两种切口对男性乳腺发育症手术满意度影响临床对照研究

目的探讨两种手术切口入路治疗男性乳腺发育症(GYN)的疗效分析。方法回顾性分析自2013年12月至2016年12月在包头市肿瘤医院乳腺科就诊的70例GYN患者的临床资料。根据切口入路不同分为双环切口组(n=35)和乳房下皱襞切口组(n=35),比较两组患者对术后乳房外形、切口瘢痕和乳头乳晕感觉的满意度。结果双环切口组患者对术后乳房外形的满意度优于乳房下皱襞切口组,差异有统计学意义(P<0.05);而两组患者切口瘢痕及乳头乳晕感觉方面比较,差异无统计学意义(P>0.05)。结论两种切口入路手术治疗GYN疗效确切,满意度均较高;与乳房下皱襞切口比较,患者对双环切口的术后乳房外形更满意。     

保留乳头乳癌改良根治术评价

目的评价保留乳头乳癌改良根治术应用于乳腺癌的术后美容效果和近期疗效。方法对符合入选条件的早期乳癌患者按乳房大小分为两组,组一施行保留乳头乳癌根治术或一期行扩大背阔肌带蒂肌瓣再造乳房,组二施行保留乳房手术 放疗,比较术后美容效果的优良率,随访复发转移情况。结果两组间患者年龄、病理性质、临床分期相似,术后优良率无统计学差异,无复发生存差别有统计学意义。结论体积小的乳房适合做保留乳头改良根治术,术后Ⅰ期行扩大背阔肌带蒂肌瓣再造乳房效果满意;体积较大的乳房适合于保留乳房手术。保留乳头改良根治术可作为ⅠⅡ期乳癌手术的可供选择的术式。     

保留皮肤的乳腺癌改良根治术Ⅰ期假体植入重建乳房的探讨

目的探讨保留皮肤的乳腺癌改良根治术Ⅰ期假体植入乳房重建的可行性。方法对15例Ⅰ、Ⅱ期乳腺癌患者行保留皮肤的乳腺癌改良根治术后,同期于胸大、小肌间植入硅胶假体重建乳房。结果保留乳头乳晕复合体5例,不保留乳头乳晕复合体10例,术后随访5~27个月,术后外观良好,双侧乳房对称,优良率达97%。所有病例均无局部复发或远处转移。结论保留皮肤的乳腺癌改良根治术后用硅胶假体行即刻乳房重建,具有操作方便、效果明显,是安全可行的手术方法。     

乳腺癌根治和乳房重建术体位摆放及护理

目的：探讨乳腺癌根治和乳房重建术体位摆放及术中护理问题。方法：2008-01~2009-12间,本院收治的45例乳腺癌根治和乳房重建的患者,术中均先平卧位做乳房根治术,然后侧卧位消毒铺巾,取背阔肌代皮瓣做乳房重建。结果：经根治术和重建术,结合术后保持引流导管畅通和供、受瓣区护理,再造乳房全部成活,供受区切口均Ⅰ期愈合。随访至今,再造乳房外观自然,重建的腋前皱襞与健侧基本对称,腋顶及腋前皱襞凹陷畸形基本纠正。结论：乳腺癌根治乳房重建术是修复根治术后较严重缺损的较好方法,正确摆放手术体位,能有效地预防并发症的发生。术中合理、妥善的护理能有效提高手术的成功率与再造乳房的成活率。     

自体脂肪注射隆乳术后常见并发症的处理

目的探讨自体脂肪注射隆乳术后常见并发症的处理方法。方法选择自体脂肪注射隆乳术后出现并发症的患者21例,其中16例患者采用乳晕、乳房下皱襞1-2cm小切口进行治疗,5例应用硅凝胶假体隆乳的同时对原乳房内脂肪液化、硬结及钙化予以清除。结果经过6个月至3年的随访,有4例患者仍有1～2个包块或硬结,其余无并发症出现,切口愈合良好,所有患者瘢痕均不明显。同时应用硅凝胶假体隆乳者未出现并发症。结论采用乳晕、乳房下皱襞小切口和应用硅凝胶假体隆乳的同时对自体脂肪注射隆乳术后常见并发症进行处理是可行的。     

额肌瓣悬吊术治疗儿童重度先天性上睑下垂30例临床研究

重度上睑下垂 ,以往的额肌悬吊术多采用中间联系物(阔筋膜、异体巩膜、丝线等 ) ,将额肌与睑板间接地联系起来 ,患者术后往往有不同程度的皱额、耸眉现象 ,久之上睑渐渐下移 ,需再次手术矫正 ,而且切口多、效果不确切、影响美观、术后反应重等缺点。额肌瓣悬吊术治疗上睑下垂是近几年发展起来的新术式。我院自 1 992年 1 0月～ 1 998年 1 0月对 30例重度先天性上睑下垂的儿童行额肌瓣悬吊术矫治上睑下垂 ,疗效满意 ,现报告如下。1　临床资料1 1　一般资料　本组 30例 38眼 ,男 1 8例 ,2 3眼 ;女 1 2例 ,1 5眼 ;眼别 :左眼 1 7例、右眼 2 1…     

少女乳房巨大肿瘤切除一期乳房成形5例

少女单侧乳房巨大肿瘤临床比较少见。现将笔者收治5例乳房巨大肿瘤行肿瘤切除的同时作保留乳头乳晕的一期乳房成形术,术后外观满意,随访无肿瘤复发。病例1女,11岁,因左乳包块半年快速增长8 d入院。患者半年前发现左乳房外上方有枣子大小的包块,无特殊不适。8 d前自感包块迅速增大伴胀痛,局部无明显的红、肿。入院后查体:左乳较右乳明显增大,为右乳体积的3倍多,乳头乳晕向内下偏移,乳头内陷,乳房皮下静脉扩张屈曲充盈。触诊乳房肿块界限尚清,约(15×15)cm,与基底无明显粘连,表面凹凸不平呈分叶状,无触痛及乳头溢液,腋窝淋巴结无肿大。彩超显…     

乳癌切除术后单蒂模行腹直肌肌皮瓣乳房再造术后护理

报告了解5例乳癌术后单蒂模行腹直肌肌皮瓣乳房再造术后护理,注意保持引流通畅,注意再造乳房皮肤保持适度、勿受压,注意皮肤血迹尤其要保护好单蒂模行腹直肌肌皮瓣勿受压,同时做好供瓣区护理、手术全部成功。1心理护理患者术后均不同程度担心肿癌是否切除彻底,再造乳房外观如何,肌瓣能否成活,手术创腔较大,创腔愈合较慢,引流管置时间长,拨管困难等,需耐心细致的与患者多交流,勤沟通针对每个患者的不同心理做好解释工作,取得家属积极配合。2引流管理术后在胸部、下腹部切口内置须压引流,术后需放置条引流管,因术后成污情况不能从外表观察到,…     

学龄前儿童重度上睑下垂额肌瓣悬吊手术18例

重度先天性上睑下垂是一种常见的儿童眼病,不但影响外观,还导致形觉剥夺性弱视,影响视功能,应尽早进行手术矫治。笔者于2007—08至2010—08共收治学龄前儿童重度上睑下垂18例23跟,均采用全麻下单切口额肌瓣悬吊术矫治,取得良好效果。     

额肌及筋膜悬吊加双重睑术治疗上睑下垂46例分析

上睑下垂是眼科常见病 ,其病情较复杂 ,手术方式也较多 ,而选择恰当的手术方式是治疗上睑下垂矫正成功的要点。传统手术方式 :方形吊线术疗效较差 ,且适于轻度上睑下垂。阔筋膜悬吊术因较麻烦 ,现逐渐被额肌瓣悬吊术所代替。我们自 2 0 0 1年初以来 ,采用其改良术式 :额肌及筋膜悬吊 +双重睑术治疗上睑下垂 4 6例 ,5 9眼 ,术后经随访观察 ,效果满意 ,现报告如下。1　临床资料1 1　一般资料　患者 4 6例 ,5 9眼 :男性 38例 4 8眼 ,女性 8例 11眼 ,年龄 6～ 4 6岁 ,上睑下垂均为先天性。其中单纯性上睑下垂 4 8眼 ,伴有其他先天性异常 (内斜、…     

Breast MRI findings after modified radical mastectomy and transverse rectus abdominis myocutaneous flap in patients with breast cancer

PURPOSE: To evaluate the MRI findings in breast cancer patients who had undergone a modified radical mastectomy (MRM) and a transverse rectus abdominis myocutaneous (TRAM) flap. MATERIALS AND METHODS: MRI was performed on 20 patients who had been diagnosed with breast cancer and had undergone an MRM and TRAM flap. The results were examined in terms of MRI's ability to detect the flap and assess possible postoperative changes and recurrence. In addition, MRI images of the opposite breast were analyzed. Follow-up examinations were carried out on 11 patients, and all changes were assessed. RESULTS: The flap was clearly visualized by MRI in all of the patients. The signal intensity of the flap was equivalent to that of fat. The contact zone between the TRAM flap and the mastectomy site was enhanced after contrast infusion. Postoperative changes, such as skin thickening (n=20), edema (n=2), fluid collection (n=3), hematoma (n=1), and fat necrosis (n=3), were detected. In two patients, artificially inserted fat tissue was identified. On the MRI of the opposite breast, enhancing lesions were detected in seven patients. In one patient with this finding, ductal carcinoma in situ was diagnosed. On the follow-up MRI, a decrease in skin thickening, fat necrosis, and hematoma was detected. CONCLUSION: MRI is an effective method for lesion detection and evaluation of postoperative changes after MRM and TRAM flap, as well as for evaluation of the opposite breast.     

乳腺Paget病X线病理对照研究

目的 :对照分析乳腺 Paget病术前 X线、标本 X线和病理所见。方法 :分析 11例病理证实的 Paget病。其中 8例 ,对手术切除的新鲜标本 ,经冷冻处理后 ,进行了切片和 X线摄影。由放射科和病理科医师共同检查分析每个有价值的部位。结果 :5例乳头扁平或缺损变形。 8例乳晕皮肤增厚 ,其中 6例并发乳晕后三角影。 5例出现肿块。 6例显示钙化。结论 :乳头乳晕的改变和可追踪到乳头的钙化是特征性 X线表现 ,X线检查对本病的诊断颇有价值     

Konturdefekte bei brusterhaltender Therapie des Mammakarzinoms Primäre und sekundäre Möglichkeiten der Korrektur

BACKGROUND: Breast conserving treatment is increasing for primary treatment of breast carcinoma because of the importance of the cosmetic outcome. PATIENTS AND METHOD: We examined 195 patients after breast conserving therapy which was performed between 1983 and 1992. For evaluation of the cosmetic result symmetry, contour of the breast and location of the areola were examined. Radiation effect on breast tissue was evaluated by the Lent score. 72% of the patients had been treated with quadrantectomy and 28% with lumpectomy. RESULTS: Deformities of the contour were visible in 59% of the patients depending on the primary location of the tumor. Lumpectomy from medial quadrants caused poor results. Dislocation of the areola of more than 2 cm was detected in 32% of the patients. The dislocation depended on the primary kind of incision and resulted in 89% of the patients after a radial incision and only in 11% after curvilinear incisions. Telangiectasias were absent in 84% of the patients, the others showed telangiectasias Grade 1 to 3. In 48% of the patients no signs of fibrosis could be detected, in 49% fibrosis Grade 1 to 2 was found. 68% of the patients estimated the cosmetic result as very good or good. Only 10% of the patients estimated the result as fair or bad. The examiner estimated the results as good or very good in 28%. Examples of operative procedures for primary and secondary correction are demonstrated. CONCLUSIONS: Our results showed an adverse effect of long radial incisions. For lumpectomy and axillary node dissection separate incisions should be used. Correction of contour deformities should be done primarily in breast conserving procedures. This is possible by using modified reduction mammaplasties, local flaps of the breast tissue or switching a latissimus dorsi muscle flap. For secondary correction of defects after breast conserving treatment a latissimus dorsi muscle can be used as well as z-plasty for scar contracture.     

肿胀麻醉下小切口皮下修剪配合开窗引流治疗腋臭临床效果

目的 探讨肿胀麻醉下小切口皮下修剪术治疗腋臭的疗效.方法 对52例腋臭患者采用肿胀麻醉下小切口皮下修剪术剪除部分真皮和脂肪组织,结合微小切口开窗引流加压包扎处理术后区域.结果 52例患者中痊愈50例(96.15％),显效2例(3.85％),没有出现皮下血肿、感染、皮瓣坏死的情况.结论 肿胀麻醉下小切口皮下修剪治疗腋臭疗效显著、方法简单、并发症少,值得推广应用.     

湿润烧伤膏预防乳腺癌术后皮瓣坏死122例临床分析

目的：评估湿润烧伤膏预防乳腺癌术后切口皮瓣坏死等并发症的疗效。方法：在122例乳腺癌病人中有64例病人术后立即在切口边缘应用涂有湿润烧伤膏（MEBO）的无菌纱布外敷,加压包扎;另有58例病人术后仅常规加压包扎治疗,对比观察住院期间手术切缘皮瓣缺血坏死及感染表现。结果：64例乳腺癌病人术后切口2例皮瓣坏死;常规处理病人有10例出现不同程度的皮瓣坏死。结论：在乳腺癌术后切口边缘应用MEBO,可有效预防术后皮瓣坏死等并发症。     

MEBO外用预防乳腺癌根治术皮瓣坏死的临床体会

目的：探讨预防乳腺癌根治手术皮瓣坏死的临床体会。方法：对我院接受乳腺癌根治手术的52例病人，在采用微创操作和Y型管负压引流的同时，创面外用湿润烧伤膏(MEBO)治疗。结果：无死亡病例，除2例病人因Y型管负压引流放置不准确，拔管时间早，有少量皮下积液外，其余病人均如期愈合出院，未发生皮瓣坏死，亦无皮肤创缘延迟愈合及创面溃疡病例的发生。结论：乳腺癌根治手术过程中病人采用微创操作和Y型管负压引流及联合MEBO创面外用，可有效预防皮瓣坏死，促进创面愈合。     

脓肿期浆细胞性乳腺炎的MRI表现及与手术对照研究

目的:探讨脓肿期浆细胞性乳腺炎的MRI表现及其在临床诊疗中的应用价值。方法:收集经手术病理证实为脓肿期浆细胞性乳腺炎患者30例,术前均行双乳MRI平扫及增强扫描,分析其MRI表现,并与手术结果进行对照。结果:30例均为单侧发病,其中左乳21例,右乳9例。MRI示2个(6.7%)患乳内病灶局限于乳晕周围、5个(16.7%)累及单个象限及乳晕区、17个(56.7%)累及多个象限及乳晕区、4个(13.3%)累及单个象限、2个(6.7%)累及多个象限,其中15个(50%)累及乳后间隙。23个(76.7%)患乳病灶呈非肿块样,7个(23.3%)呈肿块样。采用切开扩创术3例、切开扩创术+象限切除术21例、象限切除术6个,1例切开扩创术后效果欠佳再次行切开扩创术+象限切除术,1例切开扩创术+象限切除术后效果欠佳再次行象限切除术。结论:MRI能清晰显示脓肿期浆细胞性乳腺炎病变的位置、累及范围及深度、皮下及病灶间的瘘管,具有一定特征性,与手术所见具有较高的一致性,对临床手术方案的制订有重要参考作用。     

The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions

AIM: To determine the accuracy and therapeutic success of localisation of impalpable breast lesions by hookwire with additional lesion marking with carbon suspension to mark screen detected abnormalities requiring surgical excision. MATERIALS AND METHODS: Retrospective review of all breast localisation procedures performed in our unit on women with a screen detected abnormality requiring excision over a 7 year period. RESULTS: One hundred and thirty eight women underwent breast localisation procedures. All of the mammographic abnormalities were excised at the initial surgical procedure. The benign to malignant ratio was 1:2. Pre-operative cytology was used to guide the extent of surgical excision, with clear margins in 70 of the 92 patients (75 percent) with malignancy. Twenty patients had further surgery: mastectomy in 7 and further local excision in 14. The localisation procedure was a therapeutic success in the local excision of malignancy in 73 of the 92 patients (79 percent) with malignancy. CONCLUSION: This method of localisation biopsy is an accurate technique for surgical excision of mammographically detected impalpable abnormalities. The surgeon is able to choose the site of surgical incision to give the best cosmetic result, the lesion is easier to identify at operation and the confidence that the abnormality has been excised is improved.