乳腺癌保乳术与根治术的比较

为了比较分析保乳术和根治术的治疗成本和对乳腺癌患者预后的影响,从2002年1月～2005年6月湘雅医院乳腺科的乳腺癌资料库中,随机抽取64例I～II期乳腺癌分为保乳治疗组(A组,32例)和根治术组(B组,32例),并随访.结果显示,A、B两组全部药品费用分别平均为32 474.11±16 126.00元、35 107.30±19 352.71元,总费用平均为53 959.64±22 033.28元、53 382.10±24 042.87元.两组药品费和总费用均无统计学差异(P=0.556、0.921).中位随访时间30个月,两组病例均无局部复发.A、B组远处转移率分别为6.25%、9.38%,两组无明显差异(P=0.641);Kaplan-Meier生存分析表明A、B组生存率分别为96.88%、93.75%,两组无显著性差异(P=0.4566).保乳术患者对残乳的满意率为90.61%,认为保留了乳房后其对家庭和社会生活仍充满自信的分别占75%和87.5%;相反,根治术者仅占28.13%和40.63%;A、B两组有显著性差异(P=0.000、0.000).由此得出结论,保乳术和根治/改良根治术两种治疗方法对Ⅰ～Ⅱ期乳腺癌患者的预后无差异,成本亦无明显区别,而保乳术明显提高了患者的家庭、社会生活质量.     

乳腺癌保乳术与根治术的比较

为了比较分析保乳术和根治术的治疗成本和对乳腺癌患者预后的影响,从2002年1月~2005年6月湘雅医院乳腺科的乳腺癌资料库中,随机抽取64例I~II期乳腺癌分为保乳治疗组(A组,32例)和根治术组(B组,32例),并随访。结果显示,A、B两组全部药品费用分别平均为32474.11±16126.00元、35107.30±19352.71元,总费用平均为53959.64±22033.28元、53382.10±24042.87元。两组药品费和总费用均无统计学差异(P=0.556、0.921)。中位随访时间30个月,两组病例均无局部复发。A、B组远处转移率分别为6.25%、9.38%,两组无明显差异(P=0.641);Kaplan-Meier生存分析表明A、B组生存率分别为96.88%、93.75%,两组无显著性差异(P=0.4566)。保乳术患者对残乳的满意率为90.61%,认为保留了乳房后其对家庭和社会生活仍充满自信的分别占75%和87.5%;相反,根治术者仅占28.13%和40.63%;A、B两组有显著性差异(P=0.000、0.000)。由此得出结论,保乳术和根治/改良根治术两种治疗方法对I~II期乳腺癌患者的预后无差异,成本亦无明显区别,而保乳术明显提高了患者的家庭、社会生活质量。     

乳腺癌保乳手术新进展:中国经验

乳腺癌是女性最常见的恶性肿瘤,外科手术是乳腺癌治疗的重要组成部分。手术方式经历了一个不断发展的过程,保乳手术已经成为早期乳腺癌患者的标准术式。保乳手术的操作规范主要有美国术式和欧洲术式,其中美国术式更加适合于中国患者。保乳手术要求切缘阴性,笔者所在乳腺肿瘤中心经过临床实践经验所提出的"改良腔周边缘评估法"已被证明是安全且高效的,适合中国的国情,值得推广。乳腺癌保乳手术的进展很快,近期对保乳术的阴性边缘达成了共识。美国乳腺外科医师协会(ASBS)提出的残腔环切法可以明显降低保乳术后再手术率。对于手术造成外观不满意的患者可以行乳腺整形保乳术。中国的保乳率仍然处于较低水平,多学科治疗(MDT)和乳腺专科建设可以提高保乳率,并进一步改善患者的预后,应大力提倡。     

整形外科技术在早期乳腺癌保乳手术中的临床应用

探讨整形外科技术在早期乳腺癌保乳手术中的临床应用。选取2011年6月~2013年6月应用整形外科技术施行早期乳腺癌保乳手术的29例患者,其临床资料通过回顾性分析得出,针对术后患者的乳房整形效果进行剖析,同时对肿瘤复发率进行随访。29例患者均成功应用整形外科技术完成早期乳腺癌保乳手术,术后乳房整形效果优良满意度为75.9%(22/29)。术后乳房整形效果满意度与年龄、肿瘤大小、肿瘤位置与乳头距离有相关性,其差异有统计学意义(P0.05)。跟踪随访结果无一例复发或再次手术。早期乳腺癌患者可联合应用整形外科技术实施保乳手术治疗,其术后乳房整形效果满意度较高,此术式安全有效,在限定条件下值得临床推广应用。     

现代医学模式影响下的乳腺癌手术方式递嬗

目前乳腺癌的标准治疗是以手术为主的综合治疗。在保证肿瘤学安全性的前提下,保留乳房的乳腺癌切除术不断突破原有的桎梏,在最初的标准保乳手术基础上发展出肿瘤整形保乳手术;保乳性乳房全切手术则进一步拓展了原有保乳术的外延。即便不具备保乳手术条件或对保乳手术存有顾虑而需行乳房全切术的患者,乳房重建手术为其点燃了新的希望。现代医学模式的形成完善了医学科学主义和人文主义的有机结合,按照这种思维方式,医疗目的要与患者需求相契合,治疗疾病要与生命质量相结合。乳腺癌手术方式的递嬗正是体现了现代医学模式影响下患者对生活品质的追求和医者为满足病患治疗疾病和追求生命质量双重需求谋福祉的良苦用心。     

乳腺癌的保乳治疗

保乳手术是乳腺外科史上里程碑式的重要事件,基于对乳腺癌生物学的全新认识和大量循证医学证据的证实,早期乳腺癌保乳治疗的安全性和疗效与乳房全切术相同。在精准医疗及多学科综合治疗模式下,患者获得了更好的生命质量和人文关怀。本文结合笔者团队的保乳经验,对保乳治疗的发展及临床问题做一扼要梳理。     

乳腺导管内癌患者手术方式选择及预后分析

探讨乳腺导管内癌(DCIS)患者手术方式的选择及其影响因素,并比较不同手术方式对患者预后的影响。回顾性分析2008年3月~2012年6月于笔者所在医院进行手术治疗且符合纳入标准的DCIS患者253例,收集患者临床资料,采用单因素和Logistic回归分析影响DCIS患者手术方式选择的因素,采用Kaplan-Meier法和Log-rank检验比较不同手术方式对患者预后的影响。253例患者中接受全乳切除术175例(69.17%),接受保乳术78例(30.83%),其中56例(22.13%)患者保乳术后接受了放疗;年龄≥55岁(OR=0.029,95%CI:0.009~0.091,P=0.000)、首发症状为乳头湿疹(OR=8.319,95%CI:2.229~31.045,P=0.002)、活检方式为切除活检(OR=3.155,95%CI:1.496~6.776,P=0.003)、病理类型为粉刺型(OR=11.287,95%CI:4.015~31.734,P=0.000)、瘤体最大径3cm(OR=8.362,95%CI:2.741~25.514,P=0.000)为影响DCIS患者手术方式独立因素;全乳切除术、保乳术联合放疗、单纯保留乳房术三组之间的5年无病生存率、5年总生存率比较,差异均无统计学意义(P0.05)。年龄、首发症状、活检方式、病理类型、瘤体最大径是影响DCIS患者手术方式选择的主要因素,且不同手术方式患者无病生存率和总生存率差异无统计学意义。     

开展保乳手术所遇困难引发的深入思考

随着医学研究的发展及人们对乳腺癌生物学行为的深入认识,保乳手术逐渐成为早期乳腺癌手术治疗的主流,但在我国开展保乳手术却困难重重,这其中既有社会、经济、文化的原因,也有患者、家属的原因,而医务人员本身的原因也不容忽视.     

乳腺癌保乳手术的哲学思考

保乳手术基于乳腺癌是一种全身疾病的认识,符合医学发展的方向并最大程度地满足了患者对形体美的追求,保乳手术是早期乳腺癌手术的发展趋势,保乳治疗是多种疗法序贯应用的综合治疗。乳腺外科医师应及时转变治疗观念,以更大的责任心给予乳腺癌患者最好的治疗和更多的人文关爱。     

PCI术前术后的心理障碍识别与处理

概述冠心病经皮冠状动脉介入治疗（PCI）术前术后患者合并心理障碍的较高发生率以及心理障碍对冠心病发生、发展及预后的影响,分析 PCI 术前术后患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别 PCI 术前术后患者出现的心理障碍,并以“双心医学”方式对其进行心理精神医学及心血管专科医学治疗,同时对心血管专科医学治疗效果不明显的冠心病 PCI 患者,进行相关的鉴别诊断后也要进行心理精神医学的诊断和治疗,以便有利于 PCI 术患者的康复和预后,减少不必要的检查和治疗。     

动态磁共振成像在早期乳腺癌诊断中的临床研究

评价动态增强磁共振成像在早期乳腺癌诊断中的价值。随机选取2008年10月到2011年6月本院83例经B超或B超联合钼靶检查阴性的中青年女性行乳腺MRI检查,对MRI发现可疑结节病灶的患者进行手术活检,通过病理诊断来评价MRI在诊断早期乳腺癌的准确性和临床应用价值。83例中青年女性中,发现病变7例（8．4％）,癌前改变4...     

乳腺癌患者的心理状况及相关因素分析

乳腺癌患者常常被各种心理问题所困扰,特别是乳腺癌根治术对女性性特征所带来的严重影响,各种心理问题更为突出。这些心理问题不但影响患者的生活质量,而且影响疾病的发生、发展及转归。本文回顾了患者的个人因素、疾病本身和治疗因素及其他社会心理因素与心理状况的关系,对乳腺癌患者进行心理干预、临床的综合诊治和防治过程提供新思路。     

晚期乳腺癌原发灶局部处理的若干问题

乳腺癌仍然是严重威胁女性健康的重大疾病。每年新发乳腺癌患者中约有6％为Ⅳ期乳腺癌,而这类患者5年生存率小于20％,局部处理（外科、放疗）可以根除局部病灶及微小转移灶,以延缓或者缓解症状,但是否可以带来生存获益尚无定论。本文对Ⅳ期乳腺癌原发灶的局部处理等方面的若干问题作一综述。     

The acceptability of prophylactic mastectomy among lay people and health professionals: A pilot study

IntroductionWomen with certain genetic mutations have a risk of up to 85% of developing breast cancer. Bilateral prophylactic mastectomy is the most effective way to reduce risk of cancer.ObjectiveThis pilot study focuses on the acceptability of prophylactic breast surgery and examines, in a series of concrete cases, the cognitive processes by which health professionals and lay people make their judgments. This research also aims to identify the factors involved in these judgments. An additional objective is to determine whether there are groups with different patterns of responses.MethodWe recruited two samples in France, one comprising 90 lay people and the other 30 health professionals (n = 120) and asked them how acceptable it would be for a woman at a high risk of breast cancer to undergo a prophylactic surgery (mastectomy), in each of the 64 scenarios presented to them. The scenarios were all combinations of two levels of age, of marital status, of parenting status, of body appearance investment, of reconstructive surgery and also two levels of the person suggesting oncogenetic diagnosis.ResultsWe found that lay people and health professionals structured the factors in the scenarios in nearly the same way. They assigned importance to three factors: the most important one was reconstructive surgery, and then the age of the woman. The least important factor was the person who requested the genetic test. Furthermore, the age of the participants, and knowing a person who had cancer impacted the degree of acceptability assigned by participants. Being a lay person or a health professional did not have a direct impact on acceptability but influenced the integration of factors. In addition, cluster analysis showed that only a small group was opposed to mastectomy.ConclusionThis pilot study demonstrated that three factors have to be considered when judging the acceptability of prophylactic mastectomy and showed a common cognitive foundation for future discussion, at the levels of both clinical care and health policy, of the conditions under which prophylactic surgery might be acceptable.     

Quality of Life in Women Following Various Surgeries of Body Manipulation: Organ Transplantation, Mastectomy, and Breast Reconstruction

This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health.     

Health-Related Quality of Life in Iranian Breast Cancer Survivors: A Qualitative Study

Women play the most important role in Iranian families. Therefore, it is necessary to pay attention to efforts to maintain and promote their health. The diagnosis and treatment of breast cancer have significant physical and psycho-social impacts on patients, families and friends. This qualitative study was designed to analyze the role of several social and cultural factors and their relationship to health-related quality of life among Iranian breast cancer survivors. In-depth semi-structured and unstructured face-to-face interviews were conducted with 39 breast cancer survivors. The results of the present study revealed that most prevalent physical problems that were reported by Iranian breast cancer survivors were fatigue, pain and lymphedema related to the adverse effects of mastectomy. We found that most participants have a strong sense of spirituality and used this as a source of psychological support to help them accept their disease. Spirituality has been found to be a strong source of psychological support among Iranian breast cancer survivors. Religious faith has provided this community the strength and motivation to seek medical treatment and to be patient and relax. These findings can help researchers to provide a framework for the development of appropriate and effective culturally sensitive health interventions.     

晚期乳腺癌外科治疗的时机与个体化选择

IV期乳腺癌是难以治愈的疾病,治疗方法是综合治疗,目的是缓解症状、改善生活质量、延长生存期。外科治疗作为综合治疗的一部分,对手术切除Ⅳ期乳腺癌原发灶或转移灶的临床意义和手术时机存在争议,本文结合文献从哲学的角度分析讨论Ⅳ期乳腺癌是否需要外科处理。认为Ⅳ期乳腺癌全身治疗和外科治疗是治疗过程中矛盾主要方面和次要方面的关系,可互相转化,两者作用相辅相成,当全身治疗病情缓解时,个体化选择外科治疗不仅改善生存质量,还可能提高生存率。     

Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up.

Between 1984 and 1989, 129 Stage 1 and Stage 2 breast cancer patients were entered into a behavioral study in Pittsburgh. Approximately 70% of these patients had elected to have breast conservation (lumpectomy) surgery, with the remainder choosing mastectomy. Using the Profile of Mood States, a measure of perceived social support, and Karnofsky ratings of physical functional status, patients were assessed 3 to 5 days following surgery and again 3 and 15 months following surgery. The data were analyzed using a repeated-measures analysis of covariance, adjusting for aggressiveness of chemotherapy. Compared to mastectomy patients, patients who received breast conservation surgery were rated as more functional by observers, but they perceived themselves as having less energy and less emotional support, especially over the first 3 months of the recovery period. Because there is accumulating evidence that emotional support may act as a stress buffer in various populations and may have survival value, these findings may be particularly troublesome. This study shows that breast conservation surgery is not a psychosocial panacea. Patients whose breasts are spared, especially younger patients, have psychological symptoms that appear acutely worse in the short run and, in the end, are similar to those of patients who elect to have mastectomies. Therefore, patients choosing lumpectomies are not necessarily psychosocially better off than those electing to have mastectomies. Additionally, these patients, particularly younger patients, may require greater social support and potential mental health interventions than they seem to be receiving.     

乳腺癌诊治过程中的多学科协作

乳腺癌是全身疾病,其治疗和诊断都需要多个学科的积极参与协作才能完成。本文就自身体会认为乳腺专科医生掌握诸如肿瘤外科技术与肿瘤内科治疗措施,熟悉乳腺癌放疗与美容整形的相关技术,并能掌握诸如乳腺B超等检查手段等多个学科知识,同时和病理等相关科室紧密协作,是处理好乳腺癌诊治过程中的多学科协作问题的一种有效方法。     

乳腺癌保乳治疗的进展与临床选择

保乳治疗既能满足乳腺癌的治疗要求,又适于追求更高的生活质量,但应用时必须严格掌握适应证,还要充分考虑到病人及其家庭的经济和心理承受能力,医院的综合治疗条件等因素,充分做到科学性与人性化的高度结合,才能获得最佳临床效果。