垂直切口乳房缩小术

目的：随着生活水平的提高，巨乳的发病率有增加的趋势。巨乳缩小术以倒“T”形手术为代表，术后遗留明显的手术瘢痕。为了减少手术瘢痕，本文介绍了我们应用垂直切口巨乳缩小的手术方法与体会。方法：采用Lejour蚊子头式手术设计，切除乳房下方的皮肤、腺体，乳头乳晕以上方真皮腺体组织蒂抬高到正常位置，进行乳房塑形，术后仅留有垂直瘢痕。结果：采用垂直切口巨乳缩小术治疗6例患者，手术效果满意，乳房形态良好。1例术后6个月切口下端局部修整残留的猫耳朵。结论：垂直切口巨乳缩小手术效果良好，术后瘢痕减少，值得推广应用。     

1例乳癌病人行保乳根治及双乳巨乳缩小上提成形术的护理配合

随着我国医疗科技韵不断发展和人们消费水平的日益提升,乳房的整形美容手术也逐步成为一部分人美化自我,改善自我和实现完美生活的一种途径。双乳巨乳缩小上提成形术是切除部分乳房皮肤、乳腺组织,使乳房体积缩小和乳头位置改善,并进行乳头和乳晕的整形。现将1例乳癌病人行乳癌保乳根治同时行双乳巨乳缩小上提成形术的护理配合介绍如下。     

双环法乳房缩小术的临床探讨

目的探讨一种设计简单且切口隐蔽、瘢痕不明显的巨乳、垂乳整形术式。方法通过以乳头为中心的双环切口,切除多余的腺体、脂肪组织和皮肤,重新塑形乳房,使之大小适度,乳头位于第四肋间水平,呈圆锥状。结果对11例患者、22只乳房行巨乳缩小或乳房下垂矫正术,除2例2只乳房乳晕上缘切口部分裂开、延期愈合;1例乳头乳晕感觉迟钝外,其余均取得满意疗效。结论双环法乳房缩小术设计简单、合理;手术操作简捷,切口隐蔽;且不破坏过多的乳腺组织。对于单纯乳房下垂悬吊的患者还不影响其泌乳功能。     

乳晕真皮帽双环法巨乳缩小术临床应用体会

目的：总结应用乳晕真皮帽双环法行巨乳缩小术术式，为临床操作提供参考。方法：回顾分析了我科近2年来，6例巨乳症患者采用乳晕真皮帽双环法术式进行治疗的情况，分析其术前设计、手术方法与太后效果的相关性。结果：除一例发生脂肪液化外，所有患者均进行了3月以上随访，无明显瘢痕，乳房塑形良好。结论：乳晕双环法适用于轻、中度巨乳症伴或不伴乳房下垂的患者。     

巨乳缩小术致乳头乳晕坏死一例报告分析

女，40岁，因先天性巨乳要求行缩乳术。手术在高硬膜外麻醉下采用传统的横向双蒂方法，术后12小时病人自觉左乳房呈放射性巨痛。即打开敷料观察，乳头、乳晕呈黑色，荷叶缝合边缘有部分小水疱，触之感觉不明显。即拆除一侧荷叶包缝合，发现乳头、乳晕下有紫黑色血块，乳腺组织严重缺血。     

超声波去脂技术在巨乳缩小术中的应用

目的探讨利用超声波去脂技术在巨乳缩小术(缩乳术)中的应用.方法利用超声波去脂技术去除巨乳中的脂肪组织,并借超声波震荡及操作刺激以使皮肤收紧.结果通过超声波去脂技术使巨乳缩小的手术方法、特点、及其效果,介绍了该技术在缩乳术中应用的可行性,阐明了提高手术效果的相应处理办法和注意事项.结论超声波去脂缩乳术较单纯性手术缩乳优越.利用超声波去除巨乳脂肪手术安全,术后局部皮肤平滑,乳房自然、美观;是一项值得推广的新技术.     

巨乳缩小术围手术期的临床护理

近些年来,越来越多的女性患者实施巨乳缩小术,而围手术期的护理及康复治疗在整个手术及术后的治疗过程中发挥着重要的作用,因此我们不断探讨该手术围手术期的临床护理及康复治疗,以期为临床实际工作提供一定的指导意义。     

双环形切口巨乳缩小术腺体切除量预估模型

  目的  建立双环形切口巨乳缩小术腺体切除量的预估模型。  方法  回顾性收集78例患者的133侧双环形切口巨乳缩小术的相关资料, 包括术前测量的患者双侧锁乳距、胸乳距、乳房内径、乳房下径、乳房外径数据(cm), 及术中精确测量的每侧切除的乳腺腺体重量(g)。对数据进行统计学分析, 利用多元逐步回归得出术前乳房的测量数据与术中切除乳腺腺体量的关系。  结果  双环形切口巨乳缩小术中乳腺腺体切除量的计算公式为:乳腺腺体切除量=32×锁乳距+31×乳房下径+8×乳房内径-986, 或乳腺腺体切除量=25×胸乳距+32×乳房下径+13×乳房内径-868。  结论  该公式为双环形切口巨乳缩小术腺体切除量的经验性总结, 应用该公式有助于术前估算, 指导术中乳腺腺体切除量, 以及维持术后双侧乳房的对称性。     

巨乳缩小围手术期的护理探讨

目的探讨巨乳缩小患者垂直双蒂法围手术期的护理体会。方法 14例患者进行术前心理护理,术后保持皮瓣有效血液循环、伤口引流管通畅、换药护理、预防感染,康复期进行按摩、功能锻炼。结果 14例患者疗效满意,其中1例术后伤口部分裂开经换药愈合,1例引流管滑脱,经重新放置后通畅。结论围手术期优质护理是手术成功的关键。     

软组织扩张术乳头再造法治疗乳头缺失疗效观察

目的 探讨软组织扩张术乳头再造法治疗乳头缺失的可行性。方法 采用软组织扩张法，即在残存乳头及乳晕区皮肤软组织下埋置扩张器，注水扩张，进而形成乳腺组织瓣作支撑，行乳头再造。结果 本组5例患者，行10侧乳头再造术后均取得了良好效果。结论 软组织扩张术乳头再造法能充分利用局部组织材料资源，减少额外创伤，且符合人体生理结构，是一种较理想的乳头再造方式。     

垂直上蒂法乳房缩小整形术的改良应用

目的探讨垂直上蒂法乳房缩小整形术在治疗巨乳症中的改良应用。方法 2007年1月-2009年10月对18例乳房肥大患者行垂直上蒂法乳房缩小整形术,设计乳晕下做垂直切口,乳房下皱襞上1～2cm做弧形切口;乳晕上新乳头区域去皮制皮下蒂,切开形成左右两侧皮瓣,乳头乳晕垂直向上折叠缝合于新乳头位置,逐步分次去除多余皮肤及乳腺组织,不悬吊固定切除后的乳腺组织,向中央收紧乳房,获得轮廓饱满、曲线圆滑的新乳房。结果手术效果良好,乳房外形饱满,轮廓曲线圆滑,随访半年后乳头乳晕感觉恢复良好,切口瘢痕小,患者满意。结论此改良法治疗中重度巨乳症术后乳房形态效果满意,设计与手术操作简便,值得推广。     

两种巨乳缩小手术在临床中的应用

【目的】比较两种不同的巨乳缩小成形术手术方法的临床效果,探讨各自的适应证。【方法】对31例巨乳症患者行手术治疗,其中17例中重度巨乳采用垂直单蒂法,轻中度巨乳采用双环法14例。观察术后两组乳头乳晕血运循环,感觉及乳房外形。【结果】所有患者全部恢复良好,无乳头乳晕坏死,乳房外形均满意,垂直单蒂切除的组织量明显多于双环法（P＜0．05）,重度巨乳患者多采用垂直单蒂法。【结论】垂直双蒂法较适用于中重度巨乳症,双环法较适用于轻中度巨乳症。     

乳腺癌细胞膜蛋白的SELDI-TOF-MS分析

目的比较乳腺癌细胞株和正常乳腺上皮细胞膜蛋白指纹图谱,为乳腺癌亚细胞蛋白组学的研究奠定基础。方法试剂盒提取两株乳腺癌细胞株MDA-MB-231,MCF-7及一株乳腺正常上皮细胞HBL-100的膜蛋白,SEL-DI-TOF-MS分析蛋白指纹图谱,寻找差异蛋白。结果在分子量2kD-100kD范围内3株细胞均可检测到近100个蛋白点,MDA-MB-231和MCF-7与HBL-100相比,膜蛋白差异点分别为32个和34个(P<0.05),其中7.8kD,8.3kD和8.8kD的蛋白在两株癌细胞中表达均降低,9.6kD的蛋白在两株癌细胞中表达均增高。结论 SELDI-TOF-MS可以快速灵敏地检测到乳腺癌亚细胞蛋白水平的差异,为乳腺癌早期诊断提供依据。     

Methods of arterial site skin preparation and dressing

Before an arterial line is inserted, the skin at the site is prepped typically with the traditional iodophor-based preps. The arterial site is then covered with an occlusive dressing. When arterial lines are maintained for even a few days, it is not uncommon that some form of complication develops at the arterial site, such as redness, inflammation, positional problems, or even infection. Unfortunately, due to the nature of this traditional preparation and dressing method, the site is obscured constantly and complications are not always detected before a resulting infection occurs. This prospective study was designed to examine the efficiency and effectiveness of a new transparent prep, used with a transparent dressing at the arterial site. Sixty patients' arterial line sites were evaluated to determine the incidence of complications of the two arterial site prep and dressing methods. The effectiveness that the dressings may serve in securing the arterial lines in place was also evaluated. There were no complications in this study directly related to either skin preparation or dressing method, thus, there were no statistically significant differences. However, the transparent prep and transparent dressing method provided constant visual access to the arterial site and required fewer steps, clearly significant advantages not provided by the traditional method.     

纵折下颌第一磨牙修复治疗后的临床效果观察

目的评价保存治疗纵折下颌第一磨牙的临床疗效。方法选取95例颊舌方向纵折之下颌第一磨牙病例，完全纵剖牙冠及髓室底，获得独立的近远中残根，完整的根管治疗后，行桩核和烤瓷熔附金属全冠修复，3年后进行临床评价。结果修复体边缘完整性检查满意率为85％，与对侧同名牙对照组比较，平均牙龈指数无显著性差异．P〉0．05。结论该方法治疗纵折下颌第一磨牙的远期效果较好。     

Automated Skin Segmentation in Ultrasonic Evaluation of Skin Toxicity in Breast Cancer Radiotherapy

Skin toxicity is the most common side effect of breast cancer radiotherapy and impairs the quality of life of many breast cancer survivors. We, along with other researchers, have recently found quantitative ultrasound to be effective as a skin toxicity assessment tool. Although more reliable than standard clinical evaluations (visual observation and palpation), the current procedure for ultrasound-based skin toxicity measurements requires manual delineation of the skin layers (i.e., epidermis-dermis and dermis-hypodermis interfaces) on each ultrasound B-mode image. Manual skin segmentation is time consuming and subjective. Moreover, radiation-induced skin injury may decrease image contrast between the dermis and hypodermis, which increases the difficulty of delineation. Therefore, we have developed an automatic skin segmentation tool (ASST) based on the active contour model with two significant modifications: (i) The proposed algorithm introduces a novel dual-curve scheme for the double skin layer extraction, as opposed to the original single active contour method. (ii) The proposed algorithm is based on a geometric contour framework as opposed to the previous parametric algorithm. This ASST algorithm was tested on a breast cancer image database of 730 ultrasound breast images (73 ultrasound studies of 23 patients). We compared skin segmentation results obtained with the ASST with manual contours performed by two physicians. The average percentage differences in skin thickness between the ASST measurement and that of each physician were less than 5% (4.8 ± 17.8% and −3.8 ± 21.1%, respectively). In summary, we have developed an automatic skin segmentation method that ensures objective assessment of radiation-induced changes in skin thickness. Our ultrasound technology offers a unique opportunity to quantify tissue injury in a more meaningful and reproducible manner than the subjective assessments currently employed in the clinic.     

人类乳腺癌细胞系Bcap-37和MCF-7染色体核型特征和标记染色体的分析

背景肿瘤的细胞遗传学研究表明,肿瘤染色体的改变具有非随机性,一些肿瘤还存在有特异的染色体异常,从而为癌基因的表达提供了细胞遗传学基础.目的对人类乳腺癌细胞系Bcap-37和MCF-7进行染色体G显带分析,研究其核型特征和标记染色体.设计以细胞为观察对象的对照实验.单位北京大学医学部医学遗传学系.材料实验于1991-04/1992-05在北京大学医学部医学遗传学系完成.人类乳腺癌细胞系Bcap-37和MCF-7.方法应用低温同步法与秋水酰胺处理制备染色体标本,对人类乳腺癌细胞系Bcap-37和MCF-7的中期及早中期细胞进行G-显带分析.对每个细胞系计数50～60个分裂相,分析15～16个G-显带核型,包括320条带和500条带左右水平的分裂相.主要观察指标两个乳腺癌细胞系染色体数目以及结构改变.结果Bcap-37细胞染色体众数为63,可识别其结构的标记染色体17条;MCF-7细胞染色体众数为56,可识别其结构的标记染色体13条.结论两个乳腺癌细胞系均有复杂的染色体异常,乳腺癌中染色体结构及数目的异常,它们可能引起肿瘤相关基因DNA序列重排,也可能导致某些染色体DNA丢失,从而在乳腺癌发生发展中起一定作用.     

Breast EIT using a new projected image reconstruction method with multi-frequency measurements

We propose a new method to produce admittivity images of the breast for the diagnosis of breast cancer using electrical impedance tomography(EIT). Considering the anatomical structure of the breast, we designed an electrode configuration where current-injection and voltage-sensing electrodes are separated in such a way that internal current pathways are approximately along the tangential direction of an array of voltage-sensing electrodes. Unlike conventional EIT imaging methods where the number of injected currents is maximized to increase the total amount of measured data, current is injected only twice between two pairs of current-injection electrodes attached along the circumferential side of the breast. For each current injection, the induced voltages are measured from the front surface of the breast using as many voltage-sensing electrodes as possible. Although this electrode configurational lows us to measure induced voltages only on the front surface of the breast,they are more sensitive to an anomaly inside the breast since such an injected current tends to produce a more uniform internal current density distribution. Furthermore, the sensitivity of a measured boundary voltage between two equipotential lines on the front surface of the breast is improved since those equipotential lines are perpendicular to the primary direction of internal current streamlines. One should note that this novel data collection method is different from those of other frontal plane techniques such as the x-ray projection and T-scan imaging methods because we do not get any data on the plane that is perpendicular to the current flow. To reconstruct admittivity images using two measured voltage data sets, a new projected image reconstruction algorithm is developed. Numerical simulations demonstrate the frequency-difference EIT imaging of the breast. The results show that the new method is promising to accurately detect and localize small anomalies inside the breast.     

着丝粒蛋白CENP-H对乳腺癌细胞株MCF7增殖能力的影响

目的 研究CENP-H对乳腺癌细胞增殖能力的影响,初步探讨CENP-H与乳腺癌发生、发展的关系.方法 将反转录病毒质粒pMSCV和pMSCV-CENP-H经脂质体转染至293FT细胞制备病毒,并感染MCF7细胞,用嘌呤霉素筛选及Western blot鉴定,建立CENP-H基因稳定表达的MCF7细胞株;应用噻唑盐(MTT)法、平板集落形成实验、5-溴-2-脱氧尿苷(BrdU)掺入法检测CENP-H对MCF7细胞增殖的影响.结果 成功建立稳定表达CENP-H的MCF7细胞株,并发现CENP-H过表达可上调细胞增殖相关分子cyclin D1的表达;MTT、平板克隆实验及Brdu掺入实验结果显示CENP-H过表达后,MCF7的增殖能力模型增强.结论 CENP-H可上调cyclin D1的表达,增强MCF7的增殖能力,提示CENP-H可能在乳腺癌发生、发展中起重要作用.     

厚朴酚抑制体外乳腺癌细胞株生物活性的实验研究

[目的]探讨中药厚朴提取物厚朴酚(Magnolol,Mag)抑制不同乳腺癌细胞株生物活性的作用.[方法]选取不同乳腺癌高转移细胞株(MCF-7、MDA-MB-231),在培养液中分别加入不同浓度的Mag溶液,观察处理后细胞的凋亡、侵袭、转移和黏附能力,判断Mag对乳腺癌细胞株生物活性的影响.[结果]Mag可以抑制细胞的抗凋亡、侵袭、转移和黏附能力(P<0.05),随着Mag浓度的增大,抑制生物活性的作用逐渐增强(P<0.05).[结论]Mag可以通过抑制不同受体状态乳腺癌细胞株的抗凋亡率、侵袭能力、黏附能力和迁移能力,从而抑制其生物活性,在乳腺癌的治疗及预防乳腺癌复发、转移中具有重要的临床应用价值.