PROGNOSIS OF PATIENTS WITH BREAST CANCER RELATED TO THE TIMING OF OPERATION DURING MENSTRUAL CYCLE

Objective: To evaluate the effect of operation timing during menstrual cycle on the prognosis of patients with breast cancer. Methods: 218 operated premenopausal patients with breast cancer had been followedup for more than 10 years. Prognostic factors related to these patients had been selected to be underwent univariate analysis and multivariate analysis by Cox regression model. Results: Univariage analysis showed that the menstrual timing of operation, as other Known prognostic factors (tumor size, node status, histological grade, TNM classification, adjuvent systemic therapy, etc), had an influence on the patients' outcome. Multivariate analysis by Cox regression model indicated that diseasefree rate and overall survival rate of patients operated during the periovulatory phase (123 cases) were significantly superior to those operated during the premenstrual phase (95 cases) (P<0.01). There were no significant differences in prognosis between patients who received operations during the follicular phase (96 cases) and those during the luteal phase (122 cases) (P>0.01). Conclusion: Probably there is an optimal timing of operation for premenopausal breast cancer patients. Any prospective, randomized clinical study should be carried out to make this problem clear.

Psychological evaluation of patients after breast cancer surgery and care strategies improvement

Objective: The aim of the study was to investigate the level of self-image of patients after breast cancer surgery, and explore factors influencing self-image among patients who have experienced different types of surgeries, and set out a foundation for the improvement of care strategies. Methods: The 538 patients with primary breast cancer who underwent surgery in the Department of Breast Surgery, First Hospital of China Medical University, Shenyang, China, from January 2004 to January 2009 were included in the study. The psychological status of the patients was evaluated by body image after breast cancer questionnaire (BIBCQ), social support rating scale (SSRS), self-rating anxiety scale (SRAS), depression rating scale (DRS), and general information questionnaire. The factors influencing the self-image were selected by a stepwise regression analysis. Results: The patients who underwent breast-conserving surgery were the most satisfied with their body image, followed by those underwent surgery of modified radical mastectomy with reconstruction. However, cases treated by modified radical mastectomy without reconstruction had negative outcomes. Regardless of operation type, the self-image was influenced by anxiety, level of abuse by husband, and sexual satisfaction after operation. Conclusion: The self-image of patients who underwent different breast cancer surgeries was influenced by different factors, and individualized nursing should be offered in accordance with the specific situation.

ROC analysis of CT hemodynamic in the diagnosis of breast cancer

Objective:The aim of this study was evaluate the diagnostic value of computed tomography(CT) perfusion in breast cancer by the method of receiver operator characteristic curve(ROC) analysis.Methods:Eighty-one cases with breast masses found by health examination or mammography were scanned by multi-slice spiral CT(MSCT) perfusion and hemodynamic parameters of blood flow(BF), mean transit time(MTT) and blood volume(BV) were calculated by deconvolution arithmetic.According to the pathologic results, two groups, benign and malignant were classified and statistical analysis were performed between them.The ROC characteristics of BF, MTT, BV were compared for each and the diagnostic value of the hemodynamic parameters were confirmed.Results:In the malignant group, BF was(0.735 ± 0.440) mL/min/mL, MTT was(22.771 ± 7.647) s and BV was 0.234 ± 0.082.In the benign group, BF was(0.466 ± 0.527) mL/min/mL, MTT was(26.712 ± 12.934) s and BV was 0.179 ± 0.117.There was a significant difference for BF and BV between the benign and malignant groups.When the hemodynamic parameters were used to discriminate the breast lesions, the area under the ROC curve(AUCROC) of BF was 0.832 ± 0.086, the maximum, while AUCROC of BV was 0.695 ± 0.092.There was no significant statistical difference between BF and BV.AUCROC of MTT was 0.473 ± 0.102, which was minimal.Since the threshold of BF was 0.381 mL/min/mL, the sensitivity was 82.3%, the specificity was 73.2%, the positive likelihood ratio(LR) was 3.071 and the negative LR was 0.242.The threshold of BV was 0.190 with sensitivity 73.3%, specificity 56.5%, positive likelihood ratio 1.685 and negative LR 0.473.Conclusion:BF and BV among CT hemodynamic parameters have certain diagnostic value in breast cancer, but BF or BV can not yet be single index to confirm or deny the diagnosis.

A nomogram to predict adjuvant chemotherapy recommendation in breast cancer patients with intermediate recurrence score

Objective： The indication of adjuvant chemotherapy recommendation（ACR） in breast cancer patients with intermediate recurrence score（RS） is controversial. This study investigated the relationship between routine clinicopathological indicators and ACR, and established a nomogram for predicting the probability of ACR in this subset of patients.Methods： Data for a total of 504 consecutive patients with intermediate RS from January 2014 to December2016 were retrospectively reviewed. A nomogram was constructed using a multivariate logistic regression model based on data from a training set（378 cases） and validated in an independent validation set（126 cases）. A Youdenderived cut-off value was assigned to the nomogram for accuracy evaluation.Results： The multivariate logistic regression analysis identified that age, histological grade, tumor size, lymph node（LN） status, molecular subtype, and RS were independent predictors of ACR. A nomogram based on these predictors performed well. The P value of the Hosmer-Lemeshow test for the prediction model was 0.286. The area under the curve（AUC） values were 0.905 [95% confidence interval（95% CI）： 0.876–0.934] and 0.883（95%CI： 0.824–0.942） in the training and validation sets, respectively. The accuracies of the nomogram for ACR were84.4% in the training set and 82.1% in the validation set.Conclusions： We developed a nomogram to predict the probability of ACR in breast cancer patients with intermediate RS. This model may aid the individual risk assessment and guide treatment decisions in clinical practice.

Identification of an immune classifier for predicting the prognosis and therapeutic response in triple-negative breast cancer

Triple-negative breast cancer(TNBC)poses a significant challenge due to the lack of reliable prognostic gene signatures and an understanding of its immune behavior.Methods:We analyzed clinical information and mRNA expression data from 162 TNBC patients in TCGA-BRCA and 320 patients in METABRIC-BRCA.Utilizing weighted gene coexpression network analysis,we pinpointed 34 TNBC immune genes linked to survival.The least absolute shrinkage and selection operator Cox regression method identified key TNBC immune candidates for prognosis prediction.We calculated chemotherapy sensitivity scores using the“pRRophetic”package in R software and assessed immunotherapy response using the Tumor Immune Dysfunction and Exclusion algorithm.Results:In this study,34 survival-related TNBC immune gene expression profiles were identified.A least absolute shrinkage and selection operator-Cox regression model was used and 15 candidates were prioritized,with a concomitant establishment of a robust risk immune classifier.The high-risk TNBC immune groups showed increased sensitivity to therapeutic agents like RO-3306,Tamoxifen,Sunitinib,JNK Inhibitor VIII,XMD11-85h,BX-912,and Tivozanib.An analysis of the Search Tool for Interaction of Chemicals database revealed the associations between the high-risk group and signaling pathways,such as those involving Rap1,Ras,and PI3K-Akt.The low-risk group showed a higher immunotherapy response rate,as observed through the tumor immune dysfunction and exclusion analysis in the TCGA-TNBC and METABRIC-TNBC cohorts.Conclusion:This study provides insights into the immune complexities of TNBC,paving the way for novel diagnostic approaches and precision treatment methods that exploit its immunological intricacies,thus offering hope for improved management and outcomes of this challenging disease.

改良负压封闭引流装置对预防乳腺癌改良根治术后皮下积液和皮瓣坏死的应用价值研究

目的:探究分析改良负压封闭引流(VSD)装置对预防乳腺癌改良根治术后皮下积液和皮瓣坏死的应用价值。方法:选取2022年1月—2023年12月徐州医科大学附属医院收治的86例乳腺癌患者作为研究对象,根据随机数表法分为对照组和观察组,每组各43例。对照组实施双管持续中心负压引流球干预,观察组实施改良VSD装置引流干预。比较两组术后不同阶段引流量、疼痛程度[视觉模拟量表(VAS)]和舒适度[舒适量表(Kolcaba],比较两组并发症发生率(皮下积液、皮瓣坏死)和术后恢复情况。结果:观察组术后1 d、2 d、3 d的引流量及总引流量较对照组少、VAS评分较对照组低,差异有统计学意义(P<0.05);观察组术后1 d、2 d、3 d的Kolcaba评分较对照组高,差异有统计学意义(P<0.05);观察组皮下积液、皮瓣坏死发生率低于对照组,差异有统计学意义(P<0.05);观察组胸壁及腋窝引流管拔除时间、切口愈合时间、住院时间均较对照组短,差异有统计学意义(P<0.05)。结论:乳腺癌患者改良根治术后接受改良VSD装置干预,可减轻其痛感,提高舒适度,减少引流量,缩短引流管留置时间,且降低皮下积液和皮瓣坏死的发生,促进机体康复。

Combining DCE-MRI and 1H-MRS spectroscopy by <i>distribution free</i>approach results in a high performance marker: Initial study in breast patients

Magnetic Resonance Imaging has gained popularity in breast cancer diagnosis since the introduction of contrast media, and recent developments in MRI have demonstrated a new potential use in diagnosis. Indeed, the application of in vivo spectroscopy to mammary tissue has revealed that the spectral appearance of choline could be a marker of malignancy, but early diagnosis and unambiguous breast cancer characterization could benefit by a standardized protocol for the simultaneous use of Dynamic Contrast Enhancement MRI and Magnetic Resonance Spectroscopy and combined interpretation of associated markers. A total of 29 female patients took part in the study. The combined protocol was performed on a General Electric Signa HDtx 1.5 Tesla, and the DCE data analysis was performed through an evaluation of the ROI signal intensity over time. The MRS data analysis evaluated choline concentration and the signal to noise ratio of the choline peak. Sensitivity, specificity and accuracy were assessed by the Receiver Operating Characteristic methodology for Dynamic Contrast Enhancement, Magnetic Resonance Spectroscopy and their linear combination. We performed a linear combination of Dynamic Contrast Enhancement MRI and 1H-Magnetic Resonance Spectroscopy by distribution free approach to obtain a high level diagnostic index. Combining the results of the two diagnostic tests has resulted in a new, very effective, diagnostic index able to discriminate between patients with and without malignant disease.

罗伊纽曼理念的手术室护理改善乳腺癌麻醉患者睡眠质量的研究

目的:探究在对乳腺癌麻醉患者护理时开展罗伊纽曼理念的手术室护理对患者睡眠质量改善的作用。方法:选取2022年2月至2023年12月福建厦门大学附属第一医院乳腺癌手术患者88例作为研究对象,按照奇偶数分为对照组和观察组,每组44例。对照组手术期间开展常规护理,观察组开展罗伊纽曼理念的手术室护理。对患者手术期间睡眠质量、应对行为以及心理弹性等进行比较。结果:护理前,2组患者睡眠质量比较,差异无统计学意义(P>0.05),护理后,观察组评分较对照组低,差异有统计学意义(P<0.05)。护理前,2组患者应对行为评分比较,差异无统计学意义(P>0.05),护理后,观察组各维度评分高于对照组,观察组CD-RISC量表评分均高于对照组,差异有统计学意义(P<0.05)。结论:在对乳腺癌麻醉患者护理时开展罗伊纽曼理念的手术室护理,可以提升患者在手术期间睡眠质量,改善其心理状态以及应对行为,保障护理效果。

蒌慈散结方对人三阴性乳腺癌细胞MDA-MB-231及BT549的生长抑制作用及其机制研究

目的观察蒌慈散结方对三阴性乳腺癌细胞的干预效应,并探讨其发挥作用的可能靶点和机制。方法将不同类型三阴性乳腺癌细胞分别分为蒌慈散结方组及空白对照组,给予蒌慈散结方或PBS处理,观察药物干预后细胞形态变化,检测细胞活力、细胞凋亡情况,分析干预后细胞转录组及相关蛋白的表达变化。结果蒌慈散结方组乳腺癌细胞密度降低,细胞聚集,体积缩小,细胞碎片增多,细胞的正常边界消失,细胞质萎缩;与空白对照组相比,蒌慈散结方组三阴性乳腺癌细胞增殖减少,细胞凋亡增加(P<0.05)。转录组分析显示,蒌慈散结方干预后,差异基因富集于细胞因子相互作用、JAK/Stat等信号通路;Western Blot检测发现,蒌慈散结方干预后Stat3蛋白表达明显降低(P<0.05),Bim、Cleaved caspase-3蛋白表达显著增加(P<0.05)。结论蒌慈散结方可能通过下调Stat3蛋白,促进促凋亡蛋白Bim和cleaved caspase-3表达增加而诱导三阴性乳腺癌细胞凋亡。

乳腺癌根治术病人术后上肢淋巴水肿风险预测模型的构建及验证

目的:构建乳腺癌根治术病人术后上肢淋巴水肿的风险预测模型,并验证其预测应用效果。方法:选择2020年4月—2022年3月在徐州市妇幼保健院收治的乳腺癌根治术病人200例为训练集,采用Logistic回归分析筛选乳腺癌根治术病人术后上肢淋巴水肿的危险因素,据此构建风险预测模型;选取2022年4月—2023年4月收治的乳腺癌根治术病人50例为验证集,验证其预测效果。结果:训练集中共58例发生上肢淋巴水肿,发生率为29.00%;多因素分析结果显示,乳腺癌根治术病人术后上肢淋巴水肿的危险因素有体质指数(BMI)≥24 kg/m^(2)、肿瘤直径>5 cm、腋淋巴结清扫范围≥10个、术后辅助放疗、术后有并发症、术后无功能锻炼(P<0.05)。内部验证结果显示,ROC曲线下面积为0.863[95%CI(0.829,0.897),P<0.001];最佳风险截断值为24.38时,灵敏度为90.38%,特异度为85.73%,约登指数为0.761,模型预测准确率为84.00%。结论:本研究构建的风险预测模型能有效预测乳腺癌根治术后病人发生上肢淋巴水肿的风险。

剪接因子3B亚单位1在乳腺癌组织中的表达及与患者临床病理特征关系

目的:探讨剪接因子3B亚单位1(SF3B1)在乳腺癌组织中的表达及与患者临床病理特征的关系。方法:分析88例乳腺癌患者乳腺癌组织和癌旁组织SF3B1的表达水平,评估SF3B1对乳腺癌的诊断价值,比较SF3B1高表达组与低表达组临床病理特征差异。结果:乳腺癌组织SF3B1表达明显高于癌旁组织(P<0.05);SF3B1诊断乳腺癌的AUC为0.713;SF3B1诊断乳腺癌的最佳截断值为110.72。高表达组年龄明显高于低表达组,淋巴结转移为N 0的比例明显低于低表达组,两组病理学分级比较差异有统计学意义(P<0.05)。结论:SF3B1在乳腺癌组织中的表达明显上调,在诊断乳腺癌方面效能较好,与临床病理参数有关,可能参与了乳腺癌的发生、侵袭和转移过程的调控。

带蒂降支背阔肌肌皮瓣即刻乳房重建在乳腺癌患者中的应用研究

目的 探讨带蒂降支背阔肌肌皮瓣即刻乳房重建在乳腺癌患者中的应用效果。方法 以2022年1月至2024年6月在郑州大学第三附属医院行带蒂降支背阔肌肌皮瓣即刻乳房重建治疗的26例乳腺癌患者为研究对象,分析皮瓣存活率、手术效果优良率和术后并发症发生率。结果 随访结果显示,26例患者皮瓣均存活,手术效果中优14例,良11例,差1例。手术效果优良率为96.15%(25/26)。术后出现背部术区感染2例,背部术区和腋窝血肿2例,上肢水肿1例,并发症发生率为19.23%(5/26)。结论 带蒂降支背阔肌肌皮瓣即刻乳房重建在乳腺癌患者中应用疗效较好,患者术后皮瓣存活率高,修复效果好,具有临床应用价值。

疏肝益肾方治疗肝郁脾虚型绝经后雌激素受体阳性乳腺癌术后患者的临床疗效

目的观察疏肝益肾方治疗绝经后雌激素受体阳性乳腺癌术后患者内分泌治疗期的临床疗效。方法选取2021年7月~2023年9月上海市中医医院收治的行芳香化酶抑制剂内分泌治疗的110例绝经后乳腺癌术后患者,采用随机数字表法将其分为观察组和对照组,每组各55例。两组患者均给予基础治疗,观察组加用疏肝益肾方,对照组加用疏肝益肾方安慰剂,疗程均为12周。观察两组患者的临床疗效及中医证候积分、骨代谢、肿瘤标志物、T细胞亚群(CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))变化情况,并进行安全性评价。结果共106例患者完成试验,其中观察组与对照组各53例。治疗后,观察组临床总有效率为75.5%,对照组为58.5%,观察组的临床疗效优于对照组(P<0.01)。与治疗前比较,两组中医证候积分均有所降低(P<0.01)。治疗后,观察组患者的β-胶原特殊序列(β-c-terminal telopeptide of type-Ⅰcollagen,β-CTX)、糖类抗原125(carbohydrate antigen 125,CA125)、糖类抗原153(carbohydrate antigen 153,CA153)、CD8^(+)均较治疗前降低(P<0.05),骨钙素N端中分子片段(N-mid osteocalcin,N-MID)、CD4^(+)、CD4^(+)/CD8^(+)均较治疗前升高(P<0.01)。治疗后,观察组β-CTX、N-MID、CA153、CD8^(+)、CD4^(+)/CD8^(+)明显优于对照组(P<0.01)。结论疏肝益肾方可改善绝经后雌激素受体阳性乳腺癌术后患者内分泌治疗引起的骨代谢异常,降低血清肿瘤标志物水平,提高患者免疫功能,且安全有效。

护理干预在改良根治术后即刻背阔肌皮瓣乳房重建中的临床观察

目的探讨改良根治术后即刻背阔肌皮瓣乳房重建及护理干预对乳腺癌患者乳房外观美容效果的影响。方法回顾性分析安阳市肿瘤医院乳腺外科2022年1月至2023年8月收治的37例采用改良根治术后即刻背阔肌皮瓣乳房重建的患者,均统一进行围术期护理,观察术后乳房的外观的恢复及对其生活质量的影响,评估手术的安全性。结果手术后患者乳房整形有效率为89.19%,手术后出现皮瓣坏死1例(2.70%),皮下血肿2例(5.41%),包膜挛缩1例(2.70%),总发生率为4例(10.81%)。经术后3个月线下门诊随访发现,远处转移1例,复发转移2例,总复发3例(8.11%)。结论对于乳腺癌患者采用改良根治术后即刻背阔肌皮瓣乳房重建术后,乳房的整形效果较为美观,手术方式不增加患者术后并发症的发生风险,临床治疗效果较好。

乳腺癌改良根治术治疗乳腺癌的疗效及对激素水平的影响

目的探讨乳腺癌改良根治术对乳腺癌患者激素水平的影响。方法选取2020年1月—2021年12月江苏省连云港市赣榆区人民医院收治的100例乳腺癌患者为研究对象,根据信封法随机分成两组,每组50例。对照组行患侧乳腺切除术与前哨淋巴结活检术,观察组行乳腺癌改良根治术。对比两组患者手术相关指标、术后并发症(皮下积液、上肢水肿、皮瓣坏死)发生情况,随访1年后对比两组患者激素水平与复发情况。结果观察组手术时间长于对照组,差异有统计学意义(P<0.05)。两组术后并发症发生率和1年内的复发率对比,差异无统计学意义(P均>0.05)。观察组术后1年游离三碘甲腺原氨酸水平(4.47±1.60)pmol/L、血清游离甲状腺素(16.33±6.09)pmol/L高于对照组的(2.70±1.23)、(12.50±2.46)pmol/L,差异有统计学意义(t=6.202、4.123,P均<0.05)。结论乳腺癌改良根治术对乳腺癌患者的治疗作用突出,可提高患者术后激素水平,安全性较高。

乳腺癌根治术患者心理社会适应现状及与家庭关怀度和社会支持度的关系研究

目的:探讨乳腺癌根治术患者心理社会适应现状及其与家庭关怀度和社会支持度的关系。方法:选择2021年7月—2023年7月接受乳腺癌根治术患者85例,共发放问卷85份,有效回收80份,按照心理社会适应问卷[<132分纳入低适应组(47例),≥132分纳入中高适应组(33例)]、家庭关怀度指数问卷(APGAR)[≤3分纳入低关怀组(29例),4~10分纳入中高关怀组(51例)]、社会支持评定量表(SSRS)[<20分纳入低支持组(17例),20~40分纳入中高支持组(63例)]得分情况进行分组。比较不同分组患者的得分情况,并分析乳腺癌根治术患者心理社会适应现状与家庭关怀度、社会支持度的相关性。结果:共发放问卷85份,有效回收80份,回收率为94.12%。中高适应组心理社会适应问卷中的自尊和自我接纳、自我控制和自我效能感、归属感、态度各维度得分及总分高于低适应组(P<0.05),焦虑/抑郁得分低于低适应组,差异有统计学意义(P<0.05)。中高关怀组APGAR问卷中的适应度、亲密度、情感度、合作度、成长度各条目得分及总分高于低关怀组,差异有统计学意义(P<0.05)。中高支持组SSRS量表中的主观支持、客观支持、对支持的利用度各维度得分及总分高于低支持组,差异有统计学意义(P<0.05)。除焦虑/抑郁外,乳腺癌根治术患者心理社会适应问卷各维度得分与APGAR问卷、SSRS量表各维度得分均呈正相关(P<0.05),焦虑/抑郁与APGAR问卷、SSRS量表各维度得分均呈负相关(P<0.05)。结论:乳腺癌根治术患者心理社会适应现状不佳,提高家庭关怀度和社会支持度可能有利于改善患者心理社会适应能力。

补肾益气方对乳腺癌化疗后骨髓抑制及免疫功能影响的临床研究

目的探究补肾益气方对乳腺癌化疗后骨髓抑制及免疫功能的影响。方法选取解放军总医院第六医学中心2023年1月至2024年1月收治的110例经表柔比星+环磷酰胺序贯多西紫杉醇(EC-T)方案化疗的乳腺癌患者作为研究对象,采用随机方法分为对照组和观察组,各55例。其中对照组给予EC-T方案治疗,观察组在对照组基础上口服补肾益气方治疗。观察2组患者治疗前后血常规指标、细胞免疫功能、中医症状积分、生存质量评分(QLQ-C30)变化。结果治疗后,2组白细胞计数、中性粒细胞绝对值、血红蛋白、血小板计数水平均低于治疗前,但观察组均高于对照组(均P<0.05)。治疗后,2组CD_(3)^(+)、CD_(4)^(+)水平及CD_(4)^(+)/CD_(8)^(+)比值均低于治疗前,但观察组均高于对照组,CD_(8)^(+)水平均高于治疗前,但观察组低于对照组(均P<0.05)。治疗后,2组气短乏力、心悸失眠、头晕眼花、面色少华、畏寒肢冷、腰膝酸软积分均高于治疗前,但观察组均低于对照组(均P<0.05)。治疗7、20 d后,2组QLQ-C30评分均低于治疗前,但观察组均高于对照组[(75.2±2.1)分比(74.1±1.9)分、(78.9±2.2)分比(75.9±2.1)分](均P<0.05)。结论补肾益气方能够有效预防乳腺癌化疗后骨髓抑制情况,纠正化疗后免疫功能紊乱情况,同时亦能改善患者化疗后继发的临床症状,明显提高生存质量,可以作为乳腺癌化疗患者的辅助补充治疗。

手术室复合保温联合正念减压训练对行乳腺癌手术患者术中低体温和不良情绪的影响研究

目的探讨手术室复合保温联合正念减压训练对行乳腺癌手术患者术中低体温和不良情绪的影响。方法以接受手术治疗的60例乳腺癌患者作为研究对象,将其随机分为对照组(30例)和实验组(30例)。对照组常规访视患者,实验组以对照组为依据进行复合保温联合正念减压训练。对比两组患者体温变化和心理弹性。结果两组患者术前(T1)、麻醉时(T2)的体温无统计学差异(P>0.05);实验组术中0.5 h(T_(3))、术中1 h(T_(4))、术中2 h(T5)、术后(T6)的体温分别为(36.58±0.18)、(36.55±0.14)、(36.54±0.15)、(36.49±0.13)℃,均显著高于对照组的(36.14±0.12)、(35.81±0.13)、(35.25±0.15)、(34.14±0.12)℃,差异均有统计学意义(P<0.05)。训练后,两组患者的乐观、自强、坚韧评分及心理弹性总评分均升高,且实验组患者的乐观、自强、坚韧评分及心理弹性总评分分别为(17.26±3.78)、(32.87±4.06)、(50.24±5.67)、(100.37±7.64)分,均高于对照组的(13.56±3.34)、(24.69±3.64)、(38.97±4.57)、(76.22±8.34)分,差异均有统计学意义(P<0.05)。结论手术室应用复合保温联合正念减压训练,可以减少行乳腺癌手术患者术中发生低体温现象,提高心理弹性水平,从容应对手术,缓解患者术后压力,从而改善患者紧张焦虑的情绪,对行乳腺癌手术患者术中低体温和不良情绪具有积极作用,值得在临床上进行应用和推广。

乳腺癌根治术后早期应用微波热疗联合标准康复锻炼在防治患肢水肿中的临床研究

目的探索乳腺癌根治术后采用患肢标准康复锻炼联合早期应用915 MHz微波局部热疗,对防治患肢淋巴水肿的临床疗效。方法本研究中,选择2021年6月至2023年3月期间在南昌市人民医院接受乳腺恶性肿瘤根治术的200例患者作为研究对象,剔除4例因疾病进展退出的患者后,随机将剩余的196例患者分为观察组和对照组,每组各98例。对照组患者在乳腺恶性肿瘤根治术后仅接受标准的患肢康复锻炼,而观察组患者在接受标准康复锻炼的基础上,联合早期应用频率为915 MHz的微波局部热疗。微波热疗作用于患肢腋窝、锁骨三角区、颈部区域,输出功率为80~100 W,局部测温在39~42℃,60 min/次,3次/周,10次为1个疗程,共治疗2个疗程。两组患者分别于术后6个月、12个月、18个月回访观察患肢淋巴水肿程度。比较两组患者在干预前后患肢淋巴水肿的SAS和SDS评分、视觉模拟评分、手术相关不良事件发生率及护理服务满意度。结果治疗后,观察组在上肢淋巴水肿分级方面相比对照组有所下降,达到一个等级及以上的改善效果更为明显,具有统计学意义(P<0.05)。结论乳腺癌根治术后,患肢标准康复锻炼联合早期微波局部热疗相比单独进行标准康复锻炼,在减轻术后患肢淋巴水肿及改善临床症状方面具有更佳的临床效果,为乳腺癌手术后的康复治疗提供了一种新的有效方法。

超声定量参数与乳腺癌改良根治术后复发转移的关系

目的探究乳腺癌患者超声定量参数与其术后复发转移的关系。方法随机从2020年5月至2023年5月南京市中心医院和南京鼓楼医院接治的乳腺癌根治术治疗患者中筛选120例进行回顾性分析,参考随访复发转移情况分组,复发转移组、未复发转移组分别纳入42例、78例。对比2组临床资料和峰值强度(PI)、最大血流速度(Vmax)、阻力指数(RI)等超声定量参数,采用多因素Logistic回归与受试者工作特征(ROC)曲线分析PI、Vmax、RI与术后复发转移的关系及预测价值。结果对比未复发转移组,复发转移组的PI、Vmax、RI水平以及肿瘤直径>5 cm、淋巴结转移比例均显著升高(P<0.05);肿瘤直径>5 cm、淋巴结转移、Vmax升高、RI升高、PI升高均为影响乳腺癌改良根治术患者复发转移的独立危险因素(P<0.05);PI、Vmax、RI联合检测对乳腺癌改良根治术患者复发转移的诊断曲线下面积(AUC)显著高于单一检测(P<0.05)。结论超声定量参数是乳腺癌改良根治术患者复发转移的影响因素,超声定量参数可作为其临床预测指标,其具有较高应用价值。