全乳晕入路腔镜下甲状腺手术

目的探讨乳晕切口入路腔镜下甲状腺手术的美容效果。方法切口位置均在乳晕边缘,右乳晕3点处切口长12 mm置30°腔镜、9点处切口长7 mm置抓钳,左乳晕11点处切口长12 mm置超声刀,皮下分离制造操作空间,根据病变情况行甲状腺部分切除或大部分切除。结果10例均手术成功,手术时间110~230 m in,平均140 m in。出血量3~15m l,平均9 m l。术后无严重并发症。10例随访3~5个月,平均3.5月,切口瘢痕不明显,无复发病例。结论全乳晕入路腔镜下甲状腺手术安全、可行,美容效果好。     

Negative pressure fixation device to reduce motion artifacts on contrast‐enhanced MRI of the breast: A clinical feasibility study

Purpose

To investigate the effect of a negative pressure fixation device on misregistration artifacts in contrast‐enhanced (CE) MR subtraction images.

Materials and Methods

Nine patients, two of which had been previously diagnosed with breast cancer, were examined with T2‐weighted (T2‐w) turbo spin‐echo (TSE) and three‐dimensional (3D) spoiled gradient‐recalled echo (SPGR) CE dynamic MRI. Baselines images were subtracted from the dynamic images. A device consisting of two stiff plastic domes was placed on the breasts of each patient. Negative pressure of 27 to 37 mmHg within the domes was maintained. The patient was positioned prone in the coil without the device and imaged as a baseline. Subsequently, the patient was placed into the negative pressure domes and reimaged. One of the nine patients was also imaged supine to establish feasibility for this positioning.

Results

With the use of the negative pressure fixation device, a reduction in misregistration artifact has been demonstrated in prone imaging. Patients reported improved comfort with the device and feasibility has been shown for supine imaging.

Conclusion

The device was shown to be MRI‐compatible and successfully applied in this pilot study, opening other avenues of exploration. Supine positioning for breast imaging makes possible better access for biopsy and intervention. Further modifications to the device are in order for this purpose and to eliminate motion due to breathing in the prone position. J. Magn. Reson. Imaging 2009;30:430–436. © 2009 Wiley‐Liss, Inc.     

双侧巨大型乳头乳晕角化过度症

报告1例双侧巨大型乳头乳晕角化过度症。患者女，24岁。乳晕褐色斑10年，加重半年。患者自幼左侧乳头看不见。体格检查：双侧乳晕粗糙、增厚，呈乳头瘤样增生，右侧尤为明显。组织病理检查示表皮乳头瘤样增生，皮突延长并融合。诊断：乳头乳晕角化过度症。     

保留乳头乳晕复合体的乳腺癌改良根治术预后的相关因素分析

目的探究影响保留乳头乳晕复合体(NAC)的乳腺癌改良根治术(NSM)预后的相关因素。 方法回顾性分析2011年1月至2014年12月84例早期原发性乳腺癌并接受NAC的NSM患者临床病理资料。使用统计软件SPSS 20.0进行数据分析,采用K-M生存曲线评估术后无病生存(DFS)及总生存(OS),采用单因素分析和Cox多因素分析影响NSM术后患者DFS和OPS的影响因素。P<0.05差异有统计学意义。 结果术后局部复发8例,远处转移6例,术后5年DFS为83.3%,OS为91.7%。多因素分析显示,肿瘤最大径、肿瘤距乳头乳晕距离(TND)、腋窝淋巴结状态、组织学类型及Her-2阳性是影响DFS的独立危险因素(P<0.05);而腋窝淋巴结状态是影响术后OS的独立危险因素(P<0.05)。 结论肿瘤最大径、TND、腋窝淋巴结状态、组织学类型及Her-2阳性是DFS的独立危险因素,腋窝淋巴结状态是OS的独立危险因素;腋窝淋巴结情况同时影响患者术后DFS和OS,术前系统、精准地评估并妥善处理特殊腋窝淋巴结可提高乳腺癌患者预后。     

A new oncoplastic technique with immediate nipple reconstruction for central breast tumors using Würinger's septum-based flap

IntroductionCentrally located breast tumors represent a challenge for both oncological and reconstructive surgeons, mainly due to the necessity of nipple-areola complex (NAC) removal. We describe an original oncoplastic solution utilizing a displacement flap technique with immediate nipple reconstruction.MethodsSince 2008, we developed an oncoplastic technique using a septum-based island flap for the reconstruction of central breast defects, including the NAC. This technique is based on the Würinger's septum which is centered around the intercostal perforators. A retrospective study was performed collecting data on patient characteristics, oncological features, and outcomes. Patient satisfaction was reported using a Likert scale.ResultsReconstruction was successfully realized in 15 patients (14 immediate and one delayed post-lumpectomy correction). In immediate surgery, the excision margins were all free of tumor. Minor complications occurred in three patients; one small area of skin necrosis was managed by secondary intention, and two cases of partial nipple necrosis were treated by debridement under local anesthesia. Contralateral symmetrization surgery was performed on nine patients. Patient satisfaction scored high.ConclusionIn comparison with the previous oncoplastic techniques used for reconstructing central defects, the septum-based island flap has increased flexibility, provides better projection, and can be combined with immediate NAC reconstruction.     

完全乳晕入路腔镜甲状腺切除术隧道出血的分析与处理

目的探讨完全乳晕入路腔镜甲状腺切除术隧道出血的部位及处理方法。方法回顾分析2005年6月~2014年3月行完全乳晕入路腔镜甲状腺切除术1080例中发生的由穿刺套管在穿刺过程中致皮下穿刺隧道活动性出血的37例临床资料,包括出血隧道、出血部位、手术时间、术中出血量、术后引流量、术后住院时间、术后并发症。结果隧道出血发生率3.4%(37/1080),其中观察隧道出血发生率2.7%(29/1080),明显高于主操作隧道0.2%(2/1080)及辅操作隧道0.6%(6/1080)(χ2=34.830,P=0.000)。中段出血发生率2.9%(31/1080),明显高于外口0.5%(5/1080)及内口0.1%(1/1080)(χ2=43.524,P=0.000)。37例均术中成功处理隧道出血,无术后再出血。手术时间(112.6±17.5)min,术中出血量(22.5±9.6)ml,术后2天引流量(91.2±17.9)ml,术后住院时间(3.8±1.5)d。3例术后局部皮肤瘀斑、1例皮下积液,对症治疗治愈。结论出血多发生于观察隧道及隧道中段。隧道外口出血采用超声刀凝血,隧道中段及内口出血采用经皮缝扎压迫止血,效果良好。     

全乳晕入路与胸乳入路腔镜双侧甲状腺手术的临床对比研究

目的对比探讨全乳晕入路与胸乳入路腔镜双侧甲状腺手术的临床疗效。方法将2010年3月至2012年8月入住成都市第五人民医院的120例双侧甲状腺良性病变患者随机均分为对照组与观察组,对照组（n=60）行胸乳入路腔镜双侧甲状腺术,观察组（n=60）则采用全乳晕入路。对比两组患者的临床指标、临床疗效、术后生活质量及并发症发生率。结果 （1）观察组患者的切口长度、失血量、手术时间、住院时间等均优于对照组（P〈0.05）;（2）对照组治疗总有效率（83.3%,50/60）明显低于观察组治疗总有效率（96.7%,58/60）（P〈0.05）;（3）根据生活质量评估标准,对照组患者治疗后的生活质量得分为（102±7）分,低于观察组患者[（131±8）分,P〈0.05];（4）术后并发症为短暂性声音嘶哑、皮下气肿、尿失禁及胸前壁局部麻木,观察组敋中术后并发症发生率低于对照组（P〈0.05）。结论运用全乳晕入路行腔镜双侧甲状腺手术,其临床效果尤佳,可有效改善患者的临床指标,提高患者生活质量,值得在临床推广应用。     

Modified Pitanguy Technique for Intraoperative Symmetrical Localization of Nipple–Areola Complex

A symmetrical result at the end of a breast reduction is important for patient satisfaction. It can be made challenging by existing asymmetries in the patient’s body. Preoperative markings serve only as a guideline to the final shape, which is best decided on the table. We describe a simple and objective peroperative technique to visualize the symmetry of any landmark both horizontally and vertically. This helps locate the final position of, for example, the nipple, and assess symmetry toward the end of the operation and it does not leave any needle marks on the patient.     

Nipple-Sparing Mastectomy: Initial Experience at the Memorial Sloan-Kettering Cancer Center and a Comprehensive Review of Literature

Abstract: Success achieved with skin‐sparing mastectomy has led surgeons to reconsider the necessity of nipple–areola complex removal. This study reports our short‐ and mid‐term postoperative outcomes with nipple‐sparing mastectomy (NSM) and an updated review of reported literature. Data were retrospectively abstracted from medical records at our institution. Patients underwent NSM based on patient preference, oncologic criteria, and cosmesis. A literature review was undertaken through a PUBMED search and selected based on title and abstract relevance. Twenty‐five patients underwent 42 NSMs at our institution from July 2000 to October 2005. Patient mean age was 44 years (29–59 years). Indications for mastectomy were: 34 (81%) for prophylaxis, 5 (12%) for invasive ductal carcinoma, 2 (5%) for ductal carcinoma in situ, and 1 (2%) for a malignant phyllodes tumor. One prophylactic mastectomy specimen showed ductal carcinoma in situ in the retroareolar tissue, and the nipple–areola complex was removed at a second operation. Mean tumor size in cases with invasive carcinoma (n = 5) was 1.9 cm (0.7–2.5 cm). All tumors were peripherally located, and no cases showed occult nipple involvement. The nipple–areola complex was entirely preserved in 39 (93%) mastectomies. One nipple–areola complex was surgically removed, and two (5%) cases had partial loss due to infection or ischemia. Cosmetic result from surgeon’s assessment was excellent in 30 mastectomies, good in 7, acceptable in 3, and poor in 2, with slight nipple asymmetry in 8 cases. At a median follow‐up of 10.5 months (range, 0.4–56.4 months), the 39 nipple–areola complexes were intact and there were no local or systemic recurrences in cases treated for cancer. NSM represented approximately 1% of all mastectomies performed at our institution during the reported period. It was mostly used for prophylaxis and for the treatment of malignant tumors in few selected cases. NSM can be performed with a high success rate of nipple–areola complex preservation. Conclusions about the oncologic safety of this procedure cannot be drawn from our study due to small size series and short follow‐up. However, available published data show that NSM can be safely performed for breast cancer treatment in carefully selected cases. Further studies and longer follow‐up are necessary to refine selection criteria for NSM .