Boosting functional rehabilitation of affected limb after modified radical mastectomy through compound functional exercises

目的 探讨复合功能锻炼法对改善乳癌改良根治术后患肢功能康复的作用.方法 将2010年3～8月住院患者分为对照组(128例),2010年9月至2011年2月住院的乳腺癌患者分为观察组(1 32例).对照组采用传统功能锻炼方法;观察组采用复合功能锻炼法:以病友活动室为平台,由乳癌术后患肢康复小组成员对患者患肢的功能康复进行功能锻炼操和康复器材使用的指导.结果 干预12周后,观察组患侧肩关节活动度显著优于对照组,患肢水肿发生率显著低于对照组(均P＜0.01).结论 乳癌改良根治术后患者采用复合功能锻炼法进行患侧肢体训练能有效改善肩关节活动度,促进淋巴液回流及患肢功能康复,提高生活质量.     

复合功能锻炼法促进乳癌术后患肢功能康复的研究

目的探讨复合功能锻炼法对改善乳癌改良根治术后患肢功能康复的作用。方法将2010年3～8月住院患者分为对照组(128例),2010年9月至2011年2月住院的乳腺癌患者分为观察组(132例)。对照组采用传统功能锻炼方法;观察组采用复合功能锻炼法:以病友活动室为平台,由乳癌术后患肢康复小组成员对患者患肢的功能康复进行功能锻炼操和康复器材使用的指导。结果干预12周后,观察组患侧肩关节活动度显著优于对照组,患肢水肿发生率显著低于对照组(均P<0.01)。结论乳癌改良根治术后患者采用复合功能锻炼法进行患侧肢体训练能有效改善肩关节活动度,促进淋巴液回流及患肢功能康复,提高生活质量。     

穴位按摩在乳腺癌改良根治术后术肢功能康复中的应用

目的探讨穴位按摩对乳腺癌改良根治术后术肢功能的效果,寻找能有效促进术肢功能恢复的方法。方法将60例患者按手术先后顺序按照随机数字表法分为对照组和观察组各30例。对照组患者乳腺癌术后按照常规进行患肢功能锻炼,观察组在患肢常规功能锻炼基础上实施穴位按摩。比较两组肩关节功能及上肢肿胀程度。结果肩关节功能评分比较,观察组术后第3、7、10天显著高于对照组,差异有统计学意义(P0.05);术肢容积比较,观察组术后第3、7、10天低于对照组,差异有统计学意义(P0.05)。结论穴位按摩可有效改善乳腺癌改良根治术患肢功能障碍,促进水肿消退,加快术肢功能康复。     

Early discharge after modified radical mastectomy

Thirty-nine patients underwent modified radical mastectomy and were discharged with their suction drains and sutures in place after a mean postoperative stay of 4.7 days. Drains and sutures were removed at the first office visit. There were no infections, and late seromas developed in only 21 percent of the patients. Another group of patients were hospitalized until drainage effluent from their tubes was less than 30 ml/day, at which time the drains were removed and the patients discharged. This group had a mean postoperative stay of 9.5 days, and an incidence of late seroma of 43 percent. These data suggest it is both safe and effective to discharge patients 3 to 5 days after mastectomy at considerable potential cost savings due to the reduced hospital stay.     

Axillary recurrence after modified radical mastectomy

Optimal management for axillary recurrence is poorly understood. The aim of this study was to evaluate the risk factors for overall survival in the patients with axillary recurrence. Data of 1098 patients were collected from breast cancer registers from Clinic for Oncology Nis between 1990-1995. All patients underwent modified radical mastectomy. Axillary recurence was diganosed in 43 (3.92%) patients. Most patients were presented with a localized, palpable axillary mass 30 (69.77%). Cox multivariate analysis of prognostic factors for breast cancer-specific survival showed that node status HR 4.69 (1.50 to 14.72), tumor size HR 3.18 (0.90 to 11.26) and axillary radiotherapy HR 1.99 (0.69 to 5.75) had statistically significant effect on breast cancer mortality. Log-rank (54.21 p < 0.001) analysis showed significant difference for overall survival among women with a axillary recurrence based on different cancer stages. Tumor size and node status were the most important prognostic factors in women with axillary recurrence.     

Seroma prevention after modified radical mastectomy.

The most common mastectomy-associated complication is seroma formation. Seromas can be associated with other more serious complications such as skin flap necrosis, delayed wound healing, infection, and lymphedema. The flap tacking procedure that closes the axillary fossa dead space and tacks the mastectomy flaps to the chest wall has been suggested as one potential technique to reduce the incidence of postmastectomy seromas. This institution-wide study of modified radical mastectomies demonstrated a significant decrease (P < 0.0381) in the incidence of seroma when flap tacking was performed. Women who developed a seroma, compared to those who did not, averaged nearly twice as any office visits in the first 2 months after the operation. Distribution of office visits between the seroma patients and nonseroma patients was significant (P < 0.0001). When practiced by several surgeons, the flap tacking procedure 1) reduces postmastectomy seromas and 2) reduces the amount of postoperative patient office visits and care.     

乳癌根治术后血清瘤的防治

目的 探讨乳癌根治术后血清瘤的防治措施。方法 将近5年改进方法乳癌根治术100例，与过去15年乳癌根治术236例术后发生的血清瘤进行对比研究。结果 乳癌根治术后血清瘤的发生率由17.0%下降至3.0%（P＜0.05）。43例血清瘤均发生在胸壁凹陷区（腋窝、胸骨旁、锁骨下、肋间）；液体成分检验与血液淋巴液成分基本一致，未见恶性细胞。发生原因主要为引流不当或不畅，包扎不当或过早松动者，经1－3次穿刺抽液加压包扎治愈者占95.4%，仅2.3%需切开引流治愈。结论 乳癌根治术后血清的发生与胸壁凹陷、皮瓣张力高、血液及淋巴液渗漏、引流不当或不畅、包扎不当或过早松动有关，术中仔细止血，结扎相关淋巴管，多根多部位负压引流，凹陷区纱垫加压包扎是关键性预防措施；反复多次穿刺抽液加压包扎，必要时切开引流是主要治疗方法。     

Modified radical mastectomy

Surgical management in the treatment of potentially curable breast cancer has changed from a radical to a more conservative approach. The most common procedure used at the present time is the modified mastectomy, which is discussed in detail in this article.     

男性盆腔部位肿瘤术后的阴茎康复

常见的男性盆腔部位肿瘤包括前列腺癌,膀胱癌和直肠癌,上述肿瘤患者在接受根治性手术后的阴茎勃起功能障碍(ED)发生率为25%~100%。造成术后ED的最大原因是神经血管束的受损,由此造成阴茎海绵体组织供氧减少,阴茎发生纤维化。术后早期的阴茎康复疗法能促进患者改善或恢复勃起功能。本文就目前男性盆腔部位肿瘤术后的阴茎康复做一综述。     

乳腺癌改良根治术

乳腺癌改良根治术:距肿瘤边缘约5 cm做梭形切口,在皮肤与浅筋膜间做皮瓣分离,上界为锁骨下缘,下界达肋弓处,内侧界近胸骨,外侧界为背阔肌前缘,将乳腺从胸大肌表面分离。打开胸锁筋膜,将胸大小肌向内上牵拉,显露腋窝。腋淋巴结整块切除后,保留胸大肌、胸小肌、胸前神经分支以及胸长和胸背神经。放置负压引流管。仔细伤口创面止血,缝合皮肤。     

乳腺癌术后乳糜漏的诊治分析

目的探讨乳腺癌术后乳糜漏的诊断及治疗方法,为该病提供有效治疗方法。方法回顾性分析1997年6月至2013年8月收治6例乳腺癌术后并发乳糜漏的诊治经过。结果 1例保守治疗治愈。5例行手术治疗,1例治愈,4例术后仍有乳糜漏,采用碘仿纱填塞漏口加压包扎、负压引流治愈。结论术中熟悉腋窝的解剖关系、彻底结扎淋巴管可以减少乳糜漏发生。禁食营养支持治疗、局部加压包扎、碘仿纱填塞和负压引流是治愈乳腺癌术后乳糜漏的有效方法。     

乳腺癌术后皮下积液的防治

摘要：将87例行乳癌根治术病人随机分组，分别采取皮瓣下引流加腋窝负压引流(实验组)和常规腋窝负压引流(对照组)两种不同的引流方法，观察比较两组患者皮下积液的发生情况。结果示实验组患者发生皮下积液者较对照组显著降低(P<0.05)。提示应用皮瓣下引流管方便、可靠，可有效的降低乳腺癌根治术后皮下积液的发生率。     

Non-tumour morbidity and mortality after modified radical mastectomy.

From 1985 to 1987 148 patients underwent mastectomy for breast cancer, of whom 91 underwent modified radical mastectomy. Of these patients (median age 60 years (range 31-86 years)), 89 have been assessed for early (< 30 days) and late (> 30 days) non-tumour morbidity and mortality. A total of 41 patients had nodal metastases. Adjunctive therapy used was tamoxifen in 70 patients and radiotherapy in 20. Overall, 47 patients (53%) developed a total of 75 complications, and there was one 30-day mortality. Of the patients, 26 developed one complication, 14 had two complications and 7 three complications. Early complications were lymphocoele/seroma (n = 22), wound infection (n = 9) and cardiopulmonary problems (five deep vein thrombosis, two pulmonary embolus (1 death), one myocardial infarct). Late complications were lymphoedema (n = 10), pectoralis major wasting (n = 6), frozen shoulder (n = 7), intercostobrachial neuralgia (n = 4), and a small number of self-limiting wound problems (n = 9). There were two late deaths (myocardial infarcts). Early complications were not related to nodal status, and late complications were related to neither nodal status nor radiotherapy. Significant morbidity is attached to radical surgery for breast cancer. Most complications are minor and self-limiting, but there are a small number of late complications which may affect quality of life.