【摘要】 目的 比较在乳腺癌Auchincloss改良根治术中使用超声刀及电刀手术的优、缺点。 方法 2009年6月－2010年7月将176例乳腺癌患者通过信封法随机分为超声刀组和电刀组，每组88例，分别比较两组患者手术时间、术中出血量、淋巴结检出数目、术后引流量、皮下积液及术后出血量的差异。 结果 手术时间:超声刀组为（145.72±50.76） min，电刀组为（171.27±66.68） min，两组差异有统计学意义（P=0.005）；术中出血量:超声刀组为（71.56±31.34） mL，电刀组为（84.99±36.39） mL，两组差异有统计学意义（P=0.009）；清扫出的淋巴结个数:超声刀组为（20.92±9.09）个，电刀组为（17.90±6.74）个，两组差异有统计学意义（P=0.013）。而在术后平均引流量和术后积液例数方面两组的差异无统计学意义（Pgt;0.05）。两组均无术后出血的情况。 结论 在乳腺癌Auchincloss改良根治术中使用超声刀，较单独使用电刀能缩短手术时间，减少出血量，并增加淋巴结检出的数量。【Abstract】 Objective To compare the disadvantages and advantages between modified radical mastectomy with harmonic scalpel (HS) and conventional electro-scalpel (ES) for patients with breast cancer. Methods Between June 2009 and July 2010, 176 patients with breast cancer were randomly divided into two groups including the HS group and the ES group. The operation time, intra-operative bleeding volume, the number of lymph nodes detected, postoperative drainage volume, subcutaneous hydrops, and postoperative hemorrhage volume between the two groups of patients were compared. Results There were significant differences between the HS and ES groups in terms of operation time [(145.72±50.76) minutes vs. (171.27±66.68) minutes, P=0.005], intra-operative bleeding volume [(71.56±31.34) mL vs. (84.99±36.39) mL, P=0.009], and number of lymph nodes detected (20.92±9.09 vs. 17.90±6.74, Plt;0.05). The postoperative drainage volume and subcutaneous hydrops were not significantly different between the two groups (Pgt;0.05). No postoperative hemorrhage occurred in both groups. Conclusion Compared with ES, the use of HS can reduce operation time and intra-operative bleeding volume, and increase the number of lymph nodes detected during modified radical mastectomy.
目的 探讨乳腺癌改良根治术后影响局部复发与远处转移的相关因素。方法 对陕西省汉中市铁路中心医院略阳医院2000年3月至2007年3月期间行乳腺癌改良根治术且资料完整的637例原发性乳腺癌患者的临床资料进行回顾性分析。结果 66例（10.36%）患者术后发生局部复发和远处转移，其中局部复发50例（7.85%），远处转移16例（2.51%）；术后3～4年内发生复发与远处转移者47例（71.21%）。术后复发和远处转移与患者年龄、肿瘤大小、腋窝淋巴结转移情况、TNM分期、激素受体（ER/PR）表达情况及术后是否接受正规的辅助治疗有关，与患者有无家族史无关。结论 肿瘤大小、腋窝淋巴结转移情况、TNM分期、ER/PR表达情况及术后是否接受正规的辅助治疗是影响乳腺癌改良根治术后复发与远处转移的危险因素，重视乳腺癌术后随访，规范乳腺癌的手术方式，强化乳腺癌的综合治疗是降低乳腺癌改良根治术后复发与远处转移率的主要措施。
ObjectiveTo investigate the clinical application value of immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy for patients with breast cancer. MethodsA total of 28 patients with breast cancer undergoing immediate breast reconstruction using silicon implant after skin-sparing modified radical mastectomy from January 2006 to December 2009 were included in this study. The perioperative results, breast appearance evaluation and followup results were analyzed. ResultsAll 28 patients received axillary lymph node dissection and the number of lymph node dissected was 14-32 (median 21). The operation time was 117-140 min (mean 126 min), blood loss was 82-124 ml (mean 98 ml), and the time to drainage tube removal was 3-5 d. No wound infection, skin necrosis, and foreign body reaction occurred in all the patients, especially in 22 patients underwent nippleareola complex-sparing mastectomy, no ischemia or necrosis occurred in nippleareola complex. For evaluation of breast appearance, excellent was in ten cases and good in 18 cases, thus, the excellent and good rate was 100%. All patients were followed up for 12-48 months (median 24 months) after operation, and distant metastasis, local recurrence, upper extremity edema, and dysfunction were not found. No fiber kystis contracture was found and all patients were satisfied with breast appearance and good handfeels. ConclusionsImmediate breast reconstruction using silicon implant after skinsparing modified radical mastectomy has the advantage of minimal invasion, safety, simple operation, and quick postoperative recovery for patients with breast cancer and the appearance of reconstructed breast is excellent, which can be clinically used widely.
Objective To evaluate the value of extended latissimus dorsi flap (ELDF) in immediate breast reconstruction in patients with breast cancer after modified radical mastectomy. Methods Thirty-six patients with breast cancer who accepted modified radical mastectomy and 12 patients with breast cancer who accepted immediate breast reconstruction after modified radical mastectomy from January 2008 to June 2009 were included. The complications, cosmetical results and quality of life of these patients were compared. The shape of breast reconstruction was also evaluated. Results All of 12 patients succeeded in proceeding immediate breast reconstruction with ELDF. The evaluation of shape of breast reconstruction was good in 6 cases, secondary in 4 cases, and bad in 2 cases, which was beyond that in patients of radical operation group (Plt;0.001). There was no statistical difference in operation complications as hydrops, necrosis, affecting limb shoulder joint motion, drainage time, hospital stay, and starting time for adjuvant therapy between two groups (Pgt;0.05). The patients in breast reconstruction group had a better quality of life compared with the patients in radical operation group (Plt;0.001). In breast reconstruction group, 10 patients received adjuvant chemoradiotherapy and no necrosis was showed in local flap grafting. After the follow-up of 2-17 months (median 8 months), no local recurrence and metastasis was demonstrated in two groups patients. Conclusions There are good cosmetic results after immediate breast reconstruction with ELDF, and it is easy to operate. It is a safe and feasible therapeutics method for early breast cancer.
【摘要】目的探讨乳腺癌根治术式改良的方法及其在减少术后早期并发症中的意义。方法398例乳腺癌患者，行乳腺癌根治术22例，Patey氏手术83例，Anchincloss手术247例，改良Anchincloss手术46例。比较不同术式术后早期并发症发生情况。结果乳腺癌根治术术后的早期并发症发生率明显高于其它术式（Plt;0.01）； Patey氏手术与Anchincloss手术相比，皮下积液、皮瓣坏死的发生率差异无显著性意义（Pgt;0.05），但患侧上肢水肿的发生率前者高于后者（Plt;0.01）； 改良Anchincloss手术的并发症发生率明显低于前3种术式（Plt;0.01），且其手术时间比其它术式平均缩短20 min。结论改良Anchincloss手术能明显减少术后早期并发症发生率并缩短手术时间。
ObjectiveTo compare the differences in preventing subcutaneous effusion, skin flap necrosis, and patient comfort between simple negative pressure drainage and negative pressure drainage combined with chest compression bandaging after radical mastectomy for breast cancer. MethodsOne hundred and ninety-six patients underwent radical mastectomy for breast cancer from January 2010 to December 2012 in this hospital were collected.The simple negative pressure drainage (SNPD group, n=84) and negative pressure drainage combined with chest compression bandaging (NPD+CB group, n=112) after radical mastectomy for breast cancer were used to prevent postoperative subcutaneous effusion.The postoperative complications, postoperative 3 d drainage volume, and patient comfort were compared in two groups. ResultsOne hundred and ninety-six patients with breast cancer were females.The differences of general clinical data were not statistically significant in two groups (P > 0.05).The differences of chest wall mean extubation time, axillary mean extubation time, postoperative 3 d mean drainage volume, and incidences of subcutaneous effusion and skin flap necrosis were not statistically significant in two groups (P > 0.05).The rate of comfort satisfactory in the SNPD group was significantly higher than that in the NPD+CB group [76.2%(16/84) versus 22.3%(25/112), P < 0.001].The chemotherapy was not affected after operation in two groups. ConclusionsComparing with negative pressure drainage combined with chest compression bandaging, simple negative pressure drainage do not increase postoperative subcutaneous effusion and skin flap necrosis, but it greatly improves the patients satisfactory rate.
ObjectiveTo explore the clinical efficacy of immediate breast reconstruction with extended latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy for patients with early-middle breast cancer. MethodsSixty patients diagnosed with early-middle breast cancer by needle biopsy from November 2009 to October 2012 in this hospital were divided into two groups according to the surgical method.The breast reconstruction group (30 cases) were performed immediate breast reconstruction with extended latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy, the control group (30 cases) were performed traditional modified radical mastectomy.The postoperative complications, clinical efficacy, quality of life, and recurrence and metastasis were compared in two groups. Results①The ipsilateral breast was completely missing in the control group.The aesthetic effect in the breast reconstruction group was satisfactory including excellent in 22 patients, good in 7 patients, general in 1 patient.②The rates of flaps effusion, flap necrosis, and affectied limb activity limitation had no significant differences in two groups (P > 0.05).The wound healing time, operation area drainage time, hospital stay, and post-operative chemotherapy start time all had no significant differences in two groups (P > 0.05).③The frequency of psycho-logical pressure (inferiority/anxiety/fear) and rate of un-satisfaction of secondary sexual characteristics (body/curve) in the breast reconstruction group were lower than those in the control group (P < 0.001).The rate of social interaction fitness in the breast reconstruction group was higher than that in the control group (P < 0.001).④The following-up time was 12 to 38 months with an average 25 months, one case died because of brain metastasis in the control group, the rest 59 patients had no local recurrence and distant metastasis. ConclusionsThe immediate breast reconstruction with exte-nded latissimus dorsi musculocutaneous flap after nipple and areola sparing modified radical mastectomy can cure cancer on the basis of satisfactory cosmetic results of breast, excellent quality of life of patients, and fewer surgical complica-tions.It does not affect postoperative adjuvant radiochemotherapy and short-and long-term efficacy for breast cancer.
ObjectiveTo investigate the value of ultrasound knife in modified radical mastectomy for remaining pectoral nerve and intercostobrachial nerve. MethodsOne hundred and sixty patients with breast cancer were divided into ultrasound knife group and electroscalpe group and then performed modified radical mastectomy with pectoral nerve and intercostobrachial nerve remainning. the pectoralis major thickness and paresthesia of skin of inner upper arm and axillary fossa were detected on the different time after operation. Results①The age, body mass index, and mean opera-tion time had no significant differences between these two groups (P > 0.05).②On 6 months after operation, the thickness of bilateral pectoralis major was not significantly different in the ultrasound knife group (P > 0.05), which of injuried pectoralis major was significantly thinner than that of uninjuried pectoralis major in the electroscalpe group (P < 0.05).③The rates of paresthesia of skin on postoperative 3 months and 6 months in the ultrasound knife group were signifi-cantly lower than those in the electroscalpe group (P < 0.05). ConclusionCompared with monopolar electro diathermy, the use of ultrasonic harmonic scalpel in modified radical mastectomy could better protect pectoral nerve and intercosto-brachial nerve, and thus decrease nerve parafunctional rate.