)/ER(-) phenotype and p53 expression are useful molecular markers predicting loco-regional relapse-free and distant metastasis-free survival, respectively, in patients treated with breast conserving surgery and radiotherapy.     

乳腺癌非前哨淋巴结转移的预测

目的 :预测非前哨淋巴结 (non SLN)转移 ,以筛选出转移局限于前哨淋巴结 (SLN)的乳腺癌患者。方法 :采用99mTc SC作为示踪剂 ,对 95例乳腺癌患者行前哨淋巴结活检 ,对乳腺癌非前哨淋巴结转移进行单因素和多因素分析。结果 :95例患者中成功发现 91例患者有SLN (95 8% ) ,其中 85例患者SLN能准确反映腋窝淋巴结的病理状况 (93 4% )。临床肿块大小(P =0 0 2 8)、肿瘤分级 (P =0 0 40 )和原发灶cyclinD1蛋白 (P =0 0 17)的表达与non SLN转移显著相关。而Logistic多因素分析证实 ,临床肿块大小、肿瘤分级为独立的预测非前哨淋巴结转移的因子。结论 :可根据临床病理学特征 ,筛选出乳腺癌转移只局限于前哨淋巴结的患者 ,也存在免除腋窝淋巴结清扫的可能性     

The extent of agreement between frozen and paraffin block data from axillary samples in patients with early-stage breast cancer

IntroductionPatients with early-stage breast cancer currently undergo sentinel lymph node dissection to evaluate the axillary region. Frozen tissue blocks are evaluated intra operatively and paraffin-embedded samples are studied postoperatively. We explored whether sentinel lymph node dissection adequately reflected axillary involvement (as revealed by the paraffin blocks) in patients with early-stage breast cancer; we sought to avoid axillary dissection.MethodsThe agreement/non-agreement rates between the results of axillary ultrasonography and biopsy, sentinel lymph node and axillary dissections, and frozen and paraffin block results, were retrospectively analyzed for 200 patients with early-stage breast cancer. The positive predictive values and accuracies were recorded in those who were positive on both ultrasonography and biopsy. The negative predictive values were calculated for doubly negative cases.ResultsThe frozen and paraffin block results disagreed in 19 (9.5 %) cases and agreed in 181 (90.5 %). The frozen block and dissection results differed in five of 38 patients who underwent axillary dissection (AD) (one patient did not undergo AD); the results were in agreement in 32. Of the 19 block-disagreement cases, 16 were in the non-neoadjuvant chemotherapy (NAC) group and three in the NAC treatment group. Clinically, the negative predictive values of the frozen and paraffin block data were 80 % in patients lacking axillary involvement.ConclusionParaffin block evaluations only (thus, without frozen block examinations) of early-stage breast cancer lymph nodes seem to be sufficient to guide treatment. Also, a thorough clinical examination (with ultrasonography and axillary biopsy) reduces the dissection rate and the associated functional impairments.     

乳腺癌前哨淋巴结活检术中保留肋间臂神经的可行性

目的:探讨乳腺癌前哨淋巴结活检术(sentinel lymph node biopsy,SLNB)中保留肋间臂神经(intercostobrachial nerve,ICBN)的可行性.方法:回顾性分析乳腺癌前哨淋巴结活检术患者184例,其中50例行保留ICBN的SLBN,134例行切除ICBN的SLBN.比较两组的手术时间、出血量、清扫淋巴结数目及术后切口合并症;记录SLNB后术侧上臂和腋窝疼痛及感觉异常情况及转归.结果:保留ICBN组与非保留组比较,手术时间、出血量、淋巴结清扫数目及术后切口合并症比较差异无统计学意义.保留组及非保留组术侧上臂、腋窝的疼痛及感觉情况发生率近3天差异无统计学意义.而腋窝及上臂内侧区皮肤感觉异常术后0.5~3个月比较差异有统计学意义,且术后3个月非保留组的患侧腋窝及上臂内侧区皮肤感觉异常的缓解率较差,差异有统计学意义.结论:乳腺癌SLNB中保留ICBN的术式不增加手术难度,可减少患者术后术侧腋窝及上臂疼痛、感觉异常的发生率,能保持患者术后高质量的生活,保留ICBN的乳腺癌SLNB是安全可行的.