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达芬奇机器人甲状腺手术中甲状旁腺保护策略与技巧

Value of Internal Mammary Lymph Node in Staging and Adjuvant Therapy of Breast Cancer

ObjectiveTo analyze the value of internal mammary lymph node biopsy via intercostal space in staging and adjuvant therapy of breast cancer. MethodsThe clinical data of 305 breast cancer patients received any kind of radical mastectomy from may 2003 to January 2014 in the Jinan Military General Hospital of PLA were analyzed retrospectively. The patient age, axillary lymph node, and internal mammary lymph node status were integrated to investigate the changing of staging and postoperative adjuvant therapy of the breast cancer. ResultsThese 305 patients were divided into neoadjuvant chemotherapy group and non-neoadjuvant therapy group. There were 67 patients in the neoadjuvant chemotherapy group, including 45(67.2%) patients with axillary lymph node positive, 23(34.3%) patients with internal mammary lymph node positive. There were 23(34.3%) patients who had a change of pathology lympy node (pN) staging and 8(11.9%) patients who had a change of the pTNM staging. Meanwhile, there were 238 patients in the non-neoadjuvant chemotherapy group, including 155(65.1%) patients with axillary lymph node positive, 30(12.6%) patients with internal mammary node positive. There were 30(12.6%) patients who had a change of the pN staging and 23(9.66%) patients who had a change of the pTNM staging. There was a significant difference in the metastasis rate of the internal mammary lymph node (χ2=15.7, P < 0.05) or the changing ratio of the pTNM staging (χ2=5.3, P < 0.05) in two groups. ConclusionsInternal mammary lymph node status could affect pN staging of breast cancer, so do the pTNM staging (TNM, pathology tumor, lymph node, metastasis). The internal mammary lymph node status could guide the postoperative adjuvant radiative therapy by reducing excessive treatment of the internal mammary lymph node area, also could enhance the individual accurate therapy.

甲状腺癌颈淋巴结清扫术后难治性乳糜漏临床分析

目的 分析甲状腺癌手术后难治性乳糜漏的临床特点，探讨难治性乳糜漏的治疗策略。方法 回顾性分析解放军第九六〇医院（原济南军区总医院）2009年 1 月至 2021 年1 月期间收治的 5 021例行甲状腺癌颈淋巴结清扫术患者的临床资料，术后发生乳糜漏122例，其中治疗时间超过2周的难治性乳糜漏34例，对难治性乳糜漏患者的一般情况、治疗方式、峰值引流量（日最高引流量）、带管时间等进行分析总结。结果 5 021例患者中发生乳糜漏122例，占所有患者的2.4%。经非手术治疗2周内治愈者88例，占乳糜漏总数的72.1%；治疗时间超过2周的难治性乳糜漏34例，占乳糜漏总数的27.9%。难治性乳糜漏经非手术方法治愈者18例，经再次手术治愈者16例，2组患者的乳糜漏位置左侧多于右侧；34例难治性乳糜漏峰值引流量（日最高引流量）手术组（16例）高于非手术组（P<0.05），带管时间手术组短于非手术组（P<0.05）。结论 低峰值引流量乳糜漏经非手术治疗多可治愈；难治性乳糜漏左侧多见，高流量乳糜漏（峰值引流量≥1 000 mL）宜早期实施手术治疗。