Surgical Outcomes Following Partial Breast Reconstruction with Chest Wall Perforator Flaps

Introduction: In the last two decades, chest wall perforator flaps (CWPF) have become a versatile tissue replacement technique for partial breast reconstruction following breast-conserving surgery (BCS) in well-selected cases. We present the surgical outcome of 81 patients with chest wall perforator flaps used for breast-conserving surgery. Methods: We recorded the outcomes of three oncoplastic breast surgeons who performed partial breast reconstruction with chest wall perforator flaps from 1st January 2018 to 30th June 2022 at Sherwood Forest Hospitals NHS Foundation Trust. Data were collected on patient demographics, including age, BMI, smoking status, bra size, previous treatments, type of CWPF procedure, tumor size (measured clinically, via imaging and histologically), biopsy results, specimen weight, margins involvement, re-operation rate, surgical site infection (SSI), flap loss, flap shrinkage, hematoma, and seroma rates. Results: A total of 81 patients were included in this study, with an average age of 55.7 years and a body mass index (BMI) of 26.7 kg/m2. The bra size varied between A to FF with A (7.4%), B (28.3%), C (38.2%), D (13.6%), DD (11.1%), and FF (1.2%). 14.8% of the patients had neoadjuvant chemotherapy (NACT). For 45 patients, LICAP (lateral intercostal artery perforator), 16 AICAP (anterior intercostal artery perforator), 13 MICAP (medial intercostal artery perforator), and for seven patients, LTAP (lateral thoracic artery perforator) flaps were used. The average tumor was measured at 15.75 mm clinically, 19.1 mm via imaging, and 19.6 mm histologically. Biopsy showed that 16% of the tumors were ductal carcinoma in situ (DCIS), and 84% were invasive. 16% of patients had involved margins, and re-excision was required in 10 patients, and completion mastectomy was performed in 2 patients. A thirty-day SSI rate was 6.2%, with flap-related complications, including flap loss and shrinkage, at 3.7% and 4.9%, respectively. In addition, 3.7% had a hematoma, and 17.3% had other complications. Conclusion: Partial breast reconstruction with perforator flaps is an excellent volume replacement technique in breast-conserving surgery with acceptable complications in well-selected cases.

Multicenter phaseⅡstudy of apatinib single or combination therapy in HER2-negative breast cancer involving chest wall metastasis

Objective:Breast cancer(BC)with chest wall metastasis(CWM)usually shows rich neovascularization.This trial explored the clinical effect of apatinib on human epidermal growth factor receptor 2(HER2)-negative advanced BC involving CWM.Methods:This trial involved four centers in China and was conducted from September 2016 to March 2020.Patients received apatinib 500 mg/d[either alone or with endocrine therapy if hormone receptor-positive(HR+)]until disease progression or unacceptable toxicity.Progression-free survival(PFS)was the primary endpoint.Results:We evaluated 26 patients for efficacy.The median PFS(mPFS)and median overall survival(mOS)were4.9[range:2.0-28.5;95%confidence interval(95%CI):2.1-8.3]months and 18(range:3-55;95%CI:12.9-23.1)months,respectively.The objective response rate(ORR)was 42.3%(11/26),and the disease-control rate was76.9%(20/26).In the subgroup analysis,HR+patients compared with HR-negative patients had significantly improved mPFS of 7.0(95%CI:2.2-11.8)months vs.2.3(95%CI:1.2-3.4)months,respectively(P=0.001);and mPFS in patients without or with chest wall radiotherapy was 6.4(95%CI:1.6-19.5)months vs.3.0(95%CI:1.3-4.6)months,respectively(P=0.041).In the multivariate analysis,HR+status was the only independent predictive factor for favorable PFS(P=0.014).Conclusions:Apatinib was highly effective for BC patients with CWM,especially when combined with endocrine therapy.PFS improved significantly in patients with HR+status who did not receive chest wall radiotherapy.However,adverse events were serious and should be carefully monitored from the beginning of apatinib treatment.

Endoscopic Thyroid Lobectomy via Axillary-Breast-Shoulder Approach versus Open Thyroid Lobectomy

Introduction: The aim of the study was to compare the feasibility and safety of endoscopic thyroid lobectomy via axillary-breast-shoulder approach (ET via ABS) with a conventional open thyroid lobectomy (OT). Methods: From November 2014 to December 2015, 20 patients with unilateral benign thyroid nodules were treated with ET via ABS and another 20 patients were treated with an OT. We analyzed the clinical characteristics postoperative complications, pain, and patient satisfaction. Results: No statistically significant differences occurred between groups except the mean ages of the OT group and the ET via ABS group were 55 and 44 years, respectively (p = 0.015). The mean operative time was almost the same in both groups (116 min in the OT group and 114 min in the ET via ABS group). Blood loss was significantly higher in the OT group than in the ET via ABS group (p = 0.042) but postoperative drainage was detected more in the ET via ABS group (p p = 0.026). The hospital stay was three days in OT group and four days in ET via ABS group (p = 0.909). Postoperative complications such as hematoma, hoarseness, dysphagia, and prolonged subcutaneous emphysema were detected only in the ET via ABS group but without statistical difference. More patients were “very satisfied” with the treatment in the ET via ABS group than in the OT group. Conclusion: The ET via ABS is as safe and effective as the OT for patients with unilateral thyroid nodules. With less early postoperative pain and higher patient satisfaction, this endoscopic thyroidectomy approach should be considered in patients who concern about cosmetic results.

Advanced Papillary Carcinoma of the Breast Presenting as an Ulcerated Anterior Chest Wall Tumour: Case Report

BACKGROUND: Papillary carcinoma of the breast is a rare malignant tumour accounting for 1% - 2% of all breast cancers in women. Papillary carcinomas of the chest wall are always secondary to thyroid, thymus and ovaries. Other variants of breast cancer metastasizing to the chest wall have been reported. CASE: We report a 67-year-old woman presented to us with an ulcerated anterior chest wall mass of 1-year duration, bilateral axillary, supraclavicular and cervical swellings of 8-month duration. There was a history of breast lump which was noticed 5 years prior to presentation, no history of breast malignancy in the past and no family history of breast cancer. Examination revealed an ulcerated, nodular mass over the sternal angle which measured 14 cm × 12 cm × 4 cm;she had bilateral axillary, supraclavicular and cervical lymphadenopathy which were non-tender and matted. She had a firm, non-tender right breast lump measuring 6 cm × 4 cm. Chest examination and abdominal examinations were essentially normal. Chest X-ray revealed erosion of sternal bone without any evidence of intrathoracic extension. Abdominal ultrasound and thyroid scans were normal. Histology of the mass revealed papillary carcinoma. Biopsy of the right breast also revealed papillary carcinoma. She had excision of the fungating tumour and primary closure of defect. She subsequently had combination chemotherapy using ondasetron, cyclophosphamide, adriamycin and cisplantin. CONCLUSION: Papillary carcinoma of the breast is rare and rarely metastasizes to the chest wall. The diagnosis of metastatic chest wall tumour requires meticulous history taking, clinical examination and relevant investigations to ascertain the primary origin of the carcinoma.

A Multidisciplinary Approach in Management of Breast Cancer: Case Study and Literature Reviews

The diagnosis of breast cancer can cause a significant anxiety in someone’s life. The care of the breast cancer patient requires in many centres. The care of breast cancer patient is undertaken as a joint venture between the surgeon, medical oncologist, radiotherapist, pathologist and allied health professionals such as the clinical nurse specialist as well as counsellors. This is a case of a 39-years-old Malay woman presented to HUSM with a history of ulcerating breast lump with bloody pus discharge on the right breast. An initial mammogram study showed lesion suspicious of malignancy, and histopathological examination was consistent with invasive ductal carcinoma. She received neoadjuvant chemotherapy before proceeding to right modified radical mastectomy with axillary clearance and immediate chest wall reconstruction. Detailed discussion on the diagnosis, treatment, surgical intervention and progress of the patient with reference to available literature reviews are presented.

A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular Sparing Approach

A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.

Applying machine learning approaches to improving the accuracy of breast-tumour diagnosis via fine needle aspiration

Diagnosis and treatment of breast cancer have been improved during the last decade; however, breast cancer is still a leading cause of death among women in the whole world. Early detection and accurate diagnosis of this disease has been demonstrated an approach to long survival of the patients. As an attempt to develop a reliable diagnosing method for breast cancer, we integrated support vector machine (SVM), k-nearest neighbor and probabilistic neural network into a complex machine learning approach to detect malignant breast tumour through a set of indicators consisting of age and ten cellular features of fine-needle aspiration of breast which were ranked according to signal-to-noise ratio to identify determinants distinguishing benign breast tumours from malignant ones. The method turned out to significantly improve the diagnosis, with a sensitivity of 94.04%, a specificity of 97.37%, and an overall accuracy up to 96.24% when SVM was adopted with the sigmoid kernel function under 5-fold cross validation. The results suggest that SVM is a promising methodology to be further developed into a practical adjunct implement to help discerning benign and malignant breast tumours and thus reduce the incidence of misdiagnosis.

乳腺癌术后调强放疗患者体质情况与摆位误差的关系研究

目的探讨乳腺癌术后调强放疗患者体质量指数(BMI)、胸围、乳腺体积与摆位误差的关系。方法选取2019年1月至2022年10月在南通市第三人民医院接受调强放疗的乳腺癌患者63例,比较不同BMI、胸围、乳腺体积等患者摆位误差差异。结果63例乳腺癌患者中,左右方向(X轴)摆位误差为(2.61±0.72)mm,头脚方向(Y轴)摆位误差为(2.84±0.80)mm,前后方向(Z轴)摆位误差为(2.89±0.78)mm。随着BMI增加,X轴、Y轴和Z轴摆位误差逐渐增加(P<0.05),其中BMI≥24.0 kg/m^(2)患者X轴、Y轴和Z轴摆位误差分别为(3.13±0.53)mm、(3.60±0.63)mm和(3.88±0.66)mm,明显高于BMI<18.5 kg/m^(2)和18.5~23.9 kg/m^(2)患者(P<0.05)。胸围≥89 cm患者X轴和Y轴摆位误差分别为(2.84±0.52)mm和(3.07±0.56)mm,明显高于胸围<89 cm患者。随着乳腺体积增加,X轴摆位误差逐渐增加(P<0.05),其中乳腺体积>800 cm^(3)患者X轴摆位误差为(3.16±0.68)mm,明显高于乳腺体积<500 cm^(3)和500~800 cm^(3)患者(P<0.05)。不同年龄患者X轴、Y轴和Z轴摆位误差比较差异无统计学意义(P>0.05)。结论乳腺癌术后调强放疗摆位误差受患者BMI、胸围及乳腺体积的影响,与患者年龄无明显关系。

胸壁补偿膜厚度及患者体型特征对乳腺癌调强放疗摆位误差和剂量学的影响

目的:探讨胸壁补偿膜厚度及患者体型特征对乳腺癌患者手术后接受调强放疗治疗的摆位误差及放疗剂量的影响。方法:采用前瞻性研究方法,选取2021年1月至2023年6月阜阳市肿瘤医院肿瘤放疗中心治疗的103例乳腺癌患者,对患者进行锥形束CT检查,分析患者的体质量指数(BMI)、肿瘤位置、胸围、患侧乳腺体积对其摆位误差的影响,分析不同厚度的补偿膜对患者靶区、肺部、心脏、脊髓的放射剂量的影响。结果:不同BMI、不同患侧分布的乳腺癌患者在左右方向上的摆位误差无统计学意义(P>0.05);胸围≥89.0 cm、患侧乳腺体积≥650 cm^(3)患者的左右方向摆位误差大于胸围<89.0 cm、患侧乳腺体积<650 cm^(3)患者(P<0.05)。不同患侧分布的乳腺癌患者在上下方向上的摆位误差无统计学意义(P>0.05);BMI≥23.1 kg/m^(2)、胸围≥89.0 cm、患侧乳腺体积≥650 cm^(3)患者的上下方向摆位误差大于BMI<23.1 kg/m^(2)、胸围<89.0 cm、患侧乳腺体积<650 cm^(3)患者(P<0.05);不同BMI水平、不同胸围、不同乳腺体积、不同患侧分布的乳腺癌患者在前后方向上的摆位误差无统计学意义(P>0.05)。左侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的放射治疗计划靶区(PTV)D_(95%)、PTV靶区D_(5%)、左侧肺部V_(20%)、心脏V_(30%)、心脏平均剂量(D_(mean))、脊髓最大剂量(D_(max))、机器跳数(MU)、均匀性指数(HI)测定值比较,差异无统计学意义(P>0.05);采用0.5 cm补偿膜患者的适形度指数(CI)值低于采用1.0 cm补偿膜的乳腺癌患者(P<0.05),右侧乳腺癌病灶患者采用0.5 cm补偿膜和1.0 cm补偿膜的PTV靶区D_(95%)、PTV靶区D_(5%)、右侧肺部V_(20%)、脊髓D_(max)、MU、CI、HI测定值比较,差异无统计学意义(P>0.05)。结论:对于乳腺癌调强放疗患者,BMI、胸围、患侧乳腺体积均与摆位误差有关,采用0.5 cm和采用1.0 cm胸壁补偿膜均可以用于术后放疗,对放疗剂量和加速器跳数影响不大。

两种不同入路行双平面假体隆乳术临床疗效对比研究

目的探讨不同入路行双平面假体隆乳术的效果。方法回顾性分析2020年1月—2023年1月新乡市中心医院收治的629例行双平面假体隆乳术患者的临床资料,按其手术入路的不同将其分为2组,其中经乳晕入路行手术的329例患者纳入对照组,经腋窝入路行手术的300例患者纳入观察组,术后均随访6个月。对比2组手术相关指标、乳房形态变化、隆胸效果、并发症。结果观察组切口愈合时间[(7.30±1.25)d]短于对照组[(9.21±1.69)d],并发症发生率(1.67%)低于对照组(4.86%),差异有统计学意义(P<0.05)。2组术中出血量、手术时间、住院时间、术后数字评分法(numeric rating scale,NRS)评分、隆胸效果相比,差异无统计学意义(P>0.05)。术前、术后2组乳头-乳房下皱襞的经皮距离(nipple to inframammaryfold,N-IMF)、胸骨切迹-乳头距离(sternal notch to nipple,S-N)、乳头-正中线距离(nipple to midline,N-M)、乳房总体积相比,差异无统计学意义(P>0.05)。结论经乳晕入路、经腋窝入路行双平面假体隆乳术均能够取得优良的隆胸效果,但经腋窝入路行手术更能够促进切口愈合,降低并发症发生率。文章的研究结果为临床后期选择双平面假体隆乳术的入路提供了借鉴内容,具有一定的运用价值。

经胸乳入路腔镜甲状腺切除术治疗甲状腺良性肿瘤患者的效果

目的:观察经胸乳入路腔镜甲状腺切除术治疗甲状腺良性肿瘤患者的效果。方法:选取2022年1—12月该院收治的60例甲状腺良性肿瘤患者进行前瞻性研究,根据随机数字表法将其分为观察组和对照组各30例。对照组采用开放式甲状腺切除术治疗,观察组采用经胸乳入路腔镜甲状腺切除术治疗。比较两组围术期指标水平,手术前后甲状腺功能指标[游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)]水平、疼痛程度[视觉模拟评分法(VAS)]评分,瘢痕美容评分[温哥华瘢痕量表(VSS)],并发症发生率,以及复发率。结果:观察组手术时间长于对照组,术中出血量和术后引流量均少于对照组,颈部活动恢复时间和住院时间均短于对照组,差异有统计学意义(P<0.05);术后3 d,两组FT_(3)、FT_(4)水平均低于术前,但观察组高于对照组,两组TSH水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05);观察组VAS、VSS评分均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率低于对照组,差异有统计学意义(P<0.05);两组复发率比较,差异无统计学意义(P>0.05)。结论:经胸乳入路腔镜甲状腺切除术治疗甲状腺良性肿瘤患者可减少术中出血量和术后引流量,缩短颈部活动恢复时间和住院时间,减轻甲状腺功能损伤,降低VAS评分、VSS评分和并发症发生率,其效果优于开放式甲状腺切除术治疗,但手术时间需延长。

乳腺癌病人手术方式决策冲突现状及影响因素分析

目的:调查乳腺癌病人手术方式决策冲突现状,并分析其影响因素。方法:采用便利抽样法选取2021年11月-2022年6月河南省洛阳市3所三级甲等医院乳腺外科住院的175例乳腺癌手术病人作为研究对象,采用一般资料调查表、决策冲突量表、决策自我效能量表、领悟社会支持量表、住院病人焦虑抑郁量表对病人进行调查。结果:乳腺癌病人手术方式决策冲突总分为(42.25±9.86)分。多元线性回归分析结果显示,家庭人均月收入、文化程度、居住地、组织学分型、决策自我效能、焦虑抑郁是乳腺癌病人手术方式决策冲突的影响因素,共可解释总变异的67.5%。结论:乳腺癌病人手术方式决策冲突水平较高,不容忽视。决策冲突受多种因素影响,医务人员应根据影响因素制订个性化的决策辅助方案,以降低病人决策冲突水平,改善临床结局,提高病人满意度。

腔镜下甲状腺手术的疗效与方法学

目的对比经胸乳途径腔镜下甲状腺手术与传统甲状腺手术的疗效,观察患者对两种术式的认可度。方法回顾本院2019年9月-2021年1月收治的74例甲状腺良性肿瘤患者的临床资料,按手术入路分传统组(30例)和经胸乳组(44例),传统组均按传统术式完成甲状腺切除,经胸乳组均经胸乳入路行腔镜下甲状腺切除。比较2组手术耗时、术中出血量、术后引流量、住院天数、疼痛程度、并发症发生情况和手术满意度。结果2组患者均顺利完成既定手术,除术后引流量2组间无统计学差异外,经胸乳组患者的手术耗时、术中出血量、住院天数、VAS评分均优于传统组,差异有统计学意义(74.40±9.35min VS 112.20±12.45min,35±5mL VS 70±9mL,4.75±1.23d VS 10.20±1.78d,3.25±0.56 VS 6.42±1.22,P均<0.05)。传统组并发症发生率高于经胸乳组,差异有统计学意义(20.00%VS 4.55%,P<0.05)。经胸乳组患者的满意度明显高于传统组,差异有统计学意义(72.73%VS 60.00%,P<0.05)。结论与传统甲状腺切除手术比较,经胸乳组胸乳入路腔镜下甲状腺切除术式具有手术时间短、出血量少、患者恢复快、切口美观、患者满意度高等优点,值得推广应用。

经肌间入路淋巴结清除术对乳腺癌术后复发锁骨下第3组淋巴结的清除效果探讨

目的:探讨经肌间入路淋巴结清除术对乳腺癌术后复发锁骨下第3组淋巴结的清除效果。方法:收集驻马店市中医院2019年5月至2022年5月收治的92例乳腺癌术后锁骨下第3组淋巴结复发患者的临床资料,所有患者均行乳腺癌淋巴结清除术,根据其手术入路的不同将经胸大肌肌间行锁骨下第3组淋巴结清除的46例患者分为肌间入路组,经腋窝行锁骨下第3组淋巴结清除的46例患者分为腋窝入路组。比较两组手术相关指标、淋巴结清除效果、炎症相关因子水平、并发症发生率以及复发转移情况。结果:肌间入路组手术时间、术中出血量少于腋窝入路组(P<0.05),但两组引流管留置时间、总引流量、住院时间对比无差异(P>0.05);肌间入路组锁骨下区域第3组、胸大小肌间、腋窝平均淋巴结清除数均高于腋窝入路组(P<0.05);术后第1 d,两组hs-CRP、PCT均较术前升高,但两组对比无差异(P<0.05);肌间入路组淋巴水肿、胸大肌萎缩发生率低于腋窝入路组(P<0.05),其余并发症发生率对比无差异(P>0.05);肌间入路组远处转移率低于腋窝入路组(P<0.05),但两组局部复发率对比无差异(P>0.05)。结论:在乳腺癌术后复发锁骨下第3组淋巴结的手术治疗方面,经肌间入路与腋窝入路手术恢复效果相当,且不影响患者术后炎症相关因子水平,但相较而言,经肌间入路手术创伤更小,可减少术后并发症的发生,还可使淋巴结清除更彻底,降低淋巴结远处转移率。

3种不同入路腔镜手术治疗甲状腺微小癌的疗效及并发症对比研究

目的:探究3种不同入路腔镜手术治疗甲状腺微小癌的疗效及并发症发生情况。方法:回顾性选取2020年1月至2023年3月于皖南医学院第一附属医院弋矶山医院接受腔镜手术治疗的240例甲状腺微小癌患者为对象,根据手术入路方式分为经口组(经口腔前庭入路,n=71)、经腋窝组(经腋窝入路,n=73)和经胸乳组(经胸乳入路,n=96)。比较各组一般临床资料、围术期指标,评估患者术后疼痛情况、切口美观度和患者满意度,记录术后并发症发生情况。结果:经腋窝组的手术时间明显短于经口组、经胸乳组(均P<0.001);各组切口总长度比较:经口组<经胸乳组<经腋窝组(均P<0.001);经口组中央区淋巴结清扫数量多于经腋窝组、经胸乳组,清扫时间短于经腋窝组、经胸乳组(均P<0.001)。术后6 h、12 h、24 h和48 h,经口组、经腋窝组的视觉模拟评分(visual analogue scale,VAS)均小于经胸乳组(均P<0.001)。经口组、经腋窝组的切口美观度、患者满意度评分均明显高于经胸乳组(均P<0.001)。3组患者并发症总发生率比较,差异无统计学意义(P=0.491)。结论:3种入路腔镜手术治疗甲状腺微小癌的临床疗效相当,术后并发症无差别,但经腋窝入路手术时间最短,经口腔前庭入路清除中央区淋巴结效果更好,用时更短,在保证疗效的同时,美容效果更佳,临床可根据患者实际情况选择合适的入路方式。

经胸乳入路微创腔镜手术治疗甲状腺乳头状癌的效果观察

目的:探讨经胸乳入路微创腔镜手术治疗甲状腺乳头状癌患者的效果。方法:选取2022年6月-2023年6月务川仡佬族苗族自治县中医医院收治的甲状腺乳头状癌患者66例作为研究对象,采用随机数字表法分为参照组和研究组,各33例。参照组应用常规手术治疗,研究组采取经胸乳入路微创腔镜手术方案。比较两组手术相关指标、甲状腺功能指标、术后并发症发生率。结果:研究组切口长度、术后住院时间短于参照组,手术时间长于参照组,术中出血量、术后引流量少于参照组,差异有统计学意义(P<0.05);术后7d,两组促甲状腺激素水平均高于术前,研究组高于参照组,两组三碘甲状腺原氨酸、甲状腺激素水平均低于术前,研究组低于参照组,差异有统计学意义(P<0.05);研究组术后并发症发生率低于参照组,差异有统计学意义(P<0.05)。结论:应用经胸乳入路微创腔镜手术治疗甲状腺乳头状癌,有助于降低患者术后并发症发生率,缩短住院时间,改善甲状腺功能。

肺移植手术切口发展历程和研究现状

肺移植手术技术对于受者的临床预后有着显著的影响,选择合适的手术切口决定了术中的视野暴露,是手术顺利进行的第一步,直接影响后续的手术进程。肺移植切口通常默认一期关闭,但对于肺移植术毕存在如供肺过大、原发性移植物失功等高危因素患者,不能一期关闭切口,此时延迟关胸是一种应对策略。肺移植手术切口的选择及是否延迟关闭,对于肺移植围手术期预后、受者远期生存质量、手术并发症有着深远的影响。因此,本文结合国内外文献对肺移植Clamshell切口、前外侧切口、后外侧切口、胸骨正中切口的发展和研究现状进行综述,聚焦切口对肺移植预后的影响,为临床肺移植手术切口选择提供参考。

经口腔前庭入路与经胸乳入路腔镜手术治疗单侧甲状腺癌的对比研究

目的:比较经口腔前庭入路与经胸乳入路行腔镜单侧甲状腺乳头状癌手术的临床疗效。方法:回顾分析2019年9月至2021年6月收治的150例甲状腺乳头状癌患者的临床资料,根据手术路径分为经口腔前庭入路组(经口组,n=68)与经胸乳入路组(经胸乳组,n=82)。比较两组患者临床资料(如年龄、性别、侧别、肿瘤直径、BMI等)、手术时间、术后引流量、淋巴结清扫数量、住院时间、并发症发生率及术后患者美观满意度。结果:两组术后引流量、住院时间、手术并发症发生率差异无统计学意义(P>0.05)。经口组手术时间长于经胸乳组[(194.1±35.1)min vs.(177.0±40.8)min,P<0.05];但在经口组完成20例后,经口组与经胸乳组手术时间差异无统计学意义[(188.3±32.7)min vs.(177.0±40.8)min,P=0.177]。经口组中央区淋巴结清扫数量多于经胸乳组[(7.1±4.5)枚vs.(3.8±3.1)枚,P<0.01],美观满意度评分高于经胸乳组[(9.08±0.78)分vs.(8.02±0.87)分,P<0.01]。结论:与经胸乳入路腔镜甲状腺手术相比,经口腔前庭入路手术时间较长,但清扫中央区淋巴结数量更多,美容满意度更高,值得临床推广应用。

Reirradiation of recurrent breast cancer with proton beam therapy:A case report and literature review

BACKGROUND Locoregional recurrence of breast cancer is challenging for clinicians,due to the various former treatments patients have undergone.However,treatment of the recurrence with systemic therapy and subsequent reirradiation of chest wall is accompanied by increased toxicities,particularly radiation-induced cardiovascular disease.Reirradiation by proton beam therapy(PBT)enables superior preservation of adjacent organs at risk as well as concurrent dose escalation for delivery to the gross tumor.This technology is expected to improve the overall outcome of recurrent breast cancer.CASE SUMMARY A 47-year-old female presented with an extensive locoregional recurrence at 10 yr after primary treatment of a luminal A breast cancer.Because of tumor progression despite having undergone bilateral ovarectomy and systemic therapy,the patient was treated with PBT BE total dose of 64.40 Gy to each gross tumor and 56.00 Gy to the upper mediastinal and retrosternal lymphatics including the entire sternum in 28 fractions.Follow-up computed tomography showed a partial remission,without evidence of newly emerging metastasis.At 19 mo after the PBT,the patient developed a radiation-induced pericardial disease and pleural effusions with clinical burden of dyspnea,which were successfully treated by drainage and corticosteroid.Cytological analysis of the puncture fluid showed no malignancy,and the subsequent computed tomography scan indicated stable disease as well as significantly decreased pericardial and pleural effusions.The patient remains free of progression to date.CONCLUSION PBT was a safe and effective method of reirradiation for locoregionally recurrent breast cancer in our patient.

无充气腋窝入路与经胸乳入路腔镜甲状腺癌根治术的效果分析

目的对比无充气腋窝入路与经胸乳入路腔镜甲状腺癌根治术的临床疗效,以便为临床制定适合腔镜下甲状腺癌根治术术式提供参考。方法选取2019年1月至2022年2月医院收治的168例甲状腺癌患者,以随机数字表法分为研究组、对照组,各84例。对照组行经胸乳入路腔镜甲状腺癌根治术,研究组行无充气腋窝入路腔镜甲状腺癌根治术。统计两组手术情况、甲状旁腺功能变化情况,对比两组术后疼痛即围术期应激情况,比较两组术后并发症及患者对切口满意情况。结果研究组手术时间、术后引流量均高于对照组(P<0.05),两组淋巴结清扫数量比较差异无统计学意义(P>0.05)。两组手术前后甲状旁腺素(PTH)、血钙差值比较差异无统计学意义(P>0.05)。两组组内术前、术后1个月、术后3个月的疼痛视觉模拟评分(VAS)评分比较差异有统计学意义(P<0.05),两组间的VAS评分差异无统计学意义(P>0.05),两组的VAS评分变化趋势无差别(P>0.05)。两组组内术前、术后1 d、术后3 d的肾上腺素(Adr)、皮质醇(Cor)比较差异有统计学意义(P<0.05),两组的Adr、Cor差异无统计学意义(P>0.05),两组的Adr、Cor变化趋势无差别(P>0.05)。两组总并发症发生率比较差异无统计学意义(P>0.05)。研究组切口美容满意度高于对照组(P<0.05)。结论无充气腋窝入路与经胸乳入路在腔镜甲状腺癌根治术中效果、安全性方面相近,虽然无充气腋窝入路耗时长、术后引流量较高,但术式术后美容效果更佳。