摘要:目的：探讨高频电刀在乳腺癌手术皮瓣游离中的临床应用及其功率大小对术后皮瓣坏死的影响。方法：回顾性分析2003年1月至2008年9月,在我院154例行乳腺癌改良根治术患者的临床资料,其中乳腺刀组（A组）37例,小功率电刀组（B组）60例,大功率电刀组（C组）57例,对比分析各组皮瓣坏死情况。结果：共发生皮瓣坏死35例,其中A组用乳腺刀游离皮瓣6例（6/37）,B组用小功率电刀（18～22W）游离皮瓣9例（9/60）,C组用大功率（≥28W）电刀游离皮瓣20例(20/57),B组与A组比较差异无显著意义(Ｐ＞005),C组与A、B组比较差异有显著意义(Ｐ＜005);而B、C组与A组比较,游离皮瓣时出血量明显减少,差异有显著性意义（Ｐ＜005）。结论：合理应用高频电刀游离皮瓣具有术中出血少,术后恢复快的优势,但若功率过高,则会增加皮瓣坏死率。Abstract: Objective: To Analyse influence of Skin Flap Necrosis after Operation of Breast Cancer with different power of radioknife. Methods：The clinical data of 154 breast cancer patients received surgery operation trea tment was analysed retrospectively, among them there are 37 patients operation with lancet (group A), there were 60 patients operation with littlepower radioknife (group B) and there were 57 patients operation with highpower radioknife (group C). Results：There were 35 cases (22.73％) suffured from skin flap necrosis among 154 breast cancer cases received surgery operation. There were 6 cases（6/37）in group A, 9 cases（9/60）in group B and 20 cases（20/57）in group C. Group B and group C has littler hemorrhage in operation compare with group C (Ｐ＜005) . Conclusion： Radioknife for skin flap decoherence in operation of breast cancer can decrease hemorrhage but highpower radioknife will increase necrosis of skin flap.
Objective To evaluate the effect of endoscopic surgery combined with intraoperative color Doppler ultrasound on removing the injected breast augmentation agents and share our experiences. Methods Sixteen female who accepted the bilateral removal of injected breast augmentation agents through endoscopic surgery combined with intraoperative color Doppler ultrasound between 2008 and 2010 were enrolled in this study. The results, techniques, and advantages of management were analyzed retrospectively. Results One incision was made in 18 breasts, 2 in 4 breasts, 3 in 10 breasts. The length of incision was 0.5 to 1 cm. The mean operative time was 128.70 min per person. The average amount of bleeding was 52.67 ml per person. Complications such as postoperative bleeding, infection, poor drainage, or breast augmentation agents remain did not happened in all cases. No case was turned into normal operation. Female who accepted this operation were all satisfied with the appearance of incisions. During 1-3 months follow up, neither clinically palpable mass nor sensory disturbance in nipple or areola of breast was observed. Color Doppler ultrasound or magnetic resonance showed 16 cases had been cleared free of breast augmentation agents. Conclusion With the advantages of beauty, safe, minimal invasion, and partial resection of lesions at the same time, endoscopic surgery combined with intraoperative color Doppler ultrasound was an effective approach in the removal of injected breast augmentation agents.
Objective To investigate the expression of presenilin-2(PS2) and glutathione S transferase π(GSTπ) and their role in the prognosis and therapy of infiltrating ductal breast carcinoma. Methods The expression of PS2 and GSTπ in tumor tissues from 210 patients with infiltrating ductal breast carcinoma confirmed by pathologic examination and treated with modified radical mastectomy was examined by using LSAB immunohistochemical method. Results The expression rate of PS2 was 49.5%(104/210) and the expression rate of GSTπ was 48.1%(101/210). The grade of the postoperative 5-year survival rate and 10-year survival rate in four groups of 210 patients, from high to low, was the group 1 (PS2 positive expression/GSTπ negative expression), the group 2 (PS2 positive expression/GSTπ positive expression), the group 3 (PS2 negative expression/GSTπ negative expression) and the group 4 (PS2 negative expression/GSTπ positive expression). Conclusion The prognosis of the group 1 is the best, the group 2 better, the group 3 good and the group 4 the worst. The results suggest that reasonable use of endocrinotherapy and chemotherapy in infiltrating ductal breast carcinoma is necessary.
Objective To study the long-term effect of neoadjuvant chemotherapy on advanced breast cancer. Methods The CAF neoadjuvant chemotherapy 〔CTX 500 mg/m2（1st day, 8th day), 5-FU 500 mg/m2（1st day, 8th day), and ADM 30 mg/m2 (1st day) every 3 weeks〕 was carried out in 31 breast cancer patients (stageⅢ,Ⅳ) for 2 cycles before operation, compared with 30 patients (stage Ⅲa) whose therapies were never done and operations could be feasible. Results The overall response rate was 87.1%(27/31). The stages of 19 patients among 31 (61.3%) declined (6 patients to stage Ⅲa, 8 to stageⅡb, 4 to stageⅡa, 1 to stage 0, 1 to complete response and none to pathological complete response). The diseasefree survival time of the patients was 56.3 months which was obviously longer than that of the patients without neoadjuvant chemotherapy (43.5 months, P＜0.05). The 5-year diseasefree survival rate of the patients with neoadjuvant chemotherapy was 38.7% which was a little higher than that (33.3%) of the patients without the chemotherapy, and the two groups had no significant difference. Conclusion The neoadjuvant chemotherapy can reduce the stages of patients with advanced breast cancer, obviously prolong the diseasefree survival time of patients, and reduce or delay recurrence or metastasis.
ObjectiveTo study the cause of different prognosis in typical medullary carcinoma and atypical medullary carcinoma. MethodsThe immunohistochemical staining method was used to evaluate the positivity of Ecadherin,βcatenin, in 30 cases of atypical medullary carcinoma and 18 cases of typical medullary carcinoma and 10 cases of normal breast. ResultsThe positive rate and staining intensity of Ecadherin and βcatenin oncoprotein were significantly higher in typical medullary carcinoma than in atypical medullary carcinoma(Plt;0.01).ConclusionExpression of Ecadherin and βcatenin is one of the causes of similar morphology and different prognosis in medullary breast carcinoma.
ObjectiveTo study the mechanism of reducing the intratumoral microvessel density (MVD) by Ginsenoside Rg3 (Rg3) combined with cytotoxic agent in xenotransplanted human breast infiltrating duct carcinoma in nude mice. MethodsSixteen female nude mice were randomly divided into 4 groups to receive cyclophosphamid (16 mg/kg,qd) combined with Rg3 (10 mg/kg, qd),Rg3(10 mg/kg,qd) alone,cyclophosphamid (16 mg/kg,qd) alone and 0.5% sodium carboxymethyl cellulose (0.5 ml,qd) respectively for 55 days. Breast cancer mass were weighed and sampled for light microscopic observation. The intratumor MVD was examined by immunohistochemical staining. ResultsThe tumor weight of treated group was significantly lower than that of control group. The tumor weight of the Rg3 combined with CTX group was lower than that of Rg3 group. The MVD value of Rg3 group was significantly lower than that of CTX group and control group. The MVD was significantly reduced in the Rg3 combined with CTX group than that in the others.ConclusionRg3 combined with CTX can inhibit the growth of xenotransplanted human breast infiltrating duct carcinoma, and reduce the intratumoral MVD.
The DNA content, cellular ultrastructure and the expression of blood group Y antigen and immunosuppressive acidic protein-2(IAP-2) were observed in normal breast, cystic hyperplasia of breast and breast cancer. The results showed: the results observed in the cells of cystic hyperplasia with epithelial proliferation grade Ⅰ were similar to those in normal breast cells. The DNA content increased, the hypoplasia and dedifferentiation features in some structures of cellular membrane and nucleus were observed, and the abnormal antigens expressed in part of the atypical hyperplasic cells. The DNA content and ultrastructure in a part of cells with aypical hyperplasia grade Ⅲ were similar to those in the cells of breast cancer grade Ⅰ. The results indicated that in the couse of atypical hyperplasia, the biological abnormalities and its extent of those cells were closely related to the differentiation extent, the developing tendency and the risk of canceration of the cystic hyperplasia of breast.
The expression of C-erb B-2 oncogene protein in the tissues of normal breast, atypical cystic hyperplasia of breast and breast carcinoma were determined in order to analyse the significance of the changes of C-erb B-2 oncogene in the course from atypical hyperplasia to carcinoma of breast. Results: there were no expression of C-erb B-2 protein in the tissues of normal breast and cystic hyperplasia of breast with epithelia proliferation grade Ⅰ. The positive rates of the expressions of C-erb B-2 protein in the tissues of atypical hyperplasia grades Ⅱ, Ⅲ and carcinoma of breast were 20.0%, 40.0% and 54.2% respectively. The results indicated that the abnormal changes of C-erb B-2 nocogene might occured in the carcinomatous transformation phase along with the changes from normal breast epithelial cell through atypical hyperplasia to breast cancer, those changes could be the result or promotion factor of abnormal proliferation of atypical hyperplasia of breast and was one of the markers of malignant transformation of epithelia of breast.
Objective To investigate the results of skinsparing mastectomy and immediate breast reconstruction with transverse rectus abdomins musculotaneous(TRAM) flap or latissimus dorsi musculocutaneousflap plus placement of a mammary implant.Methods From June 1997 to June 2002, 11 patients were proven to have ductal carcinoma in situor huge breast carcinoid by pathological examination. The site of the biopsy incision was around the areola. The patients underwent mastectomy with skin sparing by a circumareolar incision and immediate breast reconstruction withTRAM flap or latissimus dorsi musculocutaneous flap plus placement of mammary implant.Autogenous tissue was used to fill the skin envelop. The second stage operation of nipple-areola reconstruction was performed on the replaced skin.Results Eleven patients were followed up 1 month to 6 years.The operative result was good and all patients had no relapse. The reconstructed breast achieved good results in shape, colour, sensation, symmetry and incision scar. Conclusion The skin sparing mastectomy and immediate autograft tissue breast reconstruction is an ideal reconstructive method for the patients with breast ductal carcinoma in situ or huge breast carcinoid in condition that there were strict operative indication and relapse can be prevented.
Rectus femoris muscle of the lower abdomen was used as myocutaneous flap in the reconstruction of the breast in 4 patients, of which, in 2 cases the reconstruction was carried out immediately following the radical mastectomy for breast cancer by using trancfer of the pedicled myocutaneous flap, and in the other two cases, the vascularized free myocutaneous flap was used 2 months and 5 years after the radical mastectomy, respectively. The vascularized free myocutaneous flaps were survived, however, in the pedicled myocutaneous flap group, the fat of the flaps had liquefaction 23 weeks after operation. The latter were healed after repeated dressings. The external appearance of the 4 reconstructed breasts lookedsattisfactory. The patients wete follwed up for 10 to 18 months, 2 patients hadno ill effects, while the 2 pedicled myocutaneous flaps, in which 1 patient hadbulging of the weakened abdominal wall, and the other had lost from follow up.