【摘要】 目的 比较在乳腺癌Auchincloss改良根治术中使用超声刀及电刀手术的优、缺点。 方法 2009年6月－2010年7月将176例乳腺癌患者通过信封法随机分为超声刀组和电刀组，每组88例，分别比较两组患者手术时间、术中出血量、淋巴结检出数目、术后引流量、皮下积液及术后出血量的差异。 结果 手术时间:超声刀组为（145.72±50.76） min，电刀组为（171.27±66.68） min，两组差异有统计学意义（P=0.005）；术中出血量:超声刀组为（71.56±31.34） mL，电刀组为（84.99±36.39） mL，两组差异有统计学意义（P=0.009）；清扫出的淋巴结个数:超声刀组为（20.92±9.09）个，电刀组为（17.90±6.74）个，两组差异有统计学意义（P=0.013）。而在术后平均引流量和术后积液例数方面两组的差异无统计学意义（Pgt;0.05）。两组均无术后出血的情况。 结论 在乳腺癌Auchincloss改良根治术中使用超声刀，较单独使用电刀能缩短手术时间，减少出血量，并增加淋巴结检出的数量。【Abstract】 Objective To compare the disadvantages and advantages between modified radical mastectomy with harmonic scalpel (HS) and conventional electro-scalpel (ES) for patients with breast cancer. Methods Between June 2009 and July 2010, 176 patients with breast cancer were randomly divided into two groups including the HS group and the ES group. The operation time, intra-operative bleeding volume, the number of lymph nodes detected, postoperative drainage volume, subcutaneous hydrops, and postoperative hemorrhage volume between the two groups of patients were compared. Results There were significant differences between the HS and ES groups in terms of operation time [(145.72±50.76) minutes vs. (171.27±66.68) minutes, P=0.005], intra-operative bleeding volume [(71.56±31.34) mL vs. (84.99±36.39) mL, P=0.009], and number of lymph nodes detected (20.92±9.09 vs. 17.90±6.74, Plt;0.05). The postoperative drainage volume and subcutaneous hydrops were not significantly different between the two groups (Pgt;0.05). No postoperative hemorrhage occurred in both groups. Conclusion Compared with ES, the use of HS can reduce operation time and intra-operative bleeding volume, and increase the number of lymph nodes detected during modified radical mastectomy.
Objective To analyze the influence factors of amenorrhea in premenopausal breast cancer women treated with neoadjuvant chemotherapy and the relationship of neoadjuvant chemotherapy-related amenorrhea （NCRA） to down-staging of tumor. Methods Two hundred and twenty-four premenopausal breast cancer patients undergoing neoadjuvant chemotherapy from March 2006 to March 2011 in this hospital were investigated retrospectively. The effects of age， chemotherapy regiment， ER/PR status， Her-2 status， and tamoxifen （TAM） on NCRA and recovery of menstru-ation were assessed. The average age of the patients who had accepted different chemotherapy cycles when NCRA occurred was described， and the effect of different chemotherapy cycles on recovery of menstruation was evaluated. Tumor volume change was estimated to analysis the relation between NCRA and tumor response to chemotherapy. Results One hundred and sixty-six （74.11%） cases occurred NCRA， 40 （26.49%） cases returned to normal menstruation apart from 15 cases who had accepted oophorectomy or the luteinizing hormone-releasing hormone analog goserelin before menstrual status change. The results of univariate analysis and multivariate analysis indicated that the NCRA and menstruation recovery were both related to age at diagnosis （P＜0.001，P=0.001）， and only menstruation recovery was related to chemotherapy regiments （P＜0.001）. However， the NCRA and menstruation recovery were not related to ER/PR status， Her-2 status，and TAM （P＞0.05）. Chemotherapy cycles when NCRA occurred decreased with the increase of age， and wasn’t assoc-iated with menstruation recovery （P＞0.05）. There was no correlation between NCRA and downstage of tumor after neoadjuvant chemotherapy （P＞0.05）. Conclusions Amenorrhea resulted from neoadjuvant chemotherapy in most of breast cancer patients， which occurs more commonly in elder ones with less chemotherapy cycles. Quite a few patients resume menses after NCRA， which is associated with age and chemotherapy regiments. NCRA doesn’t influence tumor response to chemotherapy.
Objective To explore the clinical application of combination of radiolabeled colloid （99Tcm-sulphur colloid） and blue dye in sentinel lymph node biopsy （SLNB） for early-stage breast cancer. Methods SLNB was performed with the guidance of blue dye, radiolabeled colloid, and the combination method in all patients enrolled, and clinical and pathological data were recorded respectively for analysis. Results Two hundred and one patients were enrolled in this study and the SLN were successfully detected in 200 cases. The identification rate of radiolabeled colloid method and combination method was 99.5% （200/201） and 99.5% （198/199） respectively, which significantly higher than blue dye method （85.4%, P＜0.001）. There were no differences of accuracy rate 〔95.3% （162/170） vs. 94.5% （189/200） vs. 98.0% （194/198）, P=0.185〕 and false negative rate 〔11.3% （8/71） vs. 13.9% （11/79） vs. 5.1% （4/79）, P=0.165） between blue dye method, radiolabeled colloid method, and combination method. The combination method could detect more SLN than radiolabeled colloid method or blue dye method only （P＜0.001）. Compared to combination method, there were 12 and 7 patients miss diagnosed in blue dye method and radiolabeled colloid method, and the miss diagnosed rate was 16.0% （12/75） and 9.3% （7/75）, respectively. Conclusions Compared to radiolabeled colloid and blue dye method, combination method has higher identification rate, and could identify more SLNs. It is recommended that the combination of radiolabeled colloid and blue dye should be adapted for procedure of SLNB in clinical practice.