目的 探討乳腔鏡輔助下早期乳腺癌保乳治療的優越性。方法 乳腔鏡輔助下行保乳術37例，術后均行乳腺和病灶區放射治療，并按病理及受體情況給予相應的輔助化療及內分泌治療。結果 乳腔鏡輔助下保乳術成功35例，2例術中因腋窩出血量多而轉開放性手術。患者無明顯手術并發癥, 且美容效果良好。術后隨訪時間最長27個月, 中位隨訪時間為18 個月,無一例局部復發、遠處轉移和死亡。術后乳腺美容效果評估： 優、良者術后6個月為68.2%，術后1年為83.4%。結論 乳腔鏡輔助下早期乳腺癌保乳術以不降低生存率、不增加復發率為原則，聯合多學科有機配合及綜合治療為保證，具有創傷小、并發癥少、外形美觀、生存質量高等優點。
Objective To evaluate the application effect of acellular dermal matrix (ADM) in immediate breast reconstruction after mammary mastectomy with prosthetic implants. Methods The clinical data of 68 patients with breast cancer undergoing immediate breast reconstruction with prosthetic implantation in our hospital were retrospectively analyzed and divided into ADM group (n=43) and non-ADM group (n=25), according to the use of ADM in the posterior space of pectoralis major muscle while prosthesis implantation or not. The size of breast prosthesis, operative time, intraoperative blood loss, drainage duration, total drainage, total hospital stay, postoperative complications, postoperative cosmetic effect and quality of life of patients were compared between the two groups. Results Patients in the ADM group showed no statistically significant difference regarding operative time, drainage duration, total drainage, hospital stay, postoperative complications and intraoperative removed gland volume with the non-ADM group (P>0.05). The average intraoperative blood loss in the ADM group was less than that of the non-ADM group, the average volume of prosthesis in the ADM group was bigger than that of the non-ADM group, the volume difference between prosthesis and removed gland in the ADM group was smaller than that of the non-ADM group, which was considered statistically significant difference (P<0.05). The subjective satisfaction and objective measurement scores of patients in the ADM group were significantly better than those of the non-ADM group, especially in the symmetry of breast, surgical scar and distance of lateral displacement of nipple (P<0.05). The postoperative quality of life in the ADM group was significantly better than that of the non-ADM group in terms of body image, sexual function and sexual interest (P<0.01). Conclusions It is safe and feasible to use ADM-assisted the immediate breast reconstruction after nipple-sparing mammary mastectomy with prosthetic implantation. As an extension of the pectoralis major muscle, ADM can enlarge the posterior space for the prosthesis implantation, making the choice of the prosthesis much more easier. The combined application of ADM can obtain a better cosmetic effect, meanwhile improving the postoperative quality of life and satisfaction of patients.
ObjectiveTo explore the safety, effectiveness and minimally invasive cosmetic evaluation results of treatment for papillary thyroid carcinoma (PTC) by video-assisted lateral neck dissection (VALND) or open lateral neck dissection (OLND).MethodsThe clinical data of patients with PTC who received surgical treatment in the Affiliated Hospital of Nanjing University Medical School from June 2015 to December 2019 were retrospectively analyzed. The data of 94 cases in the VALND group (n=47) and the OLND group (n=47) were finally included in this study, and perioperative conditions and minimally invasive cosmetic evaluation results between the two groups were studied.ResultsThere were no statistical differences of lateral metastatic lymph node numbers, operative time, postoperative drainage volume, drainage tube removal time and postoperative hospitalization days between the two groups (P>0.05). The lateral retrieved lymph node numbers, intraoperative blood loss, the degree of cervical paresthesia and the degree of cosmetic satisfaction in the VALND group were significantly better than those in the OLND group (P<0.05). There was no significant difference of surgical complications between the two groups (P>0.05).ConclusionWithout sacrificing surgical safety and effectiveness, VALND has better cosmetic effect and less neck trauma than OLND, which is worthy of clinical application and promotion.
Objective To explore the interaction of postmastectomy radiotherapy （PMRT） and breast reconstruction， and elucidate how to choose the type and timing of breast reconstruction. Method Literatures about PMRT and breast reconstruction were reviewed. Results PMRT might increase the incidence of complications and impair the cosmetic satisfaction of breast reconstruction. Breast reconstruction might also compromise the effect of PMRT. Conclusions In patients who will receive or have already received PMRT， the optimal approach is delayed autologous tissue reconstruction after PMRT. If PMRT appears likely but may not be required at the time of mastectomy，delayed-immediate reconstruction may be considered， or immediate autologous tissue reconstruction may be considered in case of patients awareness of the increased complications and impaired cosmetic outcomes from PMRT.
目的 探討局麻下經胸前入路行腔鏡甲狀腺手術的體會。方法 對2009年3月至2010年3月期間四川省南充市中心醫院普外科收治的28例在局麻下行腔鏡甲狀腺手術患者術中及術后情況進行回顧性分析。結果 1例因術中冰凍檢查發現為甲狀腺癌而轉開放性手術未納入分析。視覺模擬鎮痛評分（VAS）: 術中評分結果為0～5分，平均2.2分; 術后評分結果為0～3分，僅2例口服布洛芬緩釋膠囊鎮痛，其余25例未使用鎮痛藥物。手術時間為95～215 min，平均117 min; 術中出血量為50～150 ml，平均84 ml。術后引流量為25～70 ml，平均34 ml； 引流管放置時間為2～4 d。住院時間平均4.5 d。術后頸部及胸壁皮下無瘀血、腫脹，無聲嘶、嗆咳。經隨訪2~10個月（平均8個月），未見切口處明顯瘢痕。結論 局麻下經胸前入路行腔鏡甲狀腺手術切實可行，并具有良好的美容效果。
ObjectiveTo discuss clinical significance of total endoscopic thyroidectomy (TET) via chest-breast approach. MethodsThe clinical data of 890 patients with thyroid diseases from September 2008 to September 2015 in this hospital were analyzed retrospectively. These patients were divided into TET group (received TET, n=420) and traditional group (received traditional thyroidectomy, n=470). The data of operation and postoperative recovery were compared between these two groups. ResultsThere was no significant difference between the TET group and the traditional group in the operation time [(73.571 4±28.533 9) min versus (70.212 8±27.199 8) min, t=1.80, P=0.072 7], bleeding volume [(30.714 3±14.225 1) mL versus (29.106 4±13.559 1) mL, t=1.73, P=0.084 8], postoperative drainage [(60.000 0±27.287 9) mL versus (56.595 7±27.803 5) mL, t=1.84, P=0.066 2], postoperative hospitalization time [(5.333 3±1.085 1) d versus (5.446 8± 1.089 0) d, t=1.55, P=0.120 4], postoperative 24 h pain score [(5.333 3±2.308 7) points versus (5.404 3±2.182 1) points, t=0.47, P=0.637 8] and postoperative injury rate of recurrent laryngeal nerve [0.714 2% (3/420) versus 0.851 1% (4/470), x2=0.053 2, P=0.817 6] and hypoparathyroidism rate [0.476 2% (2/420) versus 0.851 1% (4/470), x2=0.465 5, P=0.495 1]. The score of aesthetic effect of incision on day 7 after operation in the TET group was significantly higher than that in the traditional group [(7.809 5±1.296 9) points versus (3.361 7±1.391 8) points, t=49.14, P < 0.000 1]. ConclusionTET is safe and effective, and could improve cosmetic effect for patients with thyroid diseases.
ObjectiveTo evaluate the clinical and cosmetic outcome of patients with early breast cancer underwent oncoplastic techniques in breast conserving surgery. MethodsClinical data of 59 patients with early stage breast cancer who underwent oncoplastic techniques in the breast conserving surgery were analyzed retrospectively from January 2007 to March 2011. Cosmetic outcome score and patient satisfaction questionnaire were also assessed. ResultsThe age of the patients was (53.5±9.8) years (range, 32 to 77 years). The diameter of tumors was (1.6±0.7) cm (range, 0.5 to 4.0 cm). The foci located at upper quadrant in 38, lower quadrant in 17, central area in 4. During operation, single incision approach was used in 25 patients, two incisions approach in 34 patients. A variety of methods were used to repair breast defects including mammary gland direct suture in 9 patients, mammary gland pedicle flaps in 35, local flaps or adipofascial flap in 9, latissimus dorsi myocutaneous flaps in 2, and reduction mammaplasty with “J” or double ring incision in 4. The mean followup period was 30 months (range, 3 to 53 months), no local recurrence was detected. However, bone metastases was found in one patient on 14 months after operation. Fifty-three patients (89.8%) had good to excellent aesthetic results with cosmetic outcome score ≥26. Patient satisfaction questionnaire showed that 40 patients (67.8%) were excellent, 14 (23.7%) good, 3 (5.1%) fair, and 2 (3.4%) poor. ConclusionOncoplastic techniques in the breast conservative therapy for early stage breast cancer is a safe and effective procedure, with highly satisfactory cosmetic outcomes in the majority of patients.