New concepts in axillary management of breast cancer

In the last decades, surgical treatment of breast cancer has evolved from more extensive procedures like radical mastectomy to less invasive breast conserving surgery. Similarly, surgical management of axilla has enormously changed from routine axillary dissection to sentinel lymph node biopsy. Traditional surgical approach to the axilla in case of sentinel lymph node negativity is to avoid completion axillary dissection. However, surgeons even avoid performing axillary dissection in selected patients with positive sentinel lymph node in clinical practice depending on the recent randomized controlled studies supporting this concept. All of the recent changes in the management of positive axilla necessitate surgeons to refresh their knowledge on this challenging topic.

Axillary “Exclusion”—A Successful Technique for Reducing Seroma Formation after Mastectomy and Axillary Dissection

Introduction: A seroma is the commonest complication of breast cancer surgery, and although its consequences most often cause no more than discomfort and anxiety, more important sequelae include flap necrosis and wound breakdown. Infection developing within seroma increases morbidity and often results in the need for re-admission, re-imaging, drainage and antibiotic usage. Numerous methods to reduce post-mastectomy seroma formation have been tried with no consistent success. Methods: 24 consecutive patients undergoing mastectomy and axillary clearance were recruited before and after a departmental change in practice. At the point of skin closure, patients either underwent “axillary exclusion” or not. Total drain outputs were recorded by community district nursing staff for all patients. At the first post-operative visit, the presence and severity of seroma was recorded. Results: 24 patients were included (study group 14, control group 10). Age, size of tumour, and number of positive lymph nodes and laterality were comparable between groups. Mean drain output for the entire group was 471 ml (3 - 1030 ml) over 5.21 days. The control group had a drain output of 763.5 ml (95%CI 674.2 - 852.8) while the study group had a mean drainage of 262.2 ml (95%CI 161.9 - 362.5), a reduction of over 65%, p < 0.001. 15 (62.5%) out of 24 patients developed seroma. 42.9% of the study group and 90% of the control group developed seroma, p < 0.01. Conclusion: Seromas are a common complication following mastectomy and axillary clearance. Our technique of axillary exclusion has resulted in significantly reduced drainage volumes and fewer seromas.

Metastasis in an axillary lymph node in hepatocellular carcinoma:a case report

INTRODUCTIONAlthough hepatocellular carcinoma oftenmetastasizes to regional lymph nodes,spread tomore distant lymph nodes is rare.Involvementof axillary lymph nodes by metastases appears not tohave been documented.We report a patient withhepatocellular carcinoma (HCC) with a metastasisin a lymph node in the right axilla,and discusspossible routes by which such spread might occur.

Multiple Calcifying Epitheliomas of Malherbe’s of Axilla: A Case Report of Rare Variety

Pilomatrixoma, a rare benign tumour of sebaceous gland is commonly known as calcifying epithelioma of Malherbe or Tricholemmal cyst. We came across even the rarest form of this benign tumour of skin. Our case report was interestingly detected at a higher age group, unusual site of the body, multiple in nature following postoperative incision drainage of abscess in left axilla.

Early application of percutaneous neuromuscular electric stimulation in interfering motor function of limbs and difference in temperature of axilla of patients with ischemic stroke

BACKGROUND： Temperature of axilla could be affected due to motor dysfunction of limbs and neural changes of vessel after ischemic stroke. OBJECTIVE： To observe the effect of percutaneous neuromuscular electric stimulation （PNES） on difference in temperature of axilla and analyze the relationship between function of limbs and difference in temperature of axilla. DESIGN： Randomized grouping and controlled observation SETTING： Department of Neurology, General Hospital of Shenyang Military Area Command of Chinese PLA PARTICIPANTS： Sixty patients with ischemic stroke were selected from Neurological Department of General Hospital of Shenyang Military Area Command of Chinese PLA from January to June 2003. All cases were diagnosed with clinical diagnosis criteria of ischemic stroke established by the Fourth Chinese Classification of Cerebrovasular Disease and CT examination and received neuromuscular electric stimulation （NES）. Patients were randomly divided into control group and treatment group with 30 in each group. METHODS： Control group： Patients received routinely neurological therapy. Treatment group： Except routine therapy, patients suffered from NES at 48 hours after hospitalization. NMT-91 NES equipment was used to stimulated injured limbs with low frequency once 30 minutes a day in total of 10 times a course, especially extensor muscle of upper limb and flexor muscle of lower limb. Prescription of hemiplegia was internally decided by equipment with the output frequency of 200 Hz. Intensity of electric output could cause muscle contraction. The therapy needed two or three courses. Temperature of bilateral axilla was measured every day to calculate the difference with the formula of （temperature of axilla on the injured side - temperature of axilla on the healthy side）. Motor function of limbs was measured with FugI-Meyer Motor Assessment （FMA） during hospitalization and at 2 and 4 hours after hospitalization. Among 90 points, upper and lower limb function was 54, equilibrium function 10, sensory function 10, and motion of joint 16. The higher the scores were, the better the function was. Correlation of data was dealt with linear correlation analysis. MAIN OUTCOME MEASURES ： Assessment and correlation between difference in temperature of axilla and motor function of injured limbs during hospitalization and at 2 and 4 weeks after hospitalization. RESULTS： All 60 patients with ischemic stroke were involved in the final analysis. ① Difference in temperature： Difference of 2 and 4 weeks after hospitalization was lower than that in control group and at just hospitalization [treatment group： （0.056±0.000）, （0.024±0.003） ℃; control group： （0.250±0.001）, （0.131 ±0.001）℃; hospitalization; （0.513±0.001） ℃, P 〈 0.05-0,01]. ② FMA scores： Scores of 2 and 4 weeks after hospitalization were higher than those in control group and at just hospitalization [treatment group; （43.50±15.09）, （67.97 ±18.21） points; control group： （33.33 ±13.54）, （40.87±19.34） points; hospitalization： （26.43 ±11.87） points, P 〈 0.05-0.01]. ③ Correlation： Difference in temperature of axilla was negative correlation with FMA scores （c=- -0.255 1, P 〈 0.05）. CONCLUSION： ① PNES can accelerate recovery of limb function and decrease temperature of axilla of patients with ischemic stroke. ② The lower the difference in temperature is, the better the functional recovery is.

Effect of SAM junctional tourniquet on respiration when applied in the axilla: A swine model

Purpose:SAM junctional tourniquet(SJT)has been applied to control junctional hemorrhage.However,there is limited information about its safety and efficacy when applied in the axilla.This study aims to investigate the effect of SJT on respiration when used in the axilla in a swine model.Methods:Eighteen male Yorkshire swines,aged 6-month-old and weighing 55-72 kg,were randomized into 3 groups,with 6 in each.An axillary hemorrhage model was established by cutting a 2 mm transverse incision in the axillary artery.Hemorrhagic shock was induced by exsanguinating through the left carotid artery to achieve a controlled volume reduction of 30% of total blood volume.Vascular blocking bands were used to temporarily control axillary hemorrhage before SJT was applied.In Group I,the swine spontaneously breathed,while SJT was applied for 2 h with a pressure of 210 mmHg.In Group II,the swine were mechanically ventilated,and SJT was applied for the same duration and pressure as Group I.In Group III,the swine spontaneously breathed,but the axillary hemorrhage was controlled using vascular blocking bands without SJT compression.The amount of free blood loss was calculated in the axillary wound during the 2 h of hemostasis by SJT application or vascular blocking bands.After then,a temporary vascular shunt was performed in the 3 groups to achieve resuscitation.Pathophysiologic state of each swine was monitored for 1 h with an infusion of 400 mL of autologous whole blood and 500 mL of lactated ringer solution.Tb and T0 represent the time points before and immediate after the 30% volume-controlled hemorrhagic shock,respectively.T30,T60,T90 and T120,denote 30,60,90,and 120 min after T0(hemostasis period),while T150,and T180 denote 150 and 180 min after T0(resuscitation period).The mean arterial pressure and heart rate were monitored through the right carotid artery catheter.Blood samples were collected at each time point for the analysis of blood gas,complete cell count,serum chemistry,standard coagulation tests,etc.,and thromboelastography was conducted subsequently.Movement of the left hemidiaphragm was measured by ultrasonography at Tb and T0 to assess respiration.Data were presented as mean±standard deviation and analyzed using repeated measures of two-way analysis of variance with pairwise comparisons adjusted using the Bonferroni method.All statistical analyses were processed using GraphPad Prism software.Results:Compared to Tb,a statistically significant increase in the left hemidiaphragm movement at T0 was observed in Groups I and II(bothp<0.001).In Group III,the left hemidiaphragm movement remained unchanged(p=0.660).Compared to Group I,mechanical ventilation in Group II significantly alleviated the effect of SJT application on the left hemidiaphragm movement(p<0.001).Blood pressure and heart rate rapidly increased at T0 in all three groups.Respiratory arrest suddenly occurred in Group I after T120,which required immediate manual respiratory assistance.PaO_(2) in Group I decreased significantly at T120,accompanied by an increase in PaCO_(2)(both p<0.001vs.Groups II and III).Other biochemical metabolic changes were similar among groups.However,in all 3 groups,lactate and potassium increased immediately after 1 min of resuscitation concurrent with a drop in pH.The swine in Group I exhibited the most severe hyperkalemia and metabolic acidosis.The coagulation function test did not show statistically significant differences among three groups at any time point.However,D-dimer levels showed a more than 16-fold increase from T120 to T180 in all groups.Conclusion:In the swine model,SJT is effective in controlling axillary hemorrhage during both spontaneous breathing and mechanical ventilation.Mechanical ventilation is found to alleviate the restrictive effect of SJT on thoracic movement without affecting hemostatic efficiency.Therefore,mechanical ventilation could be necessary before SJT removal.

无充气经腋窝入路腔镜下甲状腺肿瘤切除术的临床效果

目的 探讨无充气经腋窝入路腔镜下甲状腺肿瘤切除术的临床效果。方法 选取盐城市第一人民医院2020年8月至2022年8月进行甲状腺肿瘤切除术的84例患者病例资料进行回顾性分析,根据手术方式不同,无充气甲状腺肿瘤切除术的患者41例为腔镜组,开放性甲状腺肿瘤切除术患者43例为开放组。对比两组手术相关指标、术后并发症以及患者对术后切口的满意度。结果相比较开放组,腔镜组患者术中出血量较多,手术时间较长,术后血钙较高,术后48 h引流量较多,住院时间较长,差异均有统计学意义(P <0.05);两组淋巴结清扫数目、术后甲状旁腺激素水平差异无统计学意义(P> 0.05)。两组术后并发症发生率差异无统计学意义(P> 0.05)。腔镜组术后切口满意度高于开放组(P <0.05)。结论 无充气经腋窝入路腔镜下甲状腺肿瘤切除相对开放手术不影响手术根治效果,且切口隐蔽,患者满意度高。

综合干预对达芬奇机器人经腋窝乳晕入路甲状腺全麻手术患者情绪及疼痛的影响

目的:探讨综合干预对机器人经腋窝乳晕入路甲状腺全麻手术患者情绪及疼痛的影响效果。方法:选取2021年1月—2023年6月于空军军医大学第一附属医院行达芬奇机器人经腋窝乳晕入路甲状腺全麻手术的122例患者作为研究对象,采用随机数表法将其分为对照组和研究组,每组各61例。对照组实施常规护理干预,研究组实施综合护理干预。比较两组患者不良情绪、疼痛、舒适度及并发症。结果:与干预前相比,两组患者干预后汉密顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)评分均降低(P<0.05),简化舒适状况量表(GCQ)各维度评分均升高(P<0.05),且研究组患者干预后HAMA、HAMD评分比对照组更低(P<0.05);两组患者疼痛率相比,研究组Ⅰ度疼痛率高于对照组,差异具有统计学意义(P<0.05);而研究组Ⅲ度疼痛率低于对照组,差异具有统计学意义(P<0.05);研究组并发症发生率低于对照组(P<0.05)。结论:综合护理干预应用于达芬奇机器人经腋窝乳晕入路甲状腺全麻手术患者,可改善其不良情绪,减轻疼痛,提高舒适度,降低并发症。

色素性乳房外Paget病

报告1例发生于左腋下部位的色素性乳房外Paget病。患者女,35岁。4年前发现左腋下棕黑色斑疹,缓慢增大,偶有痒感。皮肤科检查:左侧腋窝不规则棕黑色斑疹,局部皮肤轻度浸润感,表面稍粗糙。皮损组织病理检查:表皮轻度角化过度,棘层增生肥厚,棘层内可见散在和成巢分布的肿瘤细胞,肿瘤细胞体积较大,胞质丰富透亮,部分细胞核深染,未突破基底膜。肿瘤细胞之间的角质形成细胞内含较多色素。真皮浅层血管周围少量淋巴组织细胞浸润。免疫组化:肿瘤细胞显示细胞角蛋白(CK)7(+)、上皮膜抗原(EMA)(+)、癌胚抗原(CEA)(+)、CK20(-)、S-100蛋白(-)、melan-A(-)及sox-10(-)。诊断:色素性乳房外Paget病。治疗:手术扩大切除皮损,随访至今无复发。

不同剂量局麻药对超声引导腋路臂丛神经阻滞效果的影响

目的:探讨不同剂量局麻药对超声引导腋路臂丛神经阻滞效果的影响。方法:90例择期行前臂和手部手术的患者,在超声引导下行腋路臂丛桡神经、正中神经、尺神经和肌皮神经阻滞,局麻药为2%利多卡因与0.75%罗哌卡因等容量混合液。随机分为A、B、C3组,每组30例,各组局麻药用量分别为每条神经8、6、4mL。记录桡神经、正中神经、尺神经、肌皮神经的感觉阻滞起效时间、麻醉持续时间和阻滞效果;评定手术全程的麻醉效果。结果:与C组比较,A组和B组各神经分支支配区麻醉起效时间较短(P<0.01),阻滞效果较好(P<0.01)。手术全程的麻醉效果评定:A组优秀29例,良好1例,麻醉优良率达100%;B组优秀28例,良好2例,麻醉优良率达100%;C组优秀11例,良好12例,失败7例,麻醉优良率76.7%,显著低于A组和B组(P<0.01)。麻醉持续时间A组和B组显著长于C组(P<0.01)。3组均无并发症。结论:超声引导腋路臂丛神经阻滞可以减少局麻药用量,是臂丛神经阻滞理想的引导方法。

腋下小切口与传统后外侧切口肺癌切除术的对比分析

目的：探讨腋下小切口在肺癌手术治疗中的临床价值。方法：将151例Ⅰ~Ⅲ期肺癌手术患者,分为腋下小切口组（80例）和传统后外侧切口组（71例）,比较2组患者的围手术期临床指标,术前1d和术后4h、1d、2d的血清C反应蛋白（CRP）及白细胞介素（IL）-6、IL-8浓度。结果：（1）腋下小切口组在术中出血量、切口长度、术后离床时间、术后引流量、带管时间、术后住院日、术后疼痛强度评分、术后吗啡片用量、术后主要并发症方面较传统后外侧切口组均明显减少（P〈0.05）。（2）与术前1d比较,2组术后4h、1d、2d时点血清CRP浓度均明显升高（P〈0.05）,且在术后1d时点达高峰;与术前1d比较,2组术后4h、1d、2d时点血清IL-6,IL-8浓度均明显升高（P〈0.05）,且在术后4h时点达高峰;与传统后外侧切口组相比,腋下小切口组术后4h、1d、2d时点血清CRP、IL-6及IL-8浓度均明显降低（P〈0.05）。结论：腋下小切口与传统后外侧切口相比具有急性期炎性反应轻,对机体损伤小、疼痛轻、恢复快等优点,该切口能完成各种肺切除术式及系统性淋巴结清扫的要求,可作为肺癌手术治疗的常规切口。

MRI鉴别诊断乳腺癌腋窝淋巴结转移

目的探讨MRI对乳腺癌患者腋窝淋巴结转移的鉴别诊断价值。方法分析经病理证实并行腋窝MR扫描的44例乳腺癌患者资料,分析MRI表现,包括淋巴结长径、短径、皮质厚度、ADC值、淋巴门情况、淋巴结边缘、周围脂肪间隙情况、DWI信号、强化方式及时间—信号强度曲线等,并绘制的ROC曲线分析淋巴结长径、短径、皮质厚度、ADC值对腋窝淋巴结转移的诊断效能。结果病理结果显示有淋巴结转移者24例(24/44,54.55%),无淋巴结转移者20例(20/44,45.45%),两者淋巴结长径、短径、皮质厚度、ADC值、淋巴门是否消失、淋巴结边缘、周围脂肪间隙、DWI信号、强化方式差异均有统计学意义(P均<0.05)。淋巴结长径、短径、皮质厚度及ADC值的ROC曲线下面积分别为0.797、0.765、0.848、0.749。结论 MRI在鉴别乳腺癌腋窝淋巴结状态中有重要价值,皮质厚度大于0.54cm高度提示腋窝淋巴结转移。

Auto-CAD计算机辅助设计软件定点测量儿童上颌窦前壁及上颌结节位置变化

背景:研究上颌窦前壁及上颌结节的位置变化,分析上颌骨的发育情况,并可掌握上颌骨骨量的多少以及发育的时机,来为正畸做更好的准备和分析,但用计算机Auto-CAD软件定点,并研究上颌窦前壁及上颌结节的位置变化尚未见报道。目的:调查分析新疆乌鲁木齐市300名4-14岁汉族儿童生长发育过程中上颌窦前壁及上颌结节的位置变化及其发育的情况。方法:对乌鲁木齐市口腔医院就诊的300例4-14岁儿童,将收录的人群按Hellman’s牙齿发育阶段分为5组(ⅡA组、ⅡC组、ⅢA组、ⅢB组、ⅢC组)。通过Auto-CAD计算机辅助设计软件对全颌曲面断层片进行画图分析,将鼻中隔与硬腭的交点设为O点,硬腭与上颌窦近中面的交点为上颌窦前壁点(PA),将两点连成一线定位X轴,过O点并与X轴垂直的为Y轴,此时O点为(0,0)点,上颌粗隆的后壁与硬腭的交点为上颌粗隆的后壁点(PP),此点会有一个精确的坐标值即(PPX,PPY),将数据进行统计分析,了解牙齿发育的不同时期,上颌窦前壁点与上颌粗隆的后壁点的位置变化。结果与结论:方差分析表明上颌窦前壁点在5个不同时期在X轴上的数值差异不显著(α>0.05)。从IIA期到ⅢA期上颌粗隆后壁的值是明显的水平向后方和垂直向下方的生长。从ⅢA期到ⅢB期,上颌粗隆的后壁点是仅发生了水平向后方的生长,垂直方向的生长不明显。从ⅢB到ⅢC期,上颌粗隆的后壁点出现明显的垂直向下的生长,而水平向后方的生长不明显。即此期是第2磨牙萌出的时间,说明第2磨牙的萌出对上颌骨垂直向的生长有一定作用。

MRI诊断乳腺癌腋窝淋巴结转移准确性的Meta分析

目的采用Meta分析评价MRI诊断乳腺癌腋窝淋巴结转移的准确性。方法计算机检索Pubmed、Embase、The Cochrane Library、中国生物医学文献数据库等,检索时间截止2014年12月。由2名研究人员独立根据纳入、排除标准筛选文献、提取资料。采用诊断准确性研究的质量评价工具进行方法学质量评价。采用STATA 12.0软件双变量模型法进行Meta分析。结果共纳入35个研究,3569例研究对象。合并敏感度、特异度、阳性似然比、阴性似然比、诊断比值比和AUC分别为82%（75%~87%）、91%（85%~94%）、8.6（5.6~13.3）、0.20（0.14~0.28）、43（24~78）和0.93（0.90~0.95）。结论 MRI诊断乳腺癌腋窝淋巴结转移的准确率较高,应作为乳腺癌术前治疗评估的主要手段。

乳腺癌腋窝淋巴结转移的临床诊断及其意义

目的:探讨查体、B超两种方法诊断乳腺癌腋窝淋巴结转移的价值。方法:以术后病理检测为金标准,评价查体、B超两种方法对乳腺癌腋窝淋巴结转移的诊断。术前查体且术后病理检测乳腺癌腋窝淋巴结的患者共468例,术前B超且术后病理检测乳腺癌腋窝淋巴结的患者共139例。分别进行灵敏度、特异度、误诊率、漏诊率、准确度、阳性预告值、阴性预告值计算并进行统计学检验。结果:查体诊断乳腺癌腋窝淋巴结转移的灵敏度为49.79％,特异度为81.39％,准确度为65.38％,阳性预测值为73.29％,阴性预测值为61.24％;B超诊断乳腺癌腋窝淋巴结转移的灵敏度为69.23％,特异度为65.57％,准确度为67.63％,阳性预告值为72.0％,阴性预测值为62.5％。B超诊断乳腺癌腋窝淋巴结转移的灵敏度与查体具有显著差异(Fisher's exact检验,P=0.004)。结论:B超诊断乳腺癌腋窝淋巴结转移的灵敏度高于查体;查体、B超两种方法对乳腺癌腋窝淋巴结转移的准确度、预告值相似,有一定的临床意义。

早期乳腺癌前哨淋巴结活检临床实践指南更新及展望

腋窝淋巴结是乳腺癌最常见和最先转移的部位，是早期乳腺癌患者重要的独立预后因子。准确的腋窝淋巴结分期对局部治疗的选择、全身综合治疗决策和预后判断等具有重要的指导作用。前哨淋巴结活检（SLNB）是一项腋窝淋巴结准确分期的微创活检技术。循证医学Ⅰ级证据证实，对腋窝淋巴结阴性的患者，SLNB可安全而有效地替代腋窝淋巴结清扫术（ALND），从而显著减少术后并发症发生，改善患者生活质量。但是，SLNB的开展有其特定的适应证和禁忌证，尤其是对于某些特定情况如多灶性或多中心病灶、有既往乳腺活检手术史、新辅助化疗后的乳腺癌患者，临床医师应该遵循指南并结合临床实践综合考虑。通常认为如果SLNB阳性则应该进一步行ALND。随着临床实践的积累和最新临床试验结果的公布，乳腺癌腋窝治疗正从单一的手术治疗走向个体化的多学科干预。充分而准确的术前腋窝淋巴结分期将越来越多原来需行SLNB的腋窝淋巴结阳性患者通过更微创的穿刺活检提前筛选出来，因此SLNB的阳性率将大幅度降低，提示今后部分早期乳癌腋窝处理可能将步入一个免除SLNB的无创时代。本文就SLNB临床实践指南的更新及展望作一综述。

三点法腋路臂丛神经阻滞——神经刺激器法和异感法的比较

目的采用随机对照的方法对神经刺激器法和异感法这两种定位方法在三点腋路臂丛阻滞中的效果进行比较。方法45名拟行前臂和手部手术的病人被随机分入异感定位组(paresthesia,PAR组n=23)和周围神经刺激器定位组(peripheralnervestimulator,PNS组n=22),分别采用异感定位法和神经刺激器定位法定位支配上肢的4支混合神经中的3支(肌皮神经、正中神经、桡神经或尺神经),将等量的2%利多卡因和0.5%布比卡因混合液40mL分别注射于3支神经周围,其中肌皮神经5mL,正中神经15mL,桡神经或尺神经15mL,另5mL侵润上臂内侧的皮神经。臂丛阻滞成功被定义为注射30min后,肘部远端5支神经(肌皮神经、桡神经、正中神经、尺神经和前臂内侧皮神经)支配区域的感觉阻滞完全,比较2组在臂丛阻滞成功率、时效和并发症等方面的差异。结果PNS组的阻滞成功率要高于PAR组(95.5%对54.5%,P<0.01),两组间差异主要由于PAR组的肌皮神经和桡神经阻滞率较低(P<0.05)。PNS组的麻醉起效时间短于PAR组(19min对29min,P<0.01)。两组中共有3例病人(6.6%)发生术后短暂的神经功能障碍,3周内均获完全恢复。结论PNS法是一种良好的定位手段。将该方法应用于三点法腋路臂丛神经阻滞,可获得优于传统异感定位法的效果。臂丛阻滞后神经功能障碍并不少见,应引起足够重视。

新生儿背部肩胛间体温与腋温关系的探讨

目的寻求简便而准确测量新生儿体温的新方法。方法对临床 2 0 0例新生儿同时进行腋下和背部肩胛间体温的测量 ,所得数值通过SPSS软件进行统计学处理。结果不同部位相同时间测量腋下体温与背部肩胛间体温具有高度正相关关系 ,确定足月正常新生儿 10min背部肩胛间体温的正常值范围 36 .0～ 37.5℃。结论此种测量方法简便安全 ,易被新生儿家属接受 ,减少了临床护士操作中的工作量。

超声引导下不同给药方法在经腋径路臂丛神经阻滞的应用

目的观察超声引导下分两点和分四点注射麻醉药物在经腋径路臂丛神经阻滞中的临床效果和安全性。方法将行上肢手术患者86例,随机分为两点注射局麻药组(A组,n=44)和四点注射局麻药组(B组,n=42)。在超声引导和神经刺激定位的配合下,A组以两点注射法、B组以四点注射法行臂丛神经阻滞。同时记录麻醉操作时间、阻滞起效时间、阻滞持续时间和并发症,评价手术区麻醉效果。结果两点注射法麻醉操作时间短于四点注射法(P<0.01),两组麻醉持续时间、麻醉优秀率和麻醉起效时间差异无统计学意义(P>0.05)。结论超声引导下两点注射法和四点注射法在经腋径路臂丛神经阻滞中的效果相似,但两点注射法效率更高。

术后放疗在T1～T2期腋窝淋巴结1～3个转移乳腺癌中的临床应用

目的探讨T1～T2期腋窝淋巴结1～3个转移乳腺癌改良根治术后放疗的疗效及影响术后复发的相关因素。方法回顾分析496例腋窝淋巴结1～3个转移的早期患者,所有患者均行乳腺癌改良根治术,术后行放射治疗者210例,未行放疗者286例。术后随访满5年,组间差异采用χ2检验,影响复发率的多因素分析采用Logistic回归分析。结果全组5年生存率:92.3%(458/496),5年局部复发率7.3%(36/496),远处转移率12.1%(60/496)。术后放疗组与未放疗组的局部复发率分别为4.3%和9.4%(χ2=4.780,P=0.029)。Logistic回归分析提示,术后复发与是否行肿瘤局切术[Exp(B)=3.420,P=0.004]、月经状况[Exp(B)=0.336,P=0.032]、肿块位置[Exp(B)=4.744,P=0.000]、淋巴结清扫个数[Exp(B)=5.507,P=0.000]相关。结论术后放疗可降低T1～T2期腋窝淋巴结1～3个转移乳腺癌患者的局部复发率;肿瘤局切术后、绝经前、肿块位于中央区或内象限、淋巴结清扫数<10个等为影响肿瘤复发的独立高危因素,对这部分患者应积极考虑行术后放疗。