乳腺癌和副乳手术肋间臂神经损伤的症状分析

目的探讨乳腺癌腋淋巴结清扫术和腋部副乳切除手术肋间臂神经损伤症状的差异及原因。方法 60例Ⅰ、Ⅱ、Ⅲa期乳腺癌患者按随机数字表分为2组,研究组27例行保留肋间臂神经腋淋巴结清扫术,对照组33例不保留肋间臂神经,术后2组均按乳腺癌指南治疗。另腋部副乳患者30例（腋部副乳组）行常规切除。3组均随访6个月。结果研究组和对照组术后发生上肢感觉异常分别为18.5%和60.6%（χ^2=10.823,P〈0.01）,疼痛发生率分别为7.4%和36.4%（χ^2=6.960,P〈0.01）,未发现局部复发。腋部副乳组发生上肢感觉异常和疼痛分别为86.7%和10.0%。结论在腋淋巴结清扫术中,保留肋间臂神经主干明显减少术后出现感觉异常、疼痛,且可恢复。腋部副乳切除术损伤的是肋间臂神经末梢分支,感觉异常、疼痛可恢复,误伤肋间臂神经主干则与腋淋巴结清扫术切除肋间臂神经的症状和转归相同。     

TENS and Pain Control after Coronary Artery Bypass Surgery

This paper describes a randomised controlled trial to evaluate the effectiveness of TENS in controlling pain following coronary artery bypass grafting (CABG). A total of 59 men undergoing CABG with internal mammary artery (IMA) at Bristol Royal Infirmary were randomly allocated to receive TENS or placebo in conjunction with patient-controlled analgesia (PCA) for one hour on their first postoperative day. A visual analogue pain score and the hourly usage of the PCA were recorded before, during and after the application of TENS or placebo. The results show that although pain scores were significantly reduced in the hour in which TENS was applied, there was no significant difference in this reduction between the TENS and placebo groups. PCA use by patients during the study period was limited, with the majority making none or one successful request per hour. The results imply that the observed reductions in pain were due to a placebo effect and that the use of TENS in conjunction with PCA following CABG with IMA is unlikely to confer a clinically important reduction in post-operative pain.     

乳腺癌保乳手术后局部复发因素的分析

目的:探讨乳腺癌患者行保乳手术治疗后局部复发的相关因素。方法:收集2002年3月—2010年3月行保乳手术治疗的356例乳腺癌患者的临床及随访资料,分析年龄、淋巴结转移、肿瘤直径、人表皮生长因子受体2(HER-2)、雌激素受体(ER)/孕激素受体(PR)与术后肿瘤局部复发的相关性。结果:356例患者的中位随访时间为53(9~120)个月;其中14例(4.3%)患者出现同侧乳房局部复发,16例(4.9%)出现远处转移;5年无远处转移生存率为95.4%,5年总体生存率为99.1%,5年无病生存率为82.3%;乳腺癌患者行保乳治疗手术后2~3年是肿瘤局部复发的高峰时期,单因素以及多因素分析发现,患者的年龄、淋巴结转移及HER-2是肿瘤局部复发的独立危险因素。结论:淋巴结转移以及HER-2与乳腺癌患者行保乳手术后的局部复发相关。     

Persistent Arm Pain Is Distinct From Persistent Breast Pain Following Breast Cancer Surgery

Persistent pain following breast cancer surgery is well documented. However, it is not well characterized in terms of the anatomic site affected (ie, breast, arm). In 2 separate growth mixture modeling analyses, we identified subgroups of women (N = 398) with distinct breast pain and arm pain trajectories. The fact that these latent classes differed by anatomic site, types of tissue affected, and neural innervation patterns suggests the need for separate evaluations of these distinct persistent pain conditions. The purposes of this companion study were to identify demographic and clinical characteristics that differed between the 2 arm pain classes and determine if differences existed over time in sensitivity in the upper inner arm and axillary lymph node dissection sites, pain qualities, pain interference, and hand and arm function, as well as to compare findings with persistent breast pain. Higher occurrence rates for depression and lymphedema were found in the moderate arm pain class. Regardless of pain group membership, sensory loss was observed in the upper inner arm and axillary lymph node dissection site. Arm pain was described similarly to neuropathic pain and interfered with daily functioning. Persistent arm pain was associated with sustained impairments in shoulder mobility.PerspectiveFor persistent breast and arm pain, changes in sensation following breast cancer surgery were notable. Persistent arm pain was associated with sustained interference with daily functioning and upper body mobility impairments. Long-term management of persistent pain following breast cancer surgery is warranted to improve the quality of survivorship for these women.     

早期乳腺癌患者行乳房保留手术的疗效分析

目的:探讨早期乳腺癌患者行乳房保留手术(保乳手术)的疗效及预后的相关因素。方法:回顾分析326例行保乳手术的早期女性乳腺癌患者(研究组)的临床资料,以同期行改良根治术或单纯乳房切除术的581例早期女性乳腺癌患者作为对照(对照组)。结果:研究组的3年和5年无病生存率(disease free survival,DFS)分别为92.7%和84.5%,对照组则分别为91.4%和85.3%。研究组的3年和5年总生存率(overall survival,OS)分别为98.2%和96.4%,对照组则分别为97.6%和95.3%。两组的DFS和OS均无统计学差异(P>0.05)。研究组中脉管无癌栓患者的3年和5年DFS分别为94.5%和92.1%,而脉管有癌栓患者的3年和5年DFS分别为90.2%和81.3%,两者的差异有统计学意义(P=0.007)。研究组患者中复发12例,其中>40岁的239例中复发5例,而≤40岁的87例中复发7例,两者的差异有统计学意义(P=0.032)。脉管无癌栓的278例患者中复发7例,脉管有癌栓的48例患者中复发5例,两者的差异有统计学意义(P=0.014)。保乳手术后的美容效果评价优良率为87.4%。结论:对于早期乳腺癌患者,行保乳手术与行传统的乳房切除手术的预后无显著差异,脉管癌栓与保乳手术的预后相关,年龄≤40岁的患者保乳术后局部复发率较高。     

经手术治疗原发性双侧乳腺癌的临床病理分析

目的探讨经手术治疗原发性双侧乳腺癌（bilateral breast cancer,BBC）的临床病理特点,探寻其潜在的危险因素。方法回顾性分析2004年6月至2013年5月之间在湖南省湘潭市第一人民医院和湘潭市中心医院确诊并进行手术治疗的0~Ⅲa期108例 BBC患者的临床及病理资料。同时期的2575例0~ⅢA期原发性单侧乳腺癌（unilateral primary breast cancer,UBC）患者将作为对照组。结果108例0~Ⅲa期BBC中,同时性双侧乳腺癌（synchronous bilateral breast cancer,SBBC）43例,占同期全部0~Ⅲa乳腺癌的1.6%（43/2683）。多因素回归分析发现,在 BBC 中年龄、家族史、小叶癌成分以及硬化性腺病的存在是SBBC的独立危险因素。双侧乳房全切手术是BBC患者最常见的手术治疗方式。结论对原发性 SBBC 而言,无论是临床还是病理方面,目前都无法给出明确的诊断标准,对于原发性 SBBC的诊断仍需要在临床以及影像学诊断的基础上,结合病理学检测结果。具有高危因素的患者,双侧乳房需要细致的临床及影像学检查,以及密切的常规随访。     

乳腺癌术后接受内分泌治疗的患者发生子宫内膜癌的危险因素分析

[目的]探讨乳腺癌术后接受内分泌治疗的患者发生子宫内膜癌的危险因素.[方法]回顾性分析2015年1月至2020年3月本院收治的288例乳腺癌术后接受内分泌治疗出现子宫内膜病变的患者临床资料,根据不同病变类型将其分为子宫内膜息肉组(n=209)、子宫内膜增生组(n=47)、子宫内膜癌组(n=32).收集患者的临床资料,回...     

Patient-Reported Pain in Patients with Breast Cancer Who Receive Radiotherapy

BackgroundPatients who receive radiation treatment (RT) for breast cancer often report pain, which contributes negatively to quality of life (QoL).AimsTo identify demographic, treatment, and disease characteristics associated with pain and changes in pain before and after RT using the Edmonton Symptom Assessment Scale (ESAS).DesignRetrospective study.SettingsOdette Cancer Centre.ParticipantsPatients diagnosed with nonmetastatic breast cancer from January 2011-June 2017 with at least one ESAS completed pre-RT and one completed post-RT.MethodsData on systemic treatment, radiation, patient demographics, and disease stage were extracted. To identify factors associated with pain before and after RT and changes in pain, univariate and multivariate general linear regression analysis were conducted. p < .05 was considered statistically significant.ResultsThis study included 1,222 female patients with a mean age of 59 years. ESAS was completed an average of 28 days before RT (baseline) and 142 days after RT, respectively. In multivariable analysis, higher baseline pain scores were associated with having recently completed adjuvant chemotherapy (p = .002) and eventual receipt of locoregional (p = .026) or chest wall (p = .003) radiation. Adjuvant chemotherapy (p = .002) and chest wall radiation (p = .03), were associated with a significant reduction in pain score after radiotherapy, while locoregional RT was associated with a higher pain score after RT (p < .001).ConclusionsPatients with locoregional RT had higher baseline pain that remained elevated after RT completion and should be screened for pain and provided with pain management and support when necessary.     

The Relationship of Age and Postoperative Pain in Women after Surgery for Breast Cancer

Background: In the past, elderly women with breast cancer were not offered surgery because of beliefs that they would experience serious complications from comorbidities and increased chronological age. Today the decision to offer surgery is based on a woman's fitness rather than her age. Objective: The purpose of this study is to compare the experience of postoperative nausea and vomiting (PONV), anxiety, and reported pain levels in women who represent four different age groups after breast cancer surgery. This study employed a prospective comparative design. A large women's hospital which houses a Comprehensive Breast Care Program. Women diagnosed with early stage breast cancer and scheduled for surgical resection. Methods: Postoperative pain was measured in the postanesthesia care unit using an 11-point verbal pain scale, PONV was measured categorically, and if present, severity of nausea was assessed. Anxiety was measured preoperatively by the short-form Profile of Mood States. Findings: A total of 97 women aged 37-78 participated in this study. Overall, 35% of all women experienced PONV; only two women (18%) in the highest age range (70-79) experienced PONV, yet they reported significantly more pain than women in the other age groups. Understanding the difference in postoperative symptoms experienced by older woman after surgery for breast cancer will support the development of age-specific strategies.     

早期乳腺癌保乳术中电子线照射的初步探讨

目的探讨早期乳腺癌保乳术中电子线放射治疗（intraoperative radiotherapy with electron,ELIOT）的可行性,评价术后并发症和术后乳房外观。方法2007年6月-2009年6月期间,共有26例早期乳腺癌（肿瘤直径不超过2.5cm）患者接受乳腺癌保乳手术及ELIOT,放疗剂量为21Gy（分割照射58~60Gy）。术后1年内第1、2、3个月,第6、9、12个月,1年后每6个月评估一次,主要评估切口愈合状况、并发症、乳房外观及肿瘤复发情况。结果术后切口愈合时间14~22d,平均17d。随访2~25个月,平均12个月,有2例切口脂肪液化,11例切口水肿伴引流液较多,全组无切口感染或血肿。随访期间内,未发现局部复发、远处转移或对侧乳腺癌。手术切口愈合后、术后6个月,1、2年对乳房外观评价结果：优秀者分别依次为57.7%、66.7%、72.7%及100%;好者分别依次为34.6%、22.2%、18.2%及0;一般者分别依次为7.7%、11.1%、9.1%及0。结论乳腺癌保乳术后行ELIOT疗效确切、安全,对早期乳腺癌患者是一种方法简便,疗效确切、安全的选择。     

Effect of TENS on Postoperative Pain and Pulmonary Function in Patients Undergoing Coronary Artery Bypass Surgery

Background: The aim of this study was to determine the effect of electrical nerve stimulation on pain intensity and pulmonary function in patients undergoing coronary artery bypass surgery. Materials and Methods: In a randomized clinical trial, a total of 100 patients undergoing coronary artery bypass surgery at Masih Daneshvari Hospital, Tehran, Iran, from February to May 2014, were divided into two groups. In the intervention group (n = 50), patients received routine care along with transcutaneous electrical nerve stimulation (TENS) immediately after admission to the intensive care unit (ICU). In the placebo group (n = 50), patients only received routine care. The pain intensity was measured using a visual analog scale (VAS) every 6 hours for 72 hours after surgery in two conditions of rest and coughing. Pulmonary function was assessed through forced expiratory volume in 1 second (FEV1) and forced volume capacity (FVC) at 24, 48, and 72 hours after surgery. Age, gender, body mass index, narcotic consumption, ICU length of stay, and requests for chest radiographs were recorded. The statistical level of significance was set at p < .05. Results: There were no significant differences between the two groups in terms of age, gender, and body mass index (p > .05). Pain intensity was significantly lower in the TENS group than the placebo group in both resting and coughing condition (p < .05). FVC and FEV1 were significantly better and faster in the TENS group than in the placebo group at 24, 48, and 72 hours after surgery (p < .05). Patients in the TENS group had significantly lower narcotic use and requests for chest radiographs compared with placebo group. Conclusions: TENS may reduce postoperative pain in resting and coughing conditions, improve pulmonary function, and reduce narcotic use in patients undergoing coronary artery bypass surgery.     

影响乳腺癌保乳术后乳房外形的因素分析

目的：分析影响乳腺癌保乳术后乳房美容效果的因素，减少乳腺癌综合保乳治疗后乳房外形的不利影响。方法：回顾近10年 来116例女性乳腺癌保乳手术治疗患者的临床资料，对手术切口、切除范围、创腔处理、术后放疗及患者自身等诸多因素与术后乳房 外形的关系加以分析。结果：本组患者112例得到随访，失访4例，随访率96． 55%；随访时间1～84个月，中位随访时间49个月。按 照国家“十五”攻关课题“早期乳腺癌规范化保乳综合治疗的临床研究”采用的乳房美容评定标准进行评价，112例中符合优良标准的 有99例，占88． 3%；不满意者13例，占11． 7%。结论：将肿瘤切除和腋窝清扫分别做切口的乳房美容效果优于作1切口，肿瘤切除时 要保证切缘阴性，过大范围的乳腺切除不仅影响术后美观，也无助于提高疗效；强行拉拢缝合创腔内腺体会明显影响乳房外形及乳头 位置；过大剂量的全乳照射也会影响乳房美容。     

乳腺癌术后皮下积液50例临床分析

收集我院2008年1月～2009年12月间收治的乳腺癌术后皮下积液患者50例的临床资料,进行分析比较。结果50例乳腺癌术后皮下积液患者经引流等处理后痊愈。术后引流可有效降低乳腺癌术后皮下积液的发生率。     

Identification of Patient Subgroups and Risk Factors for Persistent Breast Pain Following Breast Cancer Surgery

Study purposes were to determine the prevalence of persistent pain in the breast; characterize distinct persistent pain classes using growth mixture modeling; and evaluate for differences among these pain classes in demographic, preoperative, intraoperative, and postoperative characteristics. In addition, differences in the severity of common symptoms and quality of life outcomes measured prior to surgery, among the pain classes, were evaluated. Patients (n = 398) were recruited prior to surgery and followed for 6 months. Using growth mixture modeling, patients were classified into no (31.7%), mild (43.4%), moderate (13.3%), and severe (11.6%) pain groups based on ratings of worst breast pain. Differences in a number of demographic, preoperative, intraoperative, and postoperative characteristics differentiated among the pain classes. In addition, patients in the moderate and severe pain classes reported higher preoperative levels of depression, anxiety, and sleep disturbance than the no pain class. Findings suggest that approximately 25% of women experience significant and persistent levels of breast pain in the first 6 months following breast cancer surgery.     

Associations Between Catecholaminergic and Serotonergic Genes and Persistent Breast Pain Phenotypes After Breast Cancer Surgery

Genetic variations in the catecholaminergic and serotonergic pathways may contribute to the development and severity of persistent breast pain. However, investigations of these associations are limited. The purpose of this study was to evaluate for associations between breast pain phenotypes and single nucleotide polymorphisms among 15 genes involved in catecholaminergic and serotonergic neurotransmission. Women rated the presence and intensity of breast pain monthly for 6 months after breast cancer surgery. Distinct latent classes of patients were identified using growth mixture modeling. Logistic regression analyses identified significant differences between genotype or haplotype frequencies and the breast pain classes (ie, no breast pain [n?=?96] vs mild breast pain [n?=?141], moderate breast pain [n?=?46], and severe breast pain [n?=?27]). Polymorphisms in 5 genes were associated with membership in the mild pain class: ** beta-2-adrenergic receptor (ADRB2) rs2400707, beta adrenergic receptor kinase 2 (ADRBK2) HapA04, 5-hydroxytryptamine receptor 3A (HTR3A) rs10160548, solute-like carrier (SLC) family 6 member 2–noradrenaline transporter (SLC6A2) rs1566652, and tryptophan hydroxylase 2 (TPH2) rs11179000. Polymorphisms in 3 genes were associated with membership in the moderate pain class: 5-hydroxytryptamine receptor 2A (HTR2A) rs2296972, SLC6A2 rs17841327, and SLC6A3 rs403636. Polymorphisms in 3 genes were associated with membership in the severe pain class: COMT HPS haplotype, SLC family 6 member 2–noradrenaline transporter (SLC6A2) HapD01, and SLC family 6 member 3–noradrenaline transporter (SLC6A3) rs464049. The identification of these associations suggest possible underlying mechanisms that play a role in the development and severity of persistent breast pain.

A Systematic Review of Phantom Breast Pain/Sensation in Breast Cancer Patients Postmastectomy

ObjectiveTo identify the prevalence/incidence of, associations with, and treatments for phantom breast pain/sensation in breast cancer patients after mastectomy as reported in the literature within the past decade.Data SourcesPubMed, CINAHL, Embase, and Scopus databases.Study SelectionEligible articles met the following criteria: (a) English language full-text article, (b) published in the past 10 years (2012–2022), (c) peer-reviewed quantitative and qualitative study designs, and (d) specifically assessed for the presence of or factors related to phantom breast pain/sensation in the context of breast cancer treatment in humans. Eighteen studies were found to be eligible.Data ExtractionData extracted included citation; study country of origin; study design; study focus; number of participants; age range and mean age of participants; percentage of participants who reported phantom breast pain/sensation; and other findings about phantom breast pain/sensation, including relevant effect sizes. Gender identity, racial and ethnic identity, and sexual orientation were also noted.Data SynthesisThe following were obtained from the data: (a) phantom breast pain/sensation has been investigated in numerous countries worldwide in the past decade; (b) most studies lacked information on certain identity characteristics (e.g., race and ethnicity); (c) diversity of methodology and quality and risk of bias varied among the studies; (d) prevalence/incidence rates vary among studies and over time, but the more recent literature suggests that rates of the phenomenon are 0% to 19% in women; (e) a number of significant associations have been identified with the experience of the phenomenon; (f) most women have reported that pain or discomfort with the phenomenon are minimal; and (g) there has been limited research on potential treatment options.ConclusionThe recent literature suggests that a small percentage of individuals postmastectomy may experience phantom breast pain/sensation. This condition can be bothersome to some patients, and further research is necessary.     

乳腺癌患者术后自我管理知识和行为的调查

目的了解乳腺癌患者手术后自我管理知识和行为的现状及其影响因素。方法方便性抽样选择2010年11月至2011年5月在温州医学院附属第一医院肿瘤外科、温州医学院附属第二医院乳腺外科进行门诊随访和住院化疗的乳腺癌患者80例,采用自行设计的自我管理知识和行为问卷测量其自我管理知识和行为状况。结果 80例乳腺癌患者自我管理知识平均得分为(4.65±2.90)分,行为得分为(20.06±5.84)分;多元线性回归分析结果显示:文化程度、是否保乳术和年龄是影响自我管理知识的主要因素,文化程度和是否保乳术是影响自我管理行为的主要因素;自我管理知识和行为之间有明显的正相关性(r=0.893)。结论乳腺癌患者自我管理知识处于较低水平、自我管理行为处于中等水平,临床工作者可以通过加强患者的健康教育提高患者的知识水平和自我管理能力。