Clinical outcome analysis of 98 elderly women with early-stage breast cancer undergoing modified radical mastectomy or simple mastectomy

Objective: The aim of our study was to analyze the clinical results and prognosis for early elderly patients after surgery and to explore the rational treatment. Methods: Between January 1992 and December 2008, 98 early elderly breast cancer patients aged ≥ 65 years were treated with surgery, of which 52 patients received modified radical mastectomy and 46 patients received simple mastectomy. Results: Sixty-four (65.3%) patients had comorbidities including coronary heart disease, hypertension, diabetes, etc. After a median follow up of 56 months (21 to 280 months), the 5-year cumulative survival rate of breast modified radical mastectomy group and mastectomy group were 84.0% and 82.7%, separately (P = 0.653). The 5-year recurrence rate were 3.8% and 8.1%, separately (P = 0.504). Conclusion: The simple mastectomy is suitable for the treatment of early elderly breast cancer patients for its lower complication and recurrence rate. Early old women with breast cancer may be safely treated by simple mastectomy. Our findings suggest that modified radical mastectomy does not significantly increase the overall survival.

Combined thoracic paravertebral block and interscalene brachial plexus block for modified radical mastectomy:A case report

BACKGROUND Modified radical mastectomy(MRM)is the most common surgical treatment for breast cancer.General anesthesia poses a challenge in fragile MRM patients,including cardiovascular instability,insufficient postoperative pain control,nausea and vomiting.Thoracic paravertebral block(TPVB)is adequate for simple mastectomy,but its combination with interscalene brachial plexus block(IBPB)has not yet been proved to be an effective anesthesia method for MRM.CASE SUMMARY We describe our experience of anesthesia and pain management in 10 patients with multiple comorbidities.An ultrasound-guided TPVB was placed at T2-T3 and T5-T6,and combined with IBPB,with administration of 10,15 and 5 mL of 0.5%ropivacaine,respectively.A satisfactory anesthetic effect was proved by the absence of ipsilateral tactile sensation within 30 min.Propofol 3 mg/kg/h and oxygen supplementation via a nasal cannula were administered during surgery.None of the patients required additional narcotics,vasopressors,or conversion to general anesthesia.The maximum pain score was 2 on an 11-point numerical rating scale.Two patients required one dose of celecoxib 8 h postoperatively and none reported nausea or emesis.CONCLUSION This case series demonstrated that combined two-site TPVB and small-volume IBPB with sedation can be used as an alternative anesthetic modality for MRM,providing good postoperative analgesia.

Effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy

Objective: To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anesthesia on the secretion of pain-related mediators after modified radical mastectomy. Methods: A total of 108 patients with breast cancer who were treated with modified radical mastectomy in this hospital between July 2015 and February 2017 were divided into the control group (n=54) and paravertebral block group (n=54) by random number table. Control group received routine general anesthesia, and paravertebral block group received ultrasound-guided thoracic paravertebral block combined with general anesthesia. The differences in serum levels of pain mediators, inflammatory factors and stress hormones were compared between the two groups of patients immediately after surgery (T0), 6h after surgery (T1), 12h after surgery (T2) and 24h after surgery (T3). Results: At T0, there was no statistically significant difference in serum levels of pain mediators, inflammatory factors and stress hormones between the two groups. At T1, T2 and T3, serum pain mediators NPY, PGE2 and 5-HT levels of paravertebral block group were lower than those of control group;serum inflammatory factors IL-1, IL-6, TNF-α and MCP-1 levels were lower than those of control group;serum stress hormones ACTH, Cor, AngⅠ and AngⅡ levels were lower than those of control group. Conclusion: ultrasound-guided thoracic paravertebral block combined with general anesthesia can effectively reduce the release of pain mediators and relieve the systemic inflammatory stress response after modified radical mastectomy.

Effect of Breast Conserving Sentinel Lymph Node Biopsy(SLNB)and Modified Radical Mastectomy on Patients with Early Breast Cancer

Objective:To study the clinical effect of breast conserving combined with sentinel lymph node biopsy and modified radical mastectomy in patients with early breast cancer.Methods:Female patients with early breast cancer in clinical stage I and II were selected as the main objects of this study,the study period started from July 2017 to July 2020.In the breast conserving and sentinel lymph node biopsy patients,50 cases were randomly selected as the experimental group;50 cases in the modified radical mastectomy patients were randomly selected as the control group.The clinical intervention effect of the two groups was analyzed.Results:the perioperative indexes of the experimental group were shorter than those of the control group,the patients recovered faster,the incidence of complications in the experimental group was lower,and the quality of life scores of the experimental group were significantly higher than those of the control group,and the difference was statistically significant,the intervention effect of the experimental group was also better.Conclusion:The application of breast conserving and sentinel lymph node biopsy in the treatment of early breast cancer can promote the recovery of patients,shorten the operation time and reduce the rate of complications,which has significant clinical significance.

Observation on the Therapeutic Effects of Qingre Shengji Ointment(清热生肌膏)on Acute Radiation Dermatitis After Modified Radical Mastectomy

Objective:To observe the curative effect of Qingre Shengji Ointment(清热生肌膏)on acute radiation dermatitis caused by radiotherapy after modified radical mastectomy.Methods:100 patients with radiotherapy after modified radical mastectomy in our hospital from June 2019 to December 2020 were randomly divided into treatment group and control group,with 50 cases in each group.The treatment group was given Qingre Shengji Ointment(清热生肌膏)on the basis of routine nursing,and the intervention began until one week after radiotherapy,while the control group was given routine nursing.Observe and record the occurrence time of acute radiation dermatitis,the degree of acute radiation dermatitis,changes of skin erythema,pruritus,pain,changes of interleukin-6(IL-6)and curative effect were evaluated.The degree of dermatitis was evaluated by RTOG grading standard,the erythema was evaluated by TCM symptom score,and pruritus and pain were evaluated by visual analogue scale(VAS).Blood routine,liver and kidney function,electrocardiogram and other safety indicators and adverse reactions were recorded before and after the study.Results:The time of acute radiation dermatitis was 6-11 days(median 8 days)in the treatment group and 8-14 days(median 10 days)in the control group(P<0.01).The degree and probability of acute radiation dermatitis in the treatment group were 82%(41/50)in grade I,16%(8/50)in grade II and 2%(1/50)in grade III.The degree and probability of acute radiation dermatitis in the control group were 54%(27/50)in grade I,40%(20/50)in grade II and 6%(3/50)in grade III(P<0.05).The highest TCM symptom score of skin erythema in the treatment group was lower than that in the control group(P<0.01).The results of generalized estimation equation show that,The VAS scores of pruritus and pain were(1.34±0.01)and(2.08±0.02)(Waldχ^(2)=1198.123,P<0.01)in the treatment group and(2.08±1.74)(Wald^(2)=1547.804,P<0.01)in the control group,respectively.Compared with the control group,the VAS scores of pruritus and pain were(1.14±0.01)and(2.08±1.74)(Wald^(2)=1547.804,P<0.01)in the treatment group.After observation,the curative effect of the treatment group was better than that of the control group(P<0.05),and the subjective symptoms of patients were obviously improved.After treatment,the level of IL-6 in the treatment group was significantly lower than that before treatment,and was lower than that in the control group(P<0.01).Conclusion:Qingre Shengji Ointment(清热生肌膏)can prevent and treat acute radiation dermatitis to some extent,and its mechanism may be to inhibit the release of inflammatory cytokines,reduce the degree of dermatitis,improve the quality of life of patients,and its safety is good.VAS score can subjectively evaluate the changes of itching and pain,and it is easy to use,so it is worthy of clinical application.

Effect of Ketamine Instillation on Acute and Chronic Post Mastectomy Pain, a Dose Finding Clinical Study

Background: Uncontrolled acute postoperative pain is considered a risk factor for the development of chronic pain afterward. Objectives: To explore the most effective dose of ketamine instillation (1 of 3 doses: 1, 2, or 3 mg/kg) for acute and chronic post mastectomy pain (PMP). Methods: Ninety female patients with cancer breast, aged (18 - 60 yrs), weighted (50 - 90 kg), scheduled for modified radical mastectomy, randomly allocated into 3 groups to receive ketamine instillation after surgical homeostasis before wound closure (1 of 3 doses;1, 2, or 3 mg/kg as A, B or C groups respectively) patients were followed up for 48 h for acute pain (total morphine consumption, the first request of analgesia and visual analog scale at rest and movement (VASR/M), chronic pain by Leeds assessment of neuropathic signs and symptoms (LANSS) for six-months, hemodynamics, and side effects. Results: Median total dose of morphine consumption was 8 mg (5 - 10) versus 6 mg (6 - 7) in A and B groups respectively in the first 48 h postoperatively. Lowest VASR/M was recorded in C then B and lastly A group (P = 0.037). No patients in the C group requested analgesia versus thirty (100%) and nine (30%) patients in the A and B groups respectively with the first request of analgesia was 12 h (5 - 36) in the A group versus 30 h (12 - 36) in the B group respectively (P Conclusion: Ketamine instillation effectively controlled acute post mastectomy pain (PMP) in a dose-dependent manner and reduced the incidence and severity of chronic pain in patients who undergoing a modified radical mastectomy.

乳腺癌综合治疗的疗效随访

目的观察经免疫组织化学分型的乳腺癌综合治疗疗效,为临床治疗提供参考。方法随访山西省肿瘤医院2010年1月至2012年12月治疗的1240例乳腺癌患者,其中导管型883例;人表皮生长因子受体-2(HER-2)型260例;三阴性乳腺癌(TNBC)97例。保乳术(BCS)或术前新辅助化疗,或术后放化疗的共275例;改良根治术(IRM)和术前新辅助化疗,或术后放化疗的共965例。BCS和IRM后,均行术后常规患侧全乳房、全胸壁调强放疗(IMRT)和锁骨淋巴引流区放疗,DT约50 Gy。腋窝淋巴转移阳性者,补照腋窝区DT 60~70 Gy。雌激素受体(ER)阳性者,行辅助性内分泌治疗。HER-2阳性者,加用曲妥珠单克隆抗体靶向药物治疗。结果BCS和IRM患者的五年生存率分别是81.8%和78.2%(P>0.05),其中腋窝淋巴结无转移者为91.8%;1~3个淋巴结转移者为74.0%;4个以上转移者为63.0%。4个以上淋巴结转移者和无转移者五年生存率差异具有统计学意义(P<0.01)。导管型五年生存率为98.0%;HER-2型为37.7%;TNBC型为17.5%。结论导管型对内分泌治疗敏感,预后最好;HER-2型对抗HER-2靶向药物有效,预后居中;TNBC型具有较强的侵袭性,且对内分泌和靶向药物治疗效果有限,预后最差。免疫组织化学分型和腋窝淋巴结转移数的多少,是影响预后的重要因素之一。

乳腺癌改良根治术患者近端肋间臂神经联合前锯肌平面阻滞临床效果观察

目的:探讨乳腺癌改良根治术患者近端肋间臂神经阻滞联合前锯肌平面阻滞(SAPB)的临床效果。方法:选择在全身麻醉下行乳腺癌改良根治术的患者60例,采用随机数字表法分为近端肋间臂神经阻滞联合SAPB组(联合组)和SAPB组(前锯肌组),每组30例。两组分别在全麻诱导后行超声引导下近端肋间臂神经阻滞联合前锯肌平面阻滞和前锯肌平面阻滞。采用视觉模拟评分法(VAS)记录患者术后30 min及2、4、8、24 h疼痛情况。记录术中瑞芬太尼使用总量、术后24 h舒芬太尼使用总量、补救镇痛时间、24 h内补救镇痛率以及不良反应情况。结果:与前锯肌组比较,联合组术后2、8 h的VAS评分降低,术中瑞芬太尼的使用量及术后舒芬太尼的使用量减少,总不良反应率降低,首次补救镇痛时间延长,24 h内补救镇痛率降低(均P<0.05)。结论:与前锯肌平面阻滞相比,近端肋间臂神经阻滞联合前锯肌平面阻滞可以减少围手术期阿片类药物使用,改善乳腺癌改良根治术患者术后镇痛效果。

体素内不相干运动成像联合动态增强MRI评估乳腺癌改良根治术后复发的价值

目的探讨体素内不相干运动成像(IVIM)联合动态对比增强磁共振成像(DCE-MRI)对乳腺癌改良根治术后复发的评估价值。方法采用前瞻性研究,选择拟行改良根治术的乳腺癌患者作为研究对象。所有患者术前均接受IVIM与DCE-MRI检查,检测IVIM参数[单纯水分子扩散系数(D值)、灌注分数(f值)、假性扩散系数(D^(*)值)]与DCE-MRI定量参数[容量转移常数(Ktrans)、血管外细胞外容积分数(Ve)、速率常数(Kep)],实施乳腺癌改良根治术治疗,随访1年,统计随访期间患者复发情况,分析乳腺癌患者术前IVIM参数及DCE-MRI参数与术后复发的关系。同时绘制受试者工作特征(ROC)曲线分析术前IVIM参数、DCE-MRI参数对乳腺癌患者术后复发的预测价值。结果共纳入105例乳腺癌患者,术后随访1年,复发34例,占比32.38%。复发组患者术前Ktrans、Kep高于未复发组,Ve低于未复发组,差异有统计学意义(P<0.05)。复发组患者术前D值低于未复发组,f值、D^(*)值高于未复发组,差异有统计学意义(P<0.05)。经过点二列相关性分析,术前Ktrans、Kep、f值、D^(*)值与乳腺癌患者术后复发呈正相关关系(γ>0,P<0.05);Ve、D值与乳腺癌患者术后复发呈负相关关系(γ<0,P<0.05)。绘制ROC曲线结果显示,Ktrans、Ve、Kep、D值、f值、D^(*)值单独预测乳腺癌患者术后复发的AUC均>0.7,联合预测的AUC>0.9,预测价值更高。结论术前IVIM与DCE-MRI检查对乳腺癌患者改良根治术后复发具有重要的评估价值,IVIM参数联合DCE-MRI定量参数可以作为乳腺癌患者改良根治术后复发的有效预测指标。

深圳地区119例乳腺癌患者术后佩戴义乳现状调查及影响佩戴质量的因素分析

目的:调查深圳地区乳腺癌术后患者的义乳佩戴情况,探讨影响义乳佩戴质量相关因素,为制定有效的护理决策提供依据。方法:通过“汝康云”乳腺癌康复俱乐部平台,采取网络微信调查问卷的形式,对2012年5月至2020年5月期间119例乳腺癌改良根治术后患者佩戴义乳相关认知内容进行调查,并分析调查的结果。结果:79.83%乳腺癌患者知道义乳的存在,52.10%患者有获取义乳佩戴的途径。80.00%的患者认为义乳可以改善形体缺失,达到美观作用;61.05%的患者认为可维持身体平衡;47.37%的患者认为还可保护胸部。半数以上(52.10%)的患者有佩戴义乳的需求,能够接受的义乳价位主要集中在>200~≤500元之间。结论:义乳佩戴的宣传力度不够、患者对义乳作用认识不全、患者对义乳佩戴需求差异可能是影响义乳佩戴的关键因素。

保留肋间臂神经与不保留肋间臂神经对乳腺癌改良根治术患者的影响

目的探讨保留肋间臂神经与不保留肋间臂神经对乳腺癌改良根治术患者的影响。方法根据手术方式的不同将152例乳腺癌改良根治术患者分为切除组(n=71)和保留组(n=81),切除组患者术中不保留肋间臂神经,保留组患者术中保留肋间臂神经。比较两组患者的围手术期指标、上肢感觉障碍发生情况、患侧上肢活动情况以及并发症发生情况。结果两组患者手术时间、术中出血量、淋巴结清扫数目、术后引流管拔除时间、术后住院时间及并发症总发生率比较,差异均无统计学意义(P﹥0.05)。术后1周,两组患者患侧上肢外展、后伸、前屈活动度均小于本组术前,保留组患者患侧上肢外展、后伸、前屈活动度均大于切除组,差异均有统计学意义(P﹤0.05)。保留组患者上肢感觉障碍总发生率为9.88%,低于切除组患者的25.35%,差异有统计学意义(P﹤0.05)。结论保留肋间臂神经与不保留肋间臂神经对乳腺癌改良根治术患者围手术期指标及并发症发生率的影响不大,但保留肋间臂神经对患者术后上肢感觉功能影响更小,患者患侧上肢活动度更大。

优质护理模式在乳腺癌改良根治术后患者中的应用效果

目的探讨优质护理模式在乳腺癌改良根治术后患者中的应用效果。方法回顾性选取2021年7月至2023年6月泰安市肿瘤防治院肿瘤科收治的157例乳腺癌患者为研究对象,根据护理方案的不同分为干预组(75例)和对照组(82例)。干预组采用优质护理方案,对照组采用常规护理方案。比较两组焦虑自评量表(SAS)、抑郁自评量表(SDS)、生活质量评分及护理总满意率。结果干预后,干预组的SAS、SDS评分低于对照组,差异有统计学意义(P<0.05)。干预后,干预组的功能领域、症状领域和特异性症状评分高于对照组,差异有统计学意义(P<0.05)。干预组护理总满意率高于对照组(P<0.05)。结论优质护理模式能够改善乳腺癌改良根治术后患者的心理状态和生活质量,提高患者满意度。

乳腔镜下行保留乳头乳晕复合体的乳腺癌改良根治手术在女性早期乳腺癌患者中的应用效果

目的探讨乳腔镜下行保留乳头乳晕复合体的乳腺癌改良根治手术(MRM)在早期乳腺癌患者中的治疗效果。方法选取2021年1月—2023年9月白银市第一人民医院及甘肃省第三人民医院收治的80例早期乳腺癌患者为研究对象,根据所采用手术方法不同将研究对象分为对照组和观察组。对照组(n=41)行乳腺癌改良根治术,观察组(n=39)行乳腔镜下保留乳头乳晕复合体的MRM。对比两组围术期指标、肿瘤标志物、乳房外观满意度及生活质量。结果观察组术中出血量少于对照组,引流时间短于对照组,组间差异有统计学意义(P<0.05)。术前及术后3个月,两组癌胚抗原、糖类抗原125水平比较,组间差异无统计学意义(P>0.05)。观察组乳房外观满意率高于对照组,差异有统计学意义(P<0.05)。术后3个月,观察组乳腺癌生活质量量表各个维度评分均高于对照组,组间差异有统计学意义(P<0.05)。结论乳腔镜下保留乳头乳晕复合体的MRM治疗早期乳腺癌,患者术后恢复快,可提高乳房外观满意度,增强生活质量。

1例双侧乳腺癌不同术式后保留PICC患者的护理

总结1例行左侧乳腺癌改良根治术、右侧乳房重建术患者成功保留患肢PICC的护理经验。护理重点包括术前多学科评估保留PICC的利弊,制定和实施周密的综合护理方案;加强对症管理、康复锻炼,加强营养支持及心理康复;强化延续护理。结果患者术后住院18 d,切口愈合好,携带PICC出院。出院后继续相关治疗至治疗结束拔除PICC,共留置338 d(入院前留置128 d,住院期间留置85 d,出院后留置125 d),未发生PICC相关并发症。

乳腺癌改良根治术后即刻行背阔肌肌皮瓣Ⅰ期乳房重建术对乳腺癌患者围术期指标及生活质量的影响

目的分析乳腺癌改良根治术后即刻行背阔肌肌皮瓣Ⅰ期乳房重建术对乳腺癌患者围术期指标与生活质量的影响。方法回顾性分析2021年3月—2023年10月于白银市第一人民医院及甘肃省第三人民医院接受乳腺癌改良根治术治疗的140例乳腺癌患者的临床资料,根据手术方式不同将其分为对照组和试验组,每组70例。对照组患者接受乳腺癌改良根治术治疗,试验组患者在对照组基础上接受背阔肌肌皮瓣Ⅰ期乳房重建术治疗。比较两组的围术期指标、并发症发生情况、生活质量、应激反应、焦虑抑郁情况。结果术前,两组生活质量、应激反应、焦虑抑郁情况比较,组间差异无统计学意义(P>0.05);两组开始辅助化疗时间、术后引流时间、并发症发生率比较,组间差异无统计学意义(P>0.05);试验组术中出血量多于对照组,手术时间长于对照组,组间差异有统计学意义(P<0.05);术后6个月,试验组乳腺癌患者生命质量测定量表中功能情况、生理状况、情感状况、社会家庭状况、附加关注评分均高于对照组,组间差异有统计学意义(P<0.05);术后1 d,试验组超氧化物歧化酶水平高于对照组,皮质醇水平低于对照组,组间差异有统计学意义(P<0.05);术后1 d,试验组汉密尔顿焦虑量表、汉密尔顿抑郁量表评分分别为(10.36±2.14)分、(10.95±2.39)分,均低于对照组的(15.42±3.51)分、(15.64±3.92)分,组间差异有统计学意义(P<0.05)。结论乳腺癌改良根治术后即刻行背阔肌肌皮瓣Ⅰ期乳房重建术治疗,会增加患者术中出血量与手术时间,可改善患者生活质量及应激反应,减轻其焦虑抑郁情况。

改良根治术与保乳手术治疗早期乳腺癌的疗效及术后并发症观察

目的探讨改良根治术与保乳手术治疗早期乳腺癌的疗效及术后并发症情况。方法78例早期乳腺癌患者,按手术方法的不同分为对照组与观察组,每组39例。对照组使用改良根治术进行治疗,观察组使用保乳手术进行治疗。比较两组手术指标、并发症发生情况、复发情况、乳房美容效果、生活质量。结果观察组术中出血量(268.45±32.16)ml、术后引流量(170.95±28.37)ml均少于对照组的(433.54±50.27)、(382.62±52.08)ml,手术时间(162.31±23.05)min、住院时间(12.13±2.65)d均短于对照组的(221.47±29.26)min、(15.48±3.16)d(P<0.05)。观察组并发症发生率7.69%明显低于对照组的38.46%(P<0.05);观察组1年复发率与对照组相当(P>0.05)。观察组乳房美容优良率94.87%明显高于对照组的74.36%(P<0.05)。术后6个月,观察组生理状况、功能状况、社会状况、情感状况、附加关注、睡眠状况、依从状况评分均高于对照组(P<0.05)。结论改良根治术与保乳手术对早期乳腺癌的根治效果相当,但保乳手术创伤更小,术后并发症发生率低,美容效果好,能更好的提升生活质量。

心理资本干预模型的团体护理对乳腺癌改良根治术患者负面情绪及自我效能干预的效果

目的 探究在对乳腺癌改良根治术患者护理过程中实施心理资本干预模型的团体护理对于改善患者负面情绪以及提升自我效能的作用。方法 在2022年2月至2022年12月本院乳腺癌改良根治术患者中抽选43例为对照组,2023年1月至2023年6月选择同类型病例43例为观察组,对照组治疗期间开展常规护理支持,观察组开展心理资本干预模型的团体护理。针对患者在术后恢复期间负面情绪、自我效能以及心理弹性等方面改善情况进行分析。结果 对比患者负面情绪,干预前BDI、BAI评分两组差异无统计学意义(P> 0.05),干预后观察组低于对照组,差异有统计学意义(P <0.05)。对比两组自我效能,在SUPPH量表评分方面,干预前两组差异无统计学意义(P> 0.05),干预后观察组各维度评分均高于对照组,差异有统计学意义(P <0.05)。对比两组心理弹性,观察组在CD-RISC量表评分上,干预后各维度评分均高于对照组,差异有统计学意义(P <0.05)。对比两组治疗期间生活质量,在QOL-BREF量表评分上,干预前两组差异无统计学意义(P> 0.05),干预后观察组评分高于对照组,差异有统计学意义(P <0.05)。对比患者恢复期间并发症发生率,观察组低于对照组,差异有统计学意义(P <0.05)。结论 在对乳腺癌改良根治术患者护理过程中开展心理资本干预模型的团体护理可以改善患者负面情绪,增加患者自我效能以及心理弹性,提升患者在恢复期间生活质量,降低并发症发生率,有助于患者恢复。

乳腺癌改良根治术研究进展

乳腺癌是目前我国女性发病率和死亡率较高的癌症之一,由于发病前期无明显自觉症状,通常就医时癌变肿块已较大,故常采用以手术切除为主,化疗、放疗等多种治疗方式为辅的综合诊治方式。目前,乳腺癌改良根治术在我国仍是乳腺癌患者手术治疗的首选。随着医学的进步,乳腺癌改良根治术在区域神经阻滞、缩小切除范围和乳房重建等方面都取得了新的进展。

改良根治术与保乳手术治疗早期乳腺癌患者的临床效果对比

目的对比改良根治术与保乳手术治疗早期乳腺癌患者的临床效果。方法将110例早期乳腺癌患者随机分为对照组(n=55)和观察组(n=55)。对照组采用改良根治术治疗,观察组采用保乳手术治疗,比较两组患者的手术相关指标、并发症发生情况及远期预后情况。结果观察组手术时间和住院时间均短于对照组,术中出血量少于对照组(P<0.05)。观察组并发症发生率为7.27%,明显低于对照组的23.64%(P<0.05)。术后2年,两组局部复发率(7.27%vs.3.64%)及远处转移率(3.64%vs.1.82%)比较,差异无统计学意义(P>0.05)。结论早期乳腺癌患者采用改良根治术与保乳手术治疗的远期预后相当,但保乳手术可明显缩短患者手术时间、住院时间,减少患者术中出血量,降低并发症发生率。

摆位误差对乳腺癌术后放疗患者心脏剂量影响

目的研究模拟摆位误差对左侧乳腺癌患者术后放疗心脏受照剂量的影响。方法选取17例左侧乳腺癌根治术后进行调强放疗的患者为研究对象。在计划系统中,模拟靶区中心相对于计划射野中心的偏移,包括向颅(S)、尾(I)、左(L)、右(R)、前(A)和后(P)各移动5 mm,并评估心脏受照剂量,分析不同方向的摆位误差对心脏剂量的影响。结果原始计划心脏平均剂量(Dmean)为5.72 Gy。射野中心向6个不同方向移动5 mm后,L、A、S方向心脏受照剂量减少,R、P、I方向心脏受照剂量增加,P方向心脏Dmean增加(1.46±0.24)Gy,R方向心脏Dmean增加(1.14±0.17)Gy,I方向心脏Dmean增加(0.43±0.25)Gy。结论左侧乳腺癌改良根治术后放疗,向R、P、I方向的摆位误差可增加心脏受照剂量,向L、A、S方向的摆位误差可减少心脏受照剂量。