基层医院早期乳腺癌保乳手术体会

目的探讨基层医院早期乳腺癌保乳手术的可行性。方法自2005年4月至2008年8月对20例早期乳腺癌施行保乳手术，手术切除肿瘤及其边缘1～2cm正常乳腺组织以及胸大肌筋膜，腋清扫达到腋淋巴结Ⅱ水平。结果术中冰冻病理报告所有标本各切缘无残留．腋淋巴结均无转移。所有病例乳房形态保持优秀或良好，患者满意。术后未出现切13感染、积血、积液和皮肤坏死。术后随访1～40个月，未见局部复发和远处转移。结论只要正确掌握手术指征及合理的切除范围，保证术后的综合治疗，早期乳腺癌行保乳手术治疗是安全有效可行的。     

乳腺癌保乳手术切除范围的探讨

目的 探讨乳腺癌保乳手术的局部切除范围.方法 回顾性分析南京医科大学第一附属医院乳腺外科、镇江市人民医院乳腺外科和常州市中医医院行保乳手术的275例连续病例,所有患者均按统一的手术步骤操作,并采用相同的术后辅助治疗,定期随访患者局部和全身情况.结果 271例患者获得随访,随访率98.5％.随访时间1个月～9年9个月,中位随访34个月.2例局部复发,6例发生远处转移死亡.患者1年、3年、5年总生存率分别为99.5％、98.1％、95.7％.结论 切除肿瘤周围1 cm乳腺组织,冰冻切片证实边缘无肿瘤浸润,术后辅助化疗、内分泌治疗及放疗,手术是安全的,有益于提高患者生存质量.以钼靶片结合体检确定有无多中心、多灶性病变是安全、有效的.     

局部皮瓣在乳腺癌保乳术后一期修复中的应用

目的 观察应用局部皮瓣修复保乳术后乳房缺损的临床疗效。方法 2004年7月至2013年1月,对9例早期乳腺癌患者保乳手术所遗留的乳房缺损进行即刻修复,采用外侧胸背筋膜皮瓣7例,胸腹壁皮瓣2例,观察皮瓣成活情况、并发症和术后美观效果。结果 术后外观评价8例为优,1例为良。1例患者出现皮瓣局部坏死,经保守治疗愈合。1例患者出现皮瓣供区感染,口服抗菌素治疗,未影响手术效果。术后平均随访22个月,未见局部复发病例。结论 应用局部皮瓣修复保乳术后乳房部分缺损,手术效果好,并发症少,可扩大肿瘤周围的切除范围,降低肿瘤局部复发风险。     

基层医院乳腺癌保乳手术的体会

目的探讨基层医院乳腺癌保乳手术的可行性。方法自2003年10月至2005年10月对早期乳腺癌共施行了15例保乳手术,肿瘤直径在2～3cm,手术切除肿瘤范围约2cm的正常组织以确保切缘阴性,清扫是达到腋淋巴结Ⅰ水平。结果术中冰冻病理报告所有标本各切缘无癌残留,腋淋巴结均无转移。所有病例乳房形态保持良好,患者满意。无术后切口感染、积血、积液和皮肤坏死。术后随访1～48个月,未见局部复发和远处转移。结论只要严格掌握手术指征,在基层医院施行保乳手术是可行的。     

经乳晕保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌

目的探讨经乳晕或乳腔镜辅助保乳手术联合常规腋窝淋巴结清扫治疗乳腺癌的效果. 方法 2001年8月～2003年11月,对19例直径<2 cm、距离乳头>2 cm的乳腺癌经乳晕或乳腔镜辅助行保乳手术,腋窝脂肪溶解抽吸后常规开放性腋窝淋巴结清扫. 结果 1例术中冰冻病理报告一侧切缘镜下癌残留,经扩大切除后转阴.术后2例乳房创面皮下积液,抽洗加压包扎消失.保留的乳房形态良好,伤口小而隐蔽,所有患者对手术效果满意.术后随访2～19个月,平均10.6月,未见乳腺和腋窝肿瘤复发. 结论经乳晕或乳腔镜辅助下,借助乳腔镜器械可以方便地完成乳腺癌保乳手术,联合常规腋窝淋巴结清扫,手术效果肯定.     

局部进展期及较大乳腺癌的保乳治疗

目的探讨局部进展期及较大乳腺癌的保乳问题。方法对33例肿瘤直径4．1cm以上的乳腺癌患者手术前予以蒽环类为主的联合化疗方案化疗,待肿瘤缩小后行保乳手术。结果33例患者中有3l例接受1～8周期的新辅助化疗,平均3．7个周期。化疗有效率100％,其中临床完全缓解19例,临床部分缓解12例,病理学完全缓解9例。33例保乳手术最终切缘阴性率100％,手术中切除标本切缘快速冰冻病理检查1次阴性率75．8％。全部病例随访2～39个月,中位随访27个月,无一例复发。结论对于局部进展期及较大肿瘤乳腺癌,采用以新辅助化疗为主的综合治疗,多数患者可以成功保乳,近期疗效与小肿瘤患者相近。     

保留乳房的乳腺癌手术

保留乳房的乳腺癌手术是近30年来乳腺癌外科治疗的主要进展,它包括乳腺肿瘤局部扩大切除或象限切除,腋淋巴结 清扫(ALND),术后辅助放化疗、内分泌治疗。资料证明保乳手 术能获得与根治性全乳切除术一样的治疗效果,又保留了乳房 的形态,给女性患者带来了实在的益处。由“切乳”转向“保乳” 被称作革命性变化,说明乳腺癌外科治疗理念已从局部解剖为 基础、单一追求手术根治性转向以肿瘤生物学现象为指导的综 合治疗时代,这更充分地体现人类对生命质量的重视。 一、保乳手术的背景 1894年Halsted提出乳腺癌…     

早期乳腺癌保乳治疗32例疗效分析

目的探讨Ⅰ、Ⅱ期乳腺癌保乳综合治疗的疗效及相关技术,为普及早期乳腺癌保乳综合治疗提供参考。方法回顾性分析2003年2月～2010年12月32例行保乳手术治疗乳腺癌患者的相关资料,对肿瘤采取局部扩大切除并进行腋窝淋巴结清扫,术后辅以放疗、化疗或内分泌治疗。结果所有患者随访12～82个月,无局部复发及远处转移,乳房美容评定标准进行评价,符合优良标准31例（96.9%）,符合差标准1例（3.1%）。结论早期乳腺癌保乳综合治疗创伤小、疗效确切、形体改变少、能提高生存质量,值得进一步临床开展及推广。     

整形保乳术治疗乳腺癌的美容效果及预后分析

探讨整形保乳术治疗乳腺癌的美容效果及对预后的影响。选取我院拟实施保乳手术治疗的72例乳腺癌患者,采用随机数字表法分为整形组(行整形保乳术治疗)和常规组(行常规保乳手术治疗),每组各36例,对比两组手术时间、出血量、切除标本体积、切除标本最小手术切缘、切除标本最大手术切缘、乳房美容效果客观评分满意度、术后3年复发及转移情况。整形组出血量与常规组差异无统计学意义(P0.05);整形组手术时间、切除标本体积、切除标本最小手术切缘、切除标本最大手术切缘均大于常规组(P0.05);手术后6个月,整形组患者的乳房对称性、凹陷程度、手术瘢痕、乳头纵向移位距离、乳头横向移位距离、乳房顺应性差值评分均高于常规组(P0.05),整形组的乳房质地与弹性、皮肤弹性评分与常规组差异无统计学意义(P0.05);手术后3年,整形组患者肿瘤复发率、肿瘤转移率与常规组比较,差异无统计学意义(P0.05)。整形保乳术治疗乳腺癌较常规保乳手术术后具有更好的美容效果,且不会增加肿瘤复发及转移的概率。     

保留乳房的乳腺癌改良根治术治疗早期乳腺癌的临床观察

目的探讨保留乳房的乳腺癌根治术治疗早期乳腺癌的疗效。方法对22例早期乳腺癌患者行保乳手术治疗，术后并行辅助放疗、化疗等综合治疗。结果全组随访6～48个月，无局部复发和远处转移，3年生存率100％（17／17）。结论对早期乳腺癌行保乳手术疗效满意，严格掌握手术指征，规范的切除和术后放疗、化疗等综合治疗是保乳手术治疗成功的关键。     

探讨手术切口在保乳术外观的影响

目的探讨手术切口对保乳术的外观的影响。方法对我院2003．9-2009．2期间早期乳腺癌通过不同的切口来完成保乳术的63病人进行总结。肿瘤切除选择梭形横切口43例,梭形放射状切口20例。腋SLN取出选择皮纹横切口47例,与肿瘤切除同一个切12113例．弧形切口3例。全部病人均因术中冰冻切片证实肿瘤四周切缘阴性而完成保乳术。结果全部病人治愈出院,切口均无发生感染及积液等并发症,随访2～65个月,切口愈合良好,梭形横切口及腋窝皮纹切口的疤痕相对较小。结论当施行保乳术时,肿瘤切除术时选择梭形横切口,而SLN取出时应选择皮纹横切口愈合较为美观。     

Breast-conserving surgery using an inframammary fold incision technique for breast cancer

Background: Breast-conserving surgery is an established alternative for the majority of women with early stage breast cancer. Consensus on negative margins (no ink on tumour) for invasive cancer makes mutilating extensive lumpectomies unnecessary. Several breast-conserving surgical methods are described in the literature. The aim of this study was to describe and evaluate a technique using the inframammary fold incision.

Methods: Twenty-seven patients with suspected breast cancer (stage I–II) underwent breast-conserving surgery using the inframammary fold incision. Data regarding tumour characteristics, margin status, complications, oncologic and aesthetic outcome was analysed retrospectively.

Results: After a median follow-up of 35 months, 23 of the 24 patients with breast cancer (95.8%) had no evidence of disease. Post-operative complications (as defined by infection requiring antibiotic treatment and/or seroma requiring drainage) were seen in three of the 27 patients (11.1%). The final pathological examination revealed a positive excision margin in four patients (16.7%). Post-operative evaluation with the BREAST-Q? BCT module showed a mean RASCH score of 72.5 regarding ‘Satisfaction with breast’. The aesthetic result with a hidden scar is exemplified.

Conclusion: Breast-conserving surgery using the inframammary fold incision seems to be a safe method with better cosmesis; however, further research is needed.     

早期乳腺癌病人保乳手术标本病理切缘评价临床价值研究

目的 探讨早期乳腺癌保乳手术标本病理切缘评价的临床价值。方法 回顾性分析2013-01-01-2017-12-31北京大学第一医院乳腺疾病中心接受保乳手术的早期乳腺癌病人资料,探讨病理切缘范围与预后的关系,以及术中冰冻病理与术后石蜡病理对于保乳手术切缘评价的一致性。结果 共474例保乳病例纳入研究,总体复发转移发生率为3.4%,局部复发率（LRR）1.5%,5年无病存活率（DFS）95.7%,5年总存活率（OS）96.8%。术后石蜡与术中冰冻病理学检查对于保乳切缘评价的符合率为100%,首次切缘阳性与阴性相比,局部复发率差异无统计学意义（χ2=1.371,P=0.242）。切缘阴性病人不同切缘宽度的无病存活率和总存活率差异均无统计学意义（χ2=0.123,P=0.726;χ2=0.077,P=0.781）,局部复发率差异也无统计学意义（χ2=1.808,P=0.613）。结论 术中冰冻与术后石蜡病理学检查评价保乳手术切缘符合率高,不同宽度阴性切缘病人的无病存活率和局部复发率差异无统计学意义。     

Breast-Conservation Treatment Outcomes: A Community Hospital's Experience

Abstract:  In the United States, the majority of early breast cancer patients choose breast-conserving treatment in the community setting, yet there is a paucity of literature describing outcomes. In this paper, we describe our experience with breast-conserving treatment in a small community hospital. Our hospital tumor registry was used to identify breast cancer cases diagnosed at our hospital between 1997 and 2003. We limited our study to those women with initial attempts at breast-conserving surgery (BCS) who had follow-up oncology treatment at on-campus affiliated oncological services. We looked at factors that influence survival for early stage 0–II disease such as tumor and patient characteristics, completeness of local surgical tumor excision, and adjuvant treatment. We also evaluated the percentage of cases in which the initial BCS did not achieve adequate surgical oncological results and the number and type of subsequent surgeries that were required to achieve this goal. There were 185 cases with a median patient age of 55 and a median follow-up time of 53 months. Most tumors were stage 0–I (68%) or stage II (23%). A single surgery was deemed sufficient to achieve the desired oncological outcome in 54% of cases; the remaining cases (46%) required additional surgeries. A final margin of 5 mm or greater was successfully achieved in 81% of cases. Ninety-two percent of the patients underwent radiotherapy, 65% received hormonal therapy, and 49% underwent chemotherapy. One hundred and sixty one patients had successful breast-conserving surgeries (87%) and 24 patients (13%) ultimately required mastectomy. There were four loco-regional recurrences and 19 deaths during the study period. Our disease-free survival rate for early-stage cancer (stage 0–II) was 91% at 5 years. Our study shows that high-quality patient outcomes for breast-conserving treatment can be achieved in the community setting.     

乳腺癌保乳手术中乳房缺损的修复方法

目的综述乳腺癌保乳手术中乳房缺损的修复方法。方法分析近年来相关文献,对有关乳腺癌保乳手术中乳房缺损的修复方法、适应证、切口选择以及优缺点进行分析。结果保乳手术后部分患者存在乳房畸形,美容效果不佳。如何选择手术切口、怎样修复肿瘤切除后的乳房缺损,以获得较好的美容效果是外科手术中的焦点问题。将乳房整形技术应用于保乳手术,可明显改善美容效果。结论选择合适的早期乳腺癌患者采用乳房整形技术进行保乳手术治疗,安全、有效,术后患者对乳房外形及整体美容效果满意度高,是值得推荐的一种技术。     

Endoscopy-assisted Breast-Conserving Surgery for Early Breast Cancer

Purpose Breast-conserving surgery is now accepted as one of the standard therapeutic options for stages I and II breast cancers. Although breast-conserving surgery can help retain a good breast shape, a long marked scar would be a disadvantage. Endoscopic surgery can be performed via a small and remote incision that becomes inconspicuous after surgery. To improve the cosmetic outcome, endoscopic breast-conserving surgery, which can be performed through minimal axillary and periareolar semicircular incisions, was undertaken. Methods and materials From October 2002 to October 2004, 20 breast cancer patients whose tumor sizes were less than 3 cm and who were clinically node negative without invasion to the skin and pectoralis major muscle underwent endoscopic breast-conserving surgery. First, endoscopic dye-guided sentinel node biopsy was done through a low transverse axillary incision lateral to the pectoralis major muscle. The subpectoral pocket was gently created by Vein Harvest under the view of endoscopic monitor. We made the periareolar semicircular incision to create the skin flap and to resect the tumor-containing quadrant by using Visiport and PowerStar scissors. Frozen-section biopsies were done to rule out tumor invasion to the resection margin. Patient characteristics, tumor characteristics, operation time, and amount of bleedings were all evaluated. Results The mean age of patients was 45 (range: 25–64). The mean tumor size was 2.2 cm (range: 0.2–4.0 cm). The average operation time of the early 9 cases, except the 3 cases that underwent axillary-node dissection, was 178 minutes, and that of the later 8 cases was 130 minutes (P < 0.001). The mean amount of operative bleeding was 184 ± 130 ml. There were no major complications. Conclusion Endoscopic breast-conserving surgery is a new technique that can minimize the long operation scar of classic breast-conserving surgery. In properly selected cases, our results showed the maximized cosmetic satisfaction of the breast cancer patients and a shortened operation time after the learning period, promising it could be an alternative to the classic breast-conserving surgery. This article contains a supplementary video. This paper is to be presented as a video-mode presentation for the 41st World Congress of Surgery at the International Surgical Society/Societe Internationale de Chirurgie (August 21–25, 2005, Durban, South Africa)     

Technical factors,surgeon case volume and positive margin rates after breast conservation surgery for early-stage breast cancer

Background

For patients with breast cancer, a negative surgical margin at first breast-conserving surgery (BCS) minimizes the need for reoperation and likely reduces postoperative anxiety. We assessed technical factors, surgeon and hospital case volume and margin status after BCS in early-stage breast cancer.

Methods

We performed a retrospective cohort study using a regional cancer centre database of patients who underwent BCS for breast cancer from 2000 to 2002. We considered the influence of patient, tumour and technical factors (e.g., size of specimen and preoperative diagnosis of cancer available) and surgeon and hospital case volume on margin status at first and final operation. We performed univariate and multivariate regression analyses.

Results

We reviewed 489 cases. There were no differences in patient or tumour characteristics among the low-, medium- and high-volume surgeon groups. High-volume surgeons were significantly more likely than other surgeons to operate with a confirmed preoperative diagnosis and to resect a larger volume of tissue. In our univariate analysis and at first operation, the rates of positive margins were 16.4%, 32.9% and 29.1% for high-, medium- and low-volume surgeons, respectively (p = 0.002). In the multivariate analysis, tumour factors (palpability, size, histology), presence of a confirmed preoperative diagnosis and size of resection specimen significantly predicted negative margins. However, when we controlled for these and other factors, high surgeon volume was not a predictor of negative margins at first surgery (odds ratio 1.8, 95% confidence interval 0.9–3.8, p = 0.09). Increased hospital volume was not associated with a lower rate of positive margins at first surgery.

Conclusion

Various tumour and technical factors were associated with negative margins at first BCS, whereas surgeon and hospital volume status were not. Technical steps that are under the control of the operating surgeon are likely effective targets for quality initiatives in breast cancer surgery.     

Immediate reconstruction following breast-conserving surgery: Management of the positive surgical margins and influence on secondary reconstruction

The efficacy of breast-conserving surgery for the local control of early breast cancer has been repeatedly evidenced. Although immediate reconstruction following breast-conserving surgery has been described, little information is available regarding surgical management in reoperative settings due to positive margins. We studied the influence of intraoperatively assessed and postoperatively controlled surgical margin status on the type of breast-conserving surgery and report our results regarding complications in a reoperative breast reconstruction scenario. All patients were seen by a multidisciplinary team who recommended breast-conserving surgery. According to the breast volume, ptosis and tumor size/location, the patients were also evaluated by a plastic surgeon, who recommended reconstruction with the appropriate technique. Intraoperative assessment of surgical margins was determined by histological examination of frozen sections. The mean follow-up time was 48 months. Two hundred and eighteen patients (88.5%) underwent breast-conserving surgery and immediate reconstruction. Twelve (5.5%) patients had a positive tumor margin after review of the permanent section. All patients underwent re-exploration. In 1.3%, a second reconstructive technique was indicated and in 2.2% a skin-sparing mastectomy with total reconstruction was performed. Our findings support the important role of the intraoperative assessment of surgical margins and its interference in the selection of reconstruction techniques and negative margins; however, it will not guarantee complete excision of the tumor. Success depends on coordinated planning with the oncologic surgeon and careful intraoperative management.     

保乳手术与改良根治术对早期乳腺癌患者预后及生活质量的临床观察

目的 比较保乳手术与改良根治术对早期乳腺癌(临床I、Ⅱ期)患者的预后及生活质量的差别.方法 回顾我院诊治的180例早期乳腺癌,分为保乳组与改良组,各90例.2组术后均按适应证进行放疗、化疗及内分泌治疗,观察其预后及生活质量的差别.结果 患者均术后随访5年,2组的无病生存期差异无统计学意义,但保乳组的生活质量(总体健康、生理功能、生理职能、躯体疼痛、活力、社会功能、情感职能及精神健康)明显高于改良组.结论 对早期乳腺癌患者应用保乳手术治疗,效果理想,且能取得良好的美容效果,提高生活质量,临床可积极应用.