Women''s perceptions of seroma and their drainage following mastectomy and axillary lymph node dissection

AIM: The aim of this research was to study the effect of seroma on women's perception of daily functional and emotional status after surgical treatment for breast cancer. Furthermore, the experiences of the actual drainage procedure of seroma was studied. METHOD: The study had a prospective and comparative design. A study specific questionnaire was developed and used. Eighty-two women operated with modified radical mastectomy completed the forms. Forty-one women with seroma were compared with the 41 without seroma. The items focused on women's perceptions of daily-life situations, postoperative pain, problems with the surgical scar, preoperative information, general health, levels of anxiety, depression, psychosocial support and contact with the registered nurse in the hospital. RESULTS: Overall the perceived emotional and functional status, pain and general health did not differ between the two groups. Women with seroma contacted the registered nurse in the hospital more frequently after hospital discharge. Most women with seroma had no or little pain and anxiety during the aspiration and found the procedure fully acceptable. Practical information concerning self-care and the aspiration procedure was considered insufficient. The return visit to the nurse for wound observation was important and provided psychosocial support. CONCLUSION: Seroma and its drainage is well accepted. Patients should be better informed about the possibility of a seroma and its treatment. Staff continuity and particularly the presence of a special trained nurse for wound control and for psychosocial support are much appreciated.     

Efficacy of an in-home nursing intervention following short-stay breast cancer surgery

This randomized controlled trial (n = 240) was designed to test the efficacy of a sub-acute home nursing intervention following short-stay surgery for breast cancer. Intervention participants received the in-home nursing protocol, whereas non-intervention participants received agency nursing care or no nursing care. Data, collected via questionnaire, telephone interview, and chart audit, included surgical recovery/self-care knowledge, functional status, anxiety, quality of life (QOL), and health service utilization. There were no significant group differences on postoperative functional status, anxiety, QOL, further surgeries, or complications. Intervention participants were more likely to receive instruction on surgical self-care (p 相似文献   

18F-FDG PET/CT乳腺癌病灶标准摄取值与其影响因素的相关性研究

目的：评价乳腺癌灶的大小，乳腺组织密度、年龄、绝经状态对18F-脱氧葡萄糖（FDG）PET/CT标准摄取值的影响。方法：对27例临床疑单侧原发性乳腺癌患者（13例绝经前期和14例绝经后期）行18F-FDG PET/CT显像。应用ROI技术行半定量方法测得癌灶的SUVmax，并应用图像处理软件镜像技术勾画对侧正常组织的SUVmax。与乳腺病变的大小、组织密度、患者年龄、绝经状态行相关性分析。所有患者均行手术治疗。结果：27例患者共32个病灶。病理证实，乳腺癌25个，良性病变7个。乳腺癌病灶SUVmax为5.08±3.55，良性病变SUVmax为1.17±0.31，对侧正常腺体组织SUVmax为0.76±0.52。乳腺病灶SUVmax与病灶的最长径呈显著性正相关（r=0.546，P＜0.05)。病灶SUVmax与患者年龄呈显著性负相关（r=-0.45，P＜0.05)。正常乳腺组织的SUVmax与患者年龄无显著性相关（P＞0.05）。病灶与正常乳腺组织SUVmax与CT值、绝经状态无显著性相关（P＞0.05）。结论：乳腺病变患者年龄及病灶大小影响18F-FDG SUVmax，在疾病的良恶性鉴别时应引起关注。当病变组织密度发生较大变化时，18F-FDG PET可对乳腺肿物的良、恶性鉴别提供较可靠依据。     

术前MRI影像组学模型预测保乳手术治疗乳腺癌的可行性

目的 建立术前MRI影像组学模型，观察以之预测保乳手术(BCS)治疗乳腺癌的可行性。方法 纳入90例接受BCS治疗的乳腺癌患者，其中61例BCS成功(成功组)、29例失败(失败组);按2∶1将其分为训练集(n=60)和测试集(n=30),并于各集内划分亚组，比较组间及亚组间临床及MRI资料，提取并筛选MRI影像组学特征，构建模型，评估其预测BCS可行性的价值。结果 训练集2亚组间接受新辅助治疗情况、患侧乳房体积及有无子灶差异均有统计学意义(P均<0.05);测试集2亚组间肿瘤体积、患侧乳房体积及有无子灶差异均有统计学意义(P均<0.05)。最终以5个MRI组学特征及有无子灶建立影像组学模型，其预测训练集和测试集BCS可行性的曲线下面积分别为0.961和0.855。结论 术前MRI影像组学模型可用于预测以BCS治疗乳腺癌的可行性。     

健康教育对乳腺癌术后放疗皮肤反应的影响

目的：探讨健康教育对乳腺癌术后放疗皮肤反应的影响。方法：将225例乳腺癌术后放疗患者作为实验组进行有针对性的健康教育,将246例做常规护理的乳腺癌术后放疗患者作为对照组,比较两组患者放疗后皮肤反应的情况。结果：实验组在放疗后皮肤反应明显低于对照组（P＜0.05）。结论：运用护理程序对患者进行有针对性的健康教育,能有效减轻患者放疗后皮肤反应,减轻患者痛苦,提高生存质量。     

自制手爬墙工具在乳腺癌术后功能锻炼中的效果分析

目的总结自行研制的手爬墙工具在乳腺癌患者术后患侧上肢功能锻炼中的应用效果,从而规范该器械的制作规格、应用流程,推广该器械的使用,提高乳腺癌患者术后的生活质量。方法护士应用自制的手爬墙工具辅助乳腺癌患者进行术后患肢的功能锻炼,通过与传统的术后功能锻炼方法的对比,记录应用新的手爬墙工具后,患者在患肢功能和肌力的恢复情况、锻炼依从性及患肢功能恢复满意度等指标上改善是否存在优势。结果经统计发现,应用手爬墙工具辅助患肢功能锻炼后,患者患肢功能和肌力的恢复情况、锻炼依从性及患肢功能恢复满意度等指标均较应用传统锻炼方法的患者显著提高,差异具有统计学意义（P〈0．05）。结论自制的乳腺癌术后手爬墙工具不失为乳腺癌患者术后功能锻炼所必需的专业器具。该技术使用方法简便易掌握,锻炼效果直观,从而让护士在术后康复护理中有章可循,能动态掌握患者患肢功能恢复情况,值得在临床推广应用。     

Pregnancy- and lactation-associated breast cancer: mammographic and sonographic findings.

OBJECTIVE: To evaluate the mammographic and sonographic findings of pregnancy-associated breast cancer. METHODS: A total of 22 consecutive patients with breast cancer pathologically diagnosed during pregnancy (n = 10) or lactation (n = 12) were included in this study. The ages of the patients ranged from 26 to 49 years. Both mammography and sonography were performed on 12 patients; sonography only was performed on 7 patients; and mammography only was performed on 3 patients. Mammographic and sonographic findings were evaluated retrospectively. RESULTS: Mammography revealed positive findings in 13 (86.7%) of 15 patients, even though all 15 patients had dense breasts. Mammographic findings included masses (n = 5), masses with calcifications (n = 2), calcifications with axillary lymphadenopathy (n = 2), a mass with axillary lymphadenopathy (n = 1), calcifications alone (n = 1), asymmetric density alone (n = 1), and diffuse skin and trabecular thickening alone (n = 1). Sonographic findings were positive and showed masses for all 19 patients (100%). The common sonographic findings of masses were irregular shapes (n = 15), irregular margins (n = 16), parallel orientation (n = 11), complex echo patterns (n = 14, including marked cystic [anechoic] components [n = 4]), and posterior acoustic enhancement (n = 12). Surrounding tissue effects could be seen in 5 patients, including ductal changes (n = 2), Cooper ligament thickening (n = 1), edema (n = 3), and skin thickening (n = 3). Calcifications within or outside a mass (n = 7) and axillary lymphadenopathy (n = 8) were also detected. CONCLUSIONS: Although a mass could not be discernible by mammography because of increased radiodensity during pregnancy or lactation, calcification, asymmetric density, axillary lymphadenopathy, and skin and trabecular thickening were helpful for diagnosis of pregnancy-associated breast cancer. Sonographic findings of a solid mass with posterior acoustic enhancement and a marked cystic component were somewhat different from the appearance of breast cancer in nonpregnant women, possibly because of the physiologic changes of pregnancy and lactation.     

数字乳腺断层摄影鉴别诊断浆细胞性乳腺炎与乳腺癌

目的 评价数字乳腺断层摄影(DBT)鉴别诊断浆细胞性乳腺炎(PCM)和乳腺癌的价值.方法 回顾性分析47例PCM(PCM组,50个病灶)及159例乳腺癌(乳腺癌组,163个病灶)DBT表现,以病理结果为金标准,评价DBT诊断准确率.结果 PCM组28例(28/47,59.57％)病灶侧乳晕后导管扩张,主要表现为乳晕后多...     

后牙牙冠纵裂的修复治疗

目的：评估用修复的方法保存后牙牙冠纵裂牙齿的效果。方法：采用将纵裂牙齿复位固定，牙体治疗后，用铸造或烤瓷全冠的方法修复患牙。结果：100颗患牙，成功92颗(92％)，失败8颗(8％)。结论：用全冠修复后牙牙冠纵裂是保存纵裂牙齿的有效方法之一。     

男性乳腺癌超声及临床病理学表现

目的 观察男性乳腺癌超声及临床病理学表现。方法 纳入30例男性乳腺癌患者,观察其超声及临床病理学表现;根据有无淋巴结转移分为阳性组和阴性组并进行比较。结果 24例表现为单侧乳腺乳头周围无痛性肿物（24/30,80.00%）,可伴腋下肿物、乳晕及周围皮肤红肿破溃或乳头溢液;病理类型以浸润性导管癌（IDC）为主（22/30,73.33%）。30例中,28例超声检出乳腺病灶（28/30,93.33%）,多表现为形态不规则（25/28,89.29%）的低回声（24/28,85.71%）肿物,边缘多不光整（22/28,78.57%）,内部回声多不均（22/28,78.57%）,血流多较丰富,少见钙化（5/28,17.86%）或后方回声衰减（2/28,7.14%）。超声检出16例腋窝或锁骨上、下淋巴结肿大,均经病理证实为淋巴结转移（阳性组）;12例未见淋巴结肿大（阴性组）;组间仅乳腺肿物最大径差异有统计学意义（P<0.05）。雌激素受体（ER）和孕激素受体（PR）阳性率均为95.65%（22/23）。结论 男性乳腺癌临床多表现为单侧乳腺乳头周围无痛性肿物;超声多呈形态不规则的低回声肿物,边缘多不光整,内部回声不均,血流多较丰富;病理类型以IDC为主,ER、PR阳性率高而人表皮生长因子受体2（HER-2）阳性率甚低,过半呈Ki-67高表达。     

Application of the breast imaging reporting and data system final assessment system in sonography of palpable breast lesions and reconsideration of the modified triple test.

OBJECTIVE: The purpose of our study was to evaluate the utility of the American College of Radiology's Breast Imaging Reporting and Data System (BI-RADS) sonographic final assessment system and palpation-guided fine-needle aspiration (FNA) for evaluation of palpable breast lesions. METHODS: Our computerized database identified 160 palpable lesions of the breast in which follow-up palpation-guided FNA, targeted sonography, and pathologic confirmation were performed. We used BI-RADS sonographic data on all lesions. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of malignancy were calculated for sonography and palpation-guided FNA. Two-sample binomial proportion tests were used as the statistical analysis (P<.05). RESULTS: The FNA results were defined as benign, atypical cells, suspicious for malignancy, malignancy, and insufficiency. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90.9%, 82.7%, 84.3%, 57.7%, and 97.2%, respectively, on sonography and 75.8% to 90.9%, 82.7% to 98.4%, 84.3% to 94.4%, 57.7% to 92.6%, and 93.9% to 97.2% on FNA. There was no statistically significant difference for sensitivity and negative predictive value between the two examinations. CONCLUSIONS: The diagnostic accuracy of sonography was similar to that of palpation-guided FNA for not missing the malignancy. Clinical application of FNA results can be difficult, especially when the result is insufficiency or atypical cells. Moreover, FNA is invasive and overlaps other procedures. Therefore, we conclude that sonography can replace palpation-guided FNA for diagnosis of palpable lesions of the breast when the BI-RADS sonographic final assessment system is used appropriately.     

自动勾画临床靶区和危及器官用于制定早期乳腺癌保乳术后放疗计划

目的 观察自动勾画临床靶区(CTV)和危及器官(OAR)用于制定乳腺癌保乳术后放疗计划的可行性。方法 选取52例女性早期右侧乳腺癌保乳术后患者，由医师于胸部CT图像中手动勾画CTV和OAR。采用AccuLearning^TM软件对其中40例(训练集)CT图像进行训练，生成自动勾画模型，并以之对其余12例(测试集)CT图像进行自动勾画，辅以手动修改获得CTV及OAR;分别根据手动和自动勾画的CTV和OAR制定放疗计划，即Plan-RS和Plan-DL,对比其CTV及OAR剂量学参数及勾画时间。结果 测试集Plan-RS与Plan-DL的CTV剂量学参数差异均无统计学意义(P均>0.05);二者间健侧肺、心脏及健侧乳腺的平均放疗剂量(D_mean)差异有统计学意义(P均<0.05),其余OAR剂量学参数差异均无统计学意义(P均>0.05)。手动勾画和自动勾画CTV平均用时分别为1 006 s和239 s,前者长于后者(P<0.05);除脊髓外，自动勾画其他OAR用时较手动勾画缩短(P均<0.001)。结论 自动勾画CTV...     

Diagnosis of the intraductal component of invasive breast cancer: assessment with mammography and sonography.

OBJECTIVE: The aim of this study was to investigate mammographic and sonographic features and their sensitivities for depiction of the intraductal component associated with invasive ductal carcinoma (IDC). METHODS: During a 1-year period, 132 patients with IDC underwent surgical treatment. All patients underwent mammography and high-resolution sonography, and the findings were reported according to the American College of Radiology's Breast Imaging Reporting and Data System lexicon. Tumors were classified as "pure IDC" and "IDC with an intraductal component" by histopathologic evaluation. We compared mammographic and sonographic features between the above 2 groups and attempted to correlate them with histopathologic findings. We also investigated separate and combined sensitivities, specificities, and accuracies of both mammography and breast sonography for showing intraductal components. Finally, imaging measurements were compared with pathologic measurements. RESULTS: One hundred four (79%) of the 132 IDCs contained an intraductal component. Patients with IDC with an intraductal component showed calcifications on mammography and showed an echogenic halo, duct dilatation, calcifications, and increased vascularity in surrounding tissue on sonography more frequently than patients with pure IDC. The sensitivities of mammography, sonography, and their combined assessment for detection of an intraductal component were 55%, 80%, and 86%, respectively. The combined assessment (r = 0.90) measured the extent of the tumor more accurately than mammography (r = 0.71) or sonography (r = 0.79) separately. CONCLUSIONS: Combined assessment with mammography and sonography offers more accurate information for the presence of an intraductal component and the extent of a tumor than each separate assessment.     

渐进式康复训练对乳腺癌乳房重建患者上肢功能的影响

目的:研究渐进式康复训练对乳腺癌乳房重建术后上肢功能的影响。方法:将2021年11月～2022年5月进行乳腺癌乳房重建术的39例患者随机分为观察组20例和对照组19例,观察组接受渐进式康复训练,对照组接受常规护理。评估术后第1及3个月时患者上肢功能恢复情况。结果:与对照组相比,观察组在术后第1及3个月时肩前屈、外展活动度明显增加(P<0.05),上肢功能障碍问卷(DASH)评分下降(P<0.05)。2组均未出现手术切口不愈合、皮瓣坏死、假体取出的情况。结论:渐进式康复训练能改善乳腺癌乳房重建患者的肩部活动度,提高上肢功能,具有较好的安全性。