The Place of Nipple-Sparing Mastectomy in the Treatment of Breast Cancer: Review of the Literature

Introduction: Mastectomy with conservation of the nipple-areola complex (NAC) in breast cancer care has been controversial with regards to the oncological safety of this procedure and the risk of complications including NAC necrosis. Aim: The objective of this study is to assess, through a literature review, the safety and reliability of a conservative NAC mastectomy in breast cancer treatment, paying attention to the rate of local recurrence and complications. Methods: A review of the literature was conducted from PubMed data, and articles published between January 2007 and December 2017, using the terms “nipple-sparing mastectomy”, “breast cancer”, “local recurrence”, “necrosis of the nipple”, “global complications”. The articles were analyzed with regards to the following parameters of evaluation: local recurrence, recurrence rate at NAC level, global complication rates and nipple necrosis rates. Results: In the 36 studies we selected, the average rate of local recurrence was 3.23%. The average rate of recurrence at the NAC was 0.81%. The average rate of complications was 20%. The average rate of necrosis of the NAC was 5.9%. The main factors of these recurrences were the tumor size > 5 cm and tumor stage > stage II. Conclusion: Conservative mastectomy of the nipple-areola complex offers an aesthetic advantage and oncological safety in carefully selected patients with breast cancer.

Expanding the Use of Nipple-Sparing Mastectomies in Obese Patients Undergoing Staged Implant-Based Reconstruction

Background: Advantages of various mastectomy techniques include skin reduction and favorable aesthetics in Wise-pattern closures, and less visible scars in nipple-sparing mastectomies (NSM). This study compares postoperative complication profiles between Wise-pattern and nipple-sparing mastectomies in the obese population. Methods: A retrospective chart review of obese patients (BMI ≥ 30) who underwent staged breast reconstruction following Wise-pattern and nipple-sparing mastectomies at our institution between February 2016 and January 2020 was conducted. Complications between cohorts were analyzed using the independent samples t-test (2-sided) and the χ2 test. Results: A total of 232 breasts (163 Wise-pattern, 69 NSM) were re-constructed in 123 obese female patients (85 Wise-pattern, 38 NSM). Complication rates in both the Wise-pattern and NSM patient cohorts were similar following stage 1 (Wise-pattern: 30.7%, NSM: 39.1%, p = 0.212) and stage 2 (Wise-pattern: 16.6%, NSM: 15.9%, p = 0.907) of reconstruction. No statistically significant differences in rates of infection, dehiscence, seroma, hematoma or malposition of tissue expander (TE)/implant following stage 1 or stage 2 were found between cohorts. Conclusions: There were no significant differences in postoperative complication rates between the Wise-pattern and NSM cohorts of obese patients. NSM can be a viable surgical option in carefully selected obese patients and offer the advantage of concealed scarring.

Mitigating the impact of skin necrosis in reconstruction after nipple-sparing mastectomy

Skin flap necrosis is a common postoperative complication after breast reconstruction,with an incidence of up to 43.4%among patients undergoing nipple-sparing mastectomy.Necrosis can adversely impact aesthetics due to the need to excise nonviable tissue,and increase the risks of infection,implant loss,nipple-areola complex sacrifice and malposition.Patient-specific factors including age,body mass index,and breast size may affect the risk of necrosis.Mastectomy and reconstruction techniques(i.e.,choosing between skin-and nipple-sparing mastectomy,and between autologous and alloplastic reconstruction)may also influence necrosis rates.Intraoperative measures such as indocyanine green angiography and autologous skin banking,and the postoperative use of nitroglycerin paste for high-risk patients and warming blankets for autologous reconstruction are methods to help prevent and minimize the morbidity of skin necrosis.Herein,we share our institution’s approaches to predicting and mitigating skin necrosis,and methods of optimizing outcomes for breast reconstruction patients.

Nipple-sparing Mastectomy in Breast Cancer： From an Oncologic Safety Perspective

Objective：To evaluate the oncologic safety of nipple-sparing mastectomy （NSM） for breast cancer patients based on current literature.Data Sources：A comprehensive literature search ofMedline,Embase databases was conducted for studies published through March 2014.Study Selection：Our search criteria included English-language studies that focused on NSM at nipple-areola complex （NAC） involvement,patient selection,and recurrence.Prophylaxis NSM,case series or reports that based on very small population were excluded.In the end,42 studies concerning NSM and oncological safety were included into the review.Results：NSM is a surgical procedure that allows the preservation of the skin and NAC in breast cancer patients or in patients with prophylactic mastectomy.However,the oncologic safety and patient selection criteria associated with NSM are still under debate.The incidence of NAC involvement of breast cancer in recent studies ranges from 9.5% to 24.6%,which can be decreased through careful patient selection.Tumour-nipple distance,tumour size,lymph node involvement and molecular characteristics can be evaluated preoperatively by clinical examinations,imaging studies and biopsies to predict the risk of NAC involvement.Currently,there is no available standard protocol for surgical approaches to NSM or pathological examination of NSM specimens.The local recurrence （ranges from 0% to 24%） of NSM is not significantly higher than that of traditional mastectomy in selected patients based on long-term follow-up.The role of radiotherapy in NSM is still controversial and is not universally accepted.Conclusions：NSM appears to be oncologically safe following careful patient selection and assessment of margins.

Investigation of the current situation of nipple-sparing mastectomy:a large multicenter study in China(CSBrs-003)

Background:Mastectomy techniques have been extended to nipple-sparing mastectomy(NSM).This study aimed to assess the actual application of NSM in China and identify the factors influencing postoperative complications.Methods:The clinical data of 615 patients(641 surgeries)undergoing NSM from January 1st,2018 to December 31st,2018 at 28 centers nationwide were retrospectively analyzed to obtain the rate of NSM and investigate factors related to NSM surgery.Results:The proportion of NSM surgery performed in this study was 2.67%(17/641).Malignant breast tumors accounted for the majority of NSM surgery(559/641,87.2%).A total of 475(77.3%)patients underwent NSM combined with reconstructive surgery.The rate of reconstruction decreased with age in our study,and implants were the most common option(344/641,53.7%)in reconstruction.Radial incision was the most selected method regardless of reconstruction.However,for those who underwent reconstruction surgery,18.4%(85/462)of cases also chose curvilinear incision,while in the simple NSM surgery group,more patients chose circumareolar incision(26/136,19.1%).The tumor-to-nipple distance(TND)influenced postoperative complications(P=0.004).There were no relationships between postoperative complications and tumor size,tumor location,histologic grade,molecular subtype,nipple discharge,and axillary lymph nodes.Conclusions:NSM surgery is feasible and only TND influenced postoperative complications of NSM surgery.But the proportion of NSM surgery performed is still low in nationwide centers of China.The selection criteria for appropriate surgical methods are important for NSM in clinical practice.To optimize clinical applications of NSM,further multicenter prospective randomized controlled studies are needed.

Breast Cancer Treatment (Mastectomy Experiences) May Initiate Individuation Process That Redefines Identities: A Systematic Review

This systematic literature review examines the impact of breast cancer treatment experiences, with a focus on mastectomy, on the psychosocial well-being of women. While previous studies have shown that mastectomy is associated with negative psychological outcomes such as anxiety, depression, and a loss of femininity, a new body of literature suggests that it can also be a catalyst for post-traumatic growth and personal transformation. The article argues that mastectomy experiences can initiate an individuation process that leads to a more empowered sense of self and a higher quality of life. The review identified 25 studies that employed qualitative methods and analyzed data from interviews, focus groups, and surveys. The article discusses the application of Jung’s individuation theory to categorize the experiences of women with breast cancer and links breast cancer diagnosis and treatment to the death-experience stage of the theory. The content highlights the importance of movement, contemplation, and spirituality in the healing process, and how they can help women connect with their bodies and develop a new sense of identity. Additionally, the content discusses the role of spirituality in enhancing growth and healing among indigenous native women patients with breast cancer. Overall, this article provides insights into how breast cancer treatment experiences can shape women’s identity, enhance resilience, and provide opportunities for personal growth and transformation.

Therapeutic Approaches to Post-Mastectomy Pain Syndrome

Background: Breast cancer is increasingly common in society and post-mastectomy pain is a striking condition associated with surgery, both intra and postoperatively. The post-mastectomy syndrome is characterized by the persistence of pain for more than 3 months after the procedure. It is mostly of neuropathic origin and is highly refractory to treatments, which vary from clinical to surgical measures and alternative techniques. In this context, it is essential to understand the possible approaches to these patients. Objective: Understand alternatives for pain management in patients undergoing mastectomy, especially in those in whom pain persists for more than 3 months. Methods: Systematic literature review, conducted in the Virtual Health Library databases includes: Lilacs, SciELO, Medline, PubMed and Cochrane between 2018 and 2023, restricted to articles in English with the descriptors: Mastectomy, chronic Pain, Nerve Blocks and Breast Cancer. 317 articles were found involving the descriptors presented, all in English. After reading the abstracts, 28 articles were selected. Results: This review analyzed 28 scientific studies that rigorously met the previously established characteristics in the sample selection. The synthesis included the following aspects: author/year of publication, article title, objective, type of study and database. Conclusion: It was concluded that, according to the analyzed studies, post-mastectomy pain is a problem that has increased its incidence and that needs the attention of health professionals. The use of antineuropathic medications, nerve blocks, fat grafting, lymph node transplantation, therapy, physical activity and acupuncture are some examples of therapeutic approaches for these women. Therefore, the team must assist the patients, seeking to provide a better prognosis, quality of life and comfort.

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。

基于美学需求的个案护理模式对乳腺癌保乳切除术后患者心理状态和瘢痕的影响

目的:探究基于美学需求的个案护理模式对乳腺癌保乳切除术后患者心理状态和瘢痕的影响。方法:选择2019年2月-2022年2月笔者医院行乳腺癌保乳切除术的106例患者,按随机数表法分为观察组(n=53)和对照组(n=53)。对照组采用常规护理模式,观察组采用基于美学需求的个案护理模式。比较两组护理干预前后心理状态[焦虑自评量表(Selfrating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)、自尊量表(Rosenberg senesteem scale,RSES)]、生活质量[乳腺癌生存质量测评量表(Functional assessment of cancer therapy-breast,FACT-B)]、瘢痕[温哥华瘢痕量表(Vancouver scar scale,VSS)]及并发症发生情况。结果:干预后,两组的SAS、SDS均低于干预前,且观察组均低于对照组(P<0.05),而两组RSES评分高于干预前,且观察组高于对照组(P<0.05);术后1、3、6个月,观察组的VSS评分均低于对照组(P<0.05);干预后,两组的FACT-B各项评分均高于干预前,且观察组的生理状况、社会/家庭状况、情感状况、功能状况、附加关注状况均高于对照组(P<0.05);观察组并发症发生率为22.64%,显著低于对照组的43.40%(P<0.05)。结论:基于美学需求的个案护理模式能够改善乳腺癌保乳切除患者术后心理状态,减轻术后瘢痕,并能提高患者的生活质量。

乳腺癌保乳术后应用3D技术填充瘤腔进行适形放疗的临床研究

目的探究乳腺癌保乳术后应用3D技术填充瘤腔进行适形放疗的靶区剂量、不良反应及美容度。方法选择2021年1月至2022年12月西安交通大学第一附属医院收治的48例乳腺癌患者,按照手术不同分为3D技术填充瘤腔组(24例)及对照组(24例)。全部患者均开展乳腺癌根治手术治疗,仅保乳方式不同,术后实施强度调控适形放射治疗计划下的加速部分乳腺照射。结果应用3D技术填充瘤腔保乳术后放疗的适形度指数及均匀性指数均明显高于常规保乳术后放疗(P<0.05)。3D技术填充瘤腔保乳术后放疗的肺及心脏危及器官剂量(平均剂量),肺的V 5、V 10、V 20、V 30、V 40及V 50均显著低于常规保乳术后放疗组(P<0.05)。2组患者的皮肤损伤、心律失常、骨髓抑制及消化道反应发生率差异无统计学意义。3D技术填充瘤腔保乳术后组患者的美容度要显著优于常规保乳术后患者(P<0.05)。结论乳腺癌保乳术后应用3D技术填充瘤腔显著增强乳腺的美容度,且不影响放疗的安全及有效性。

腋窝淋巴结手术对全乳房切除术联合即刻两期法乳房再造患者术后并发症的影响

目的比较不同术式的腋窝淋巴结手术对全乳房切除术联合即刻两期法乳房再造患者术后并发症的影响。方法收集2018年1月至2021年12月中国医科大学附属第一医院乳腺外科232例采用全乳房切除术联合即刻两期法乳房再造患者的临床资料。根据腋窝淋巴结手术方式分为前哨淋巴结活检组(SLNB组,n=84)和腋下淋巴结清扫术组(ALND组,n=148)。比较2组患者各项临床指标、术后并发症及预后情况。结果与SLNB组比较,ALND组患者T分期和N分期更高,接受新辅助化疗、化疗、放疗比例更高,术后总引流量更多,术后并发症发生率更高,差异均有统计学意义(均P<0.05)。而2组患者局部/区域复发率、远处转移率,无病生存期比较差异均无统计学意义(均P>0.05)。结论全乳房切除术联合即刻两期法乳房再造术中,与前哨淋巴结活检比较,腋下淋巴结清扫术患者术后并发症发生率更高。

伤害感受水平指数指导瑞芬太尼输注靶浓度对接受乳腺癌根治术患者细胞免疫和缺氧诱导因子-1α的影响

目的探讨伤害感受水平(NOL)指数应用于乳腺癌根治术对患者的细胞免疫和缺氧诱导因子(HIF)-1α的影响。方法招募2022年12月至2023年12月行乳腺癌根治术的80例患者,随机将患者分为观察组和对照组。观察组控制NOL指数在30~50,依此调整瑞芬太尼靶浓度,对照组起始采用瑞芬太尼4 ng/mL靶控输注,依据血流动力学调整瑞芬太尼靶浓度。记录瑞芬太尼平均靶浓度;记录手术前1 d及手术后1 d患者的静脉血CD4^(+)、CD8^(+)以及NK细胞值,测定血清中HIF-1α水平。结果两组患者的麻醉时间、手术时间、术中MAP、HR、丙泊酚靶浓度和术后VAS评分均差异无统计学意义(P>0.05),观察组术中的瑞芬太尼平均靶浓度低于对照组(P<0.05);在术后1 d,观察组的CD4^(+)、CD4^(+)/CD8^(+)、NK细胞值均高于对照组,HIF-1α水平低于对照组(P<0.05)。相比术前1 d,观察组患者在术后1 d的CD4^(+)、CD4^(+)/CD8^(+)较低,HIF-1α水平较高(P<0.05);相比术前1 d,对照组患者在术后1天的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)及NK细胞值较低,HIF-1α水平较高(P<0.05)。结论NOL指数应用于全麻下乳腺癌根治术可以减少术中瑞芬太尼的靶浓度,降低瑞芬太尼对细胞免疫的抑制,保护NK细胞的活性,同时减少HIF-1α升高水平,由此推断对患者肿瘤免疫微环境的影响更小。

针对患者自我报告症状的护理干预在乳腺癌根治术患者中的应用效果

目的探讨基于患者自我报告症状的护理方案干预措施在乳腺癌根治术患者中的应用效果。方法选取2021年6月—2022年6月医院收治的乳腺癌根治手术患者92例为研究对象,按基本资料具有可比性的原则将患者分为观察组和对照组各46例,对照组围手术期行常规性护理,观察组围手术期实施基于患者自我报告症状的护理方案,记录两组相关症状发生率、症状持续时间,比较两组干预前后症状严重程度评分及患者生活质量改善情况。结果观察组术后疼痛、疲乏、焦虑、睡眠障碍、患肢水肿等发生率依次为13.04%、17.39%、10.87%、10.87%、8.69%,对照组相关症状发生率依次为39.13%、56.52%、54.35%、47.83%、52.17%,组间比较差异有统计学意义(P<0.05)。观察组疼痛、睡眠障碍、疲乏、肢体水肿、焦虑等症状持续时间依次为2.02±0.32 d、2.63±0.38 d、2.22±0.42 d、2.85±1.21 d、2.63±0.63d,对照组相关症状持续时间依次为4.92±0.42 d、4.89±0.86 d、4.33±0.86 d、4.52±0.85 d、5.02±0.85d,两组相关症状持续时间比较差异有统计学意义(P<0.05)。干预后观察组乳腺癌生存质量评定量表(FACT-B)总评分为120.49±6.97分,对照组FACT-B总评分为98.30±5.78分,差异有统计学意义(P<0.05)。结论基于患者自我报告症状的护理方案能有效减少乳腺癌根治术患者术后不良症状发生率及持续时间,有助于患者功能状态恢复,提高患者生活质量。

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。

乳腺癌患者乳房切除术后心理体验质性研究的Meta整合

目的:系统评价乳腺癌患者乳房切除术后心理体验的质性研究,为提高该人群心理健康和建立支持体系提供参考。方法:检索中外数据库中关于乳腺癌患者乳房切除术后心理体验的质性研究,检索时限从建库至2022年12月31日。采用JBI循证卫生保健中心质性研究质量评价标准对文献质量进行评价,采用汇集性整合法对结果进行Meta整合。结果:共纳入13篇文献,提炼出53个研究结果,归纳形成10个新类别,综合为3个整合结果。分别为患者术后身体形象恶化、心理健康及性生活受到影响;采取创伤后成长、乳房再造等积极正面的应对策略;患者面临一系列困扰和挑战。结论:乳房切除术影响乳腺癌患者的身心健康及社会交往,患者存在多方面的心理体验。医务人员在今后工作中需重视患者对乳腺癌切除术的认知与体验,鼓励患者积极应对,并利用相应的心理干预措施减轻或缓解乳房切除术带给患者的困扰,完善其社会支持,提高其生活质量。

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。

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。

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。

腔镜辅助下不同手术方式治疗男性乳房发育症的效果

目的 探讨腔镜辅助下不同手术方式治疗男性乳房发育症(GYN)的效果。方法 回顾性分析2017年6月至2022年11月新疆医科大学附属肿瘤医院腔镜手术治疗男性乳房发育症患者的资料共87例,按照手术方式将其分为三孔组(27例)、单孔组(32例)、单孔非溶脂组(28例)。比较三组手术时长、拔除引流管时间、并发症。术前、术后1个月评价三组术后美观度。结果 三孔组手术时间短于单孔组、单孔非溶脂组,单孔组手术时间短于单孔非溶脂组,差异有统计学意义(P<0.05)。三组拔引流管时间比较,差异无统计学意义(P>0.05)。三组并发症总发生率比较,差异无统计学意义(P>0.05)。乳房对称度、乳头形态、乳晕形态、胸廓平整度组间比较,差异无统计学意义(P>0.05);单孔组、单孔非溶脂组手术瘢痕得分高于三孔组,差异有统计学意义(P<0.01);单孔组与单孔非溶脂组手术瘢痕得分比较,差异无统计学意义(P>0.05);单孔组及单孔非溶脂组整体外观得分高于三孔组(P<0.05),单孔非溶脂组整体外观得分高于单孔组(P<0.05)。结论 三孔法具有操作便捷、手术效率高的优势;单孔法,具有切口隐蔽、美观度好的优势;针对体型偏胖、皮下脂肪较厚的患者非溶脂手术更加合适。