Aging is one of the factors for the decline in adipose tissue browning and, consequently, age-related metabolic disorders. Metabolic disorders will in turn accelerate aging and lead to a vicious circle. Therefore, the research on the reduced browning of adipose tissue that occurs with aging, that is, adipose tissue browning aging, is necessary and of great significance for the development of metabolically healthy aging. In this study, we performed a bibliometric analysis of 2527 published articles on aging of adipose tissue browning and created a panorama from different levels so that readers could quickly understand the current state of the research field. The burst analysis and timeline analysis were used to identify the research frontiers in the field, and the newly published documents were discussed and summarized. In addition, we performed bioinformatic analysis on the GEO-derived dataset to identify the altered genes and enriched pathways associated with browning during aging. Combined with bibliometric analysis, the most concerned pathway was identified as adipogenesis, and the most concerned genes were PPARG, ADIPOQ and TG. In summary, this study provided a comprehensive picture of the current status of adipose tissue browning and aging research and identified research frontiers. Finally, the pathways and genes of most interest were identified by combined bioinformatic analysis.

Tamoxifen (TAM) is employed to treat premenopausal ER-positive breast cancer patients, but TAM resistance is the main reason affecting its efficacy. Thus, addressing TAM resistance is crucial for improving therapeutic outcomes. This study explored the potential role of Tinagl1, a secreted extracellular matrix protein, whose expression is compromised in TAM-resistant MCF-7 breast cancer cells (MCF-7R). We discovered that Tinagl1 plays a pivotal role in countering TAM resistance by inhibiting the EGFR and β1-integrin/focal adhesion kinase (FAK) signaling pathways, both of which are abnormally activated in MCF-7R cells and contribute to the resistance mechanism. Our data showed that the expression level of Tinagl1 in MCF-7R cells was lower compared to their wild-type counterparts, and TAM could further reduce Tinagl1 expression in MCF-7R cells, which was consistent with our microarray results. Moreover, Tinagl1 could restore the sensitivity of MCF-7R cells to TAM and inhibit the motility of MCF-7R cells by regulating epithelial-mesenchymal transition (EMT) in vitro and in vivo experiments. In addition, the level of Tinagl1 in TAM-resistant breast cancer samples was significantly lower than that in their matched primary tumors. Analysis of an online database further indicated that high Tinagl1 expression correlates with better recurrence-free survival (RFS), particularly in patients with ER-positive, HER2-negative breast cancer. Overall, this study positions Tinagl1 not only as a potential prognostic marker but also as a promising therapeutic target.

BACKGROUND:Induction of beige fat for grafting is an emerging transplantation strategy. However, safety concerns associated with pharmaceutical interventions limit its wider application. Moreover, because beige fat is a special type of fat with strong metabolic functions, its effect on the metabolism of recipients after grafting has not been explored in the plastic surgery domain. OBJECTIVES:The aim of this study was to explore whether cold-induced inguinal white adipose tissue (iWAT) transplantation has a higher retention rate and beneficial effects on recipient metabolism. METHODS:C57/BL6 mice were subjected to cold stimulation for 48 hours to induce the browning of iWAT and harvested immediately. Subsequently, each mouse received a transplant of 0.2 mL cold-induced iWAT or normal iWAT. Fat grafts and recipients' iWAT, epididymal adipose tissue, and brown adipose tissue were harvested at 8 weeks after operation. Immunofluorescence staining, real-time polymerase chain reaction, and western blot were used for histological and molecular analysis. RESULTS:Cold-induced iWAT grafting had a higher mean [standard error of the mean] retention rate (67.33% [1.74%] vs 55.83% [2.94%], P < .01) and more satisfactory structural integrity than normal iWAT. Histological changes identified improved adipose tissue homeostasis after cold challenge, including abundant smaller adipocytes, higher levels of adipogenesis, angiogenesis, and proliferation, but lower levels of fibrosis. More importantly, cold-induced iWAT grafting suppressed the inflammation of epididymal adipose tissue caused by conventional fat grafting, and activated the glucose metabolism and thermogenic activity of recipients' adipose tissues. CONCLUSIONS:Cold-induced iWAT grafting is an effective nonpharmacological intervention strategy to improve the retention rate and homeostasis of grafts. Furthermore, it improves the adverse effects caused by traditional fat grafting, while also conferring metabolic benefits.

BACKGROUND:Facial contouring procedures become popular in recent years, but there has been no bibliometric analysis focused on this field. OBJECTIVE:Construct visualization maps and analyze the hotspots and current trends in this field using bibliometric analysis. METHODS:Publications on facial contouring procedures were extracted from the Web of Science Core Collection database from 2003 to 2022. VOSviewer, CiteSpace, and "Bibliometrix" R package were used to analyze data. RESULTS:Seven hundred and twenty-one publications on facial contouring procedures between 2003 and 2022 were included. The United States was the leading country both in publications (206) and citations (3941). Shanghai Jiao Tong University was the institution with the greatest contribution (35 publications with 379 citations). Hu J (17 publications) from China had the most outputs, while the most cited author was Rohrich RJ (321 citations) from the United States. The Journal of Craniofacial Surgery (135 documents) published the most research, and Plastic and Reconstructive Surgery was the most cited journal (2755 citations). The most cited article focused on virtual surgical planning in mandibular reconstruction. Keywords co-occurrence analysis identified five clusters centered on "reconstruction," "augmentation," "reduction malarplasty," "face rejuvenation," and "orthognathic surgery," separately. "Hyaluronic acid," "facial feminization," and "orthognathic surgery" might be related to trend topics. CONCLUSIONS:The research on facial contouring procedures is booming. In the past 2 decades, hotspots in this field included: facial defects reconstruction, facial augmentation cosmetology, facial skeletal contour plasty, and facial rejuvenation surgery. The following aspects may be trend frontiers: precision and personalization, combined treatments, transgender facial contour, and facial contour shaping with fat and hyaluronic acid.

BACKGROUND:To summarize the experiences on the mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal and standardize this operation. PATIENTS AND METHODS:Between January 1, 2002, and October 31, 2021, a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastoscopic subcutaneous mastectomy. The follow-up endpoint was 3 months after surgery. RESULTS:All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12-28 min, and the average time was 17.7 ± 6.2 min. The amount of bleeding during unilateral operation was very small, about 5-10 ml. The total drainage volume was 5-50 ml after the operation, and the drainage tube was removed in 3-5 days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the supero-medial region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period. CONCLUSIONS:The mastoscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal has a short operation time, few surgical complications and good esthetics. It achieves the "5S" goals on the complete removal of glandular tissue (sweeping), small and scar-hidden incision are small (scarless), good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall (smoothing). LEVEL OF EVIDENCE III:The journal asks authors to assign a level of evidence to each article. For a complete description of Evidence-Based Medicine ratings, see the Table of Contents or the online Instructions for Authors at www.springer.com/00266 .

Abstract Background: To summarize the experiences on the mastopscopic subcutaneous mastectomyfor gynecomastia by "nine-step method"based on the "5S" goal ，and standardize this operation . Patients and methods： Between January 1st 2002 and October 31st 2021，a total of 2035 breasts of 1082 male patients with gynecomastia, of which 129 patients with one side, were underwent mastopscopic subcutaneous mastectomy. Results： All patients were successfully completed the operation, and none of them was transferred to open operation. The operation time for unilateral breast was 12-28 min, and the average time was 17.7±6.2 min. The amount of bleeding during unilateral operation was very small, about 5-10ml. The total drainage volume was 5ml~50ml after the operation, and the drainage tube was removed in 3~5 days. The epidermal necrosis occurred in 0.3% nipple. 0.2% chest wall had a little ecchymosis in the upper- inner region of the breast. All patients had the normal feeling of nipples and areola, the smoothing and symmetrical chest wall, and the natural contour. There was no recurrence during the follow-up period. Conclusions： The mastopscopic subcutaneous mastectomy for gynecomastia by "nine-step method" based on the "5S" goal has a short operation time, few surgical complications and good esthetics. It achieving the "5S" goals on the complete removal of glandular tissue（sweeping）, small and scar-hidden incision are small（scarless）,good symmetry of bilateral chest wall (symmetry), normal chest shape (shape), and smoothing chest wall（smoothing）.

目的 探讨腹腔镜技术在普外科急腹症诊断及治疗中的应用价值.方法 收集2020 年3 月至2023 年3 月首都医科大学附属北京安贞医院收治的以急性腹痛为表现的 83 例急腹症患者的临床资料行回顾性分析.按照手术方法不同分为开腹组(41 例)和腹腔镜组(42 例),开腹组采用常规手术探查方法,腹腔镜组使用腹腔镜探查并根据情况行治疗.对比 2 组患者总体情况、手术及效果指标、临床转归.结果 2 组患者均得到了及时有效诊断和治疗.腹腔镜组手术时间、术中出血量及住院时间短于/少于开腹组[(75±18)min比(96±21)min、(30±12)ml比(60±18)ml、(5.6±2.4)d比(8.7±3.2)d],差异均有统计学意义(均P＜0.05).2 组拔除引流管时间、血常规指标恢复时间差异均无统计学意义(均 P＞0.05).所有患者术后腹痛症状消失或明显好转,无任何并发症,经常规治疗后所有患者顺利出院.结论 腹腔镜技术对于急腹症患者的诊断和治疗安全有效,并且手术时间、术中出血量及住院时间指标优于传统开腹手术.

目的 探讨乳腺癌组织的HNF1α 反义RNA 1(HNF1α-AS1)和HNF4α反义RNA 1(HNF4α-AS1)水平及临床意义.方法 采用实时定量PCR检测 2020 年 1 月至 2021 年 12 月手术切除的 106 对乳腺癌组织和癌旁组织的HNF1α-AS1、HNF4α-AS1 水平,分析组织两者水平与乳腺癌临床病理特征的关系,Kaplan-Meier Plotter数据库在线分析乳腺癌RNAseq数据中 2976 例患者的HNF1α-AS1、HNF4α-AS1 水平与预后的关系.结果 HNF1α-AS1 水平为 5.245±0.202,高于癌旁组织的 1.436±0.044,而HNF4α-AS1 水平为 0.836±0.035,低于癌旁组织的 1.337±0.048,差异有统计学意义(P＜0.05),进一步分析显示乳腺癌组织的HNF1α-AS1 和HNF4α-AS1 水平呈负相关(r=-0.453,P＜0.001).组织HNF1α-AS1 水平与TNM分期、组织学分级和Nottingham预后指数(NPI)有关(P＜0.05),而组织HNF4α-AS1 水平与肿瘤大小、淋巴结转移、TNM分期、组织学分级、HER-2表达和NPI有关(P＜0.05).Kaplan-Meier Plotter在线分析显示,HNF1α-AS1 水平与乳腺癌的总生存期(OS)无关(HR=1.28,95％CI:0.99～1.64,P=0.056),而HNF4α-AS1 水平与乳腺癌的OS有关,其中高水平者的中位OS优于低水平组(HR=0.75,95％CI:0.59～0.96,P=0.020).结论 HNF1α-AS1 在乳腺癌中高表达而HNF4α-AS1 为低表达,两者异常表达在乳腺癌恶性进展发挥作用,有望成为乳腺癌防治的靶点.

Objective:To investigate the feasibility and clinical value of indocyanine green emulsion duct fluoresceography in nipple discharge surgery to locate the nipple discharge duct and mark the diseased glands.Methods:Retrospective analysis was performed on the clinical data of 178 patients with pathological nipple discharge who underwent surgical treatment from May 2018 to May 2021. Molybdenum target lactography and indocyanine green lactography were performed intraoperatively. SPSS 25.0 software was used to analyze the data. The measurement data were expressed by（xˉ±s），and independent sample t test was performed. The count data were represented by［n（%）］and χ2 or Fisher test was used. P<0.05 was considered statistically significant.Results:There were 193 overflowing milk ducts in 178 patients，including 133 benign lesions（68.9%），40 malignant lesions（20.7%），and 20 borderline lesions（10.4%）. Unilateral and single-hole overflow is more common，with yellow serous overflow. Mammography showed that 84（43.5%）of the milk ducts with discharge showed “trunk sign” and 109（56.5%）showed “tree sign”. The most common types of glands were inhomogeneous and dense，and mostly located in the inner and lower quadrant. Indocyanine green lactigraphy showed that 132（68.4%）of the discharge lactis were fluorescined directly through the skin，55（28.5%）were not fluorescined through the skin，and 6（3.1%）of the subcutaneous lymphatic lactis were fluorescined. There were significant differences in the development of indocyanine green in different age，pathological quadrants and molybdenum target imaging signs of discharge milk duct（P<0.05）. There was no statistically significant difference in the diameter of overflow milk duct in different fluorescein imaging（P>0.05），but there was statistically significant difference in the distance between overflow milk duct and skin（P<0.05）.Conclusion:The results of indocyanine green emulsion duct fluoroscopy were related to the age of the patient，the quadrant location of the discharge duct，molybdenum target imaging signs and the distance from the discharge duct to the skin. Indocyanine green lactigraphy can accurately locate the diseased lactis，reasonably design surgical incisions，and completely remove the diseased glandular system during nipple discharge surgery，which has clinical application value.

Objective:To investigate the prognostic value of circulating tumor cells（CTCs）in patients with stage T1-2 breast cancer with 1~3 positive axillary lymph nodes（ALNS）.Methods:Clinical data of 120 patients with breast cancer who met the standards from January 2016 to December 2019 were retrospectively analyzed. SPSS24.0 statistical software. was used for analysis. Univariate and multivariate analysis of patient prognosis was performed by COX risk regression model. ROC curve is drawn to determine the optimal critical value of CTCS. Kaplan-Meier method was used to draw disease-free survival curves of patients with different CTCS levels，and log-rank test was used to analyze the difference in survival rates. P<0.05 was considered statistically significant.Results:The follow-up period was 27~63 months，with a median of 49 months. No patient died during the follow-up period，a total of 10 patients had local recurrence，5 patients had distant metastasis，and 1 of them had local recurrence with distant metastasis. The 5-year DFS was 88.3%.Cox univariate survival analysis showed that age，PT2 stage，triple negative molecular typing and CTCS number were the influential factors for postoperative prognosis（P<0.05）. ROC curve analysis of CTCS showed that the AUC was 0.807（95%CI：0.739-0.875），the optimal cut-off value was 3，the Youden index was 0.683，the sensitivity was 0.908，and the specificity was 0.775.During the follow-up period，10 of the 71 patients in the CTCS≥3 group had recurrence and metastasis，the 5-year disease-free survival rate was 85.9%，and 4 of the 49 patients in the CTCS<3 group had recurrence and metastasis，the 5-year DFS was 91.8%. The difference in DFS between the two groups was statistically significant（χ2=4.006，P=0.045）.Conclusion:CTCS can predict the prognosis of breast cancer patients with stage T1-2 and 1~3 p ALNs positive patients. When patients have CTCs≥3，PMRT should be considered in combination with other clinicopathological characteristics such as age，PT stage，molecular typing to improve the prognosis of patients.

The aim of the study was to explore the role and molecular mechanism of dual-specificity phosphatase 8 (DUSP8) in the drug resistance of trastuzumab in breast cancer. Real-time PCR and western blot detected the difference in expression of DUSP8 between breast cancer tissue/cells and trastuzumab-resistant tissues/cells. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of DUSP8 in breast cancer. si-DUSP8 or dusp8 overexpression vector was transiently transfected, and the effects of si-DUSP8 on apoptosis, cell viability and cell migration of drug-resistant cell lines were investigated by flow cytometry, MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide) and Transwell assays, and its regulation mechanism finally explored. The results showed that the expression of DUSP8 in breast cancer tissues and cells was significantly higher than in matched non-tumor tissues and cells. DUSP8 was significantly upregulated in non-responsive patients compared with patients who responded to trastuzumab. ROC analysis showed that the area under the curve was 0.732, and the diagnostic sensitivity and specificity were 64.86% and 75.76%. DUSP8 knockdown promotes apoptosis and reduces trastuzumab resistance in BT474/TR and SKBR3/TR cells by inhibiting cell migration and cell viability. Knockdown of DUSP8 increased the expression of p-p38 and p-ERK, and the regulation of DUSP8 in chemotherapy resistance of breast cancer cells may be realized by mediating mitogen-activated protein kinase (MAPK)-related signaling pathways. In conclusion, knockdown of DUSP8 expression in trastuzumab-resistant cells can inhibit cell migration and proliferation, and leads to decreased drug resistance by activating MAPK signaling pathway in trastuzumab-resistant cells.

目的 总结微创理念在甲状腺再次手术中的应用体会.方法 回顾性分析2008年1月～2022年1月甲状腺再次手术32例的临床资料,其中复发或持续性分化型甲状腺癌6例,复发性结节性甲状腺肿23例,原发性甲状腺功能亢进(甲亢)术后复发2例,甲状腺腺瘤射频消融术后复发1例.术前精确评估甲状腺残叶、甲状旁腺和神经功能,根据既往手术范围、病理情况,制定再次手术时机和方式,腔镜辅助下联合应用外科能量器械进行精细操作.结果 32例均顺利完成手术,手术时间75～150 min,(104.7±16.8)min,出血量40～180 ml,(84.1±32.3)ml.未出现喉返神经、喉上神经和甲状旁腺损伤等并发症.随访时间2个月～14年,中位数69个月,无并发症发生,未见疾病复发.结论 微创理念指导下,甲状腺再次手术可以安全施行.

目的 分析70岁及以上老年女性乳腺癌患者的临床特点及预后.方法 回顾性分析2006年6月至2016年7月首都医科大学附属北京安贞医院收治的238例70岁及以上老年女性乳腺癌患者的临床资料.记录患者的临床特征,对患者进行术后随访并记录预后情况.采用Kaplan-Meier生存曲线分析方法计算不同临床特征患者5年总生存率和5年无病生存率,分析影响患者生存率的危险因素.结果 238例患者中,214例(89.9％)患者以无痛性乳房肿块为主要就诊症状;202例(84.9％)为浸润性导管癌;63例(26.5％)肿瘤直径≤2 cm、149例(62.6％)肿瘤直径＞2 ～5 cm、26例(10.9％)肿瘤直径＞5 cm;56例(23.5％)淋巴结转移数量≥4个;85例(35.7％)肿瘤分期Ⅰ期、123例(51.7％)肿瘤分期Ⅱ期、30例(12.6％)肿瘤分期Ⅲ期;54例(22.7％)分子分型为Luminal A型、98例(41.2％)为Luminal B型/人表皮生长因子受体2(HER-2)阴性、26例(10.9％)为LuminalB型/HER-2阳性、19例(8.0％)为HER-2过表达型、41例(17.2％)为三阴性.截至2016年10月,226例得到随访,随访率为95.0％,随访时间85(65,89)个月,随访期间37例患者死亡.Kaplan-Meier生存曲线分析结果显示,患者5年总生存率为90.5％、5年无病生存率为84.2％.多因素Cox回归分析结果显示,淋巴结转移(相对危险度=1.549,95％置信区间:1.213～2.761,P=0.018)、分子分型(相对危险度=8.460,95％置信区间:1.437 ～8.462,P=0.006)是影响患者5年总生存率的独立危险因素,淋巴结转移(相对危险度=0.423,95％置信区间:0.146～1.924,P=0.002)是影响患者5年无病生存率的独立危险因素.结论 老年女性乳腺癌分子分型以Luminal A型及Luminal B型多见.淋巴结转移、分子分型是影响患者预后的独立危险因素.

目的 探讨伊立替康联合阿帕替尼辅助治疗对术后转移性胃癌患者的效果.方法 选取2016年1月至2021年1月在首都医科大学附属北京安贞医院接受治疗的术后转移性胃癌患者68例,按随机数字表法分为观察组与对照组,各34例.对照组给予伊立替康静脉滴注治疗;观察组在对照组基础上口服阿帕替尼辅助治疗.比较2组治疗后临床疗效,用药前后免疫功能指标CD3+、CD4+、CD8+水平及CD4+/CD8+比值,肿瘤标志物糖类抗原19-9(CA19-9)、CA125、神经元特异性烯醇化酶(NSE)水平,炎性因子白细胞介素10(IL-10)、IL-6、肿瘤坏死因子α(TNF-α)水平,生存质量评分和不良反应发生情况.结果 观察组总有效率明显高于对照组[85.3％(29/34)比61.8％(21/34)],差异有统计学意义(P=0.028).用药后观察组免疫功能指标CD3+、CD4+水平及CD4+/CD8+比值均高于对照组,CD8+水平低于对照组,肿瘤标志物CA19-9、CA125、NSE水平均明显低于对照组,炎性因子IL-10、IL-6、TNF-α水平均低于对照组,各维度生存质量评分均高于对照组,差异均有统计学意义(均P<0.05).2组不良反应发生率比较,差异无统计学意义(P=0.494).结论 术后转移性胃癌患者采取伊立替康联合阿帕替尼辅助治疗的效果较好,可增强患者免疫能力,促进肿瘤标志物改善,减轻炎性反应,并提升患者生存质量.

BACKGROUND:The role of estrogen receptor β (ERβ) in the pathogenesis and development of breast cancer (BC) is controversial, and it is currently considered to play contradictory roles in different phenotypes. ERβ2 is thought to promote the BC process, but its role in triple-negative breast cancer (TNBC) has not been reported.METHODS:In this study, we collected tumor tissues from 15 patients with TNBC and obtained a variety of TNBC cell lines as research objects. The plasmid vectors and RNA interference techniques were used to change the level of target genes in cells, quantitative PCR and Western Blots were used to detect gene expression levels, CCK-8 and EdU assay were used to detect cell growth, and Transwell was used to detect cell migration and invasion. Dual-luciferase gene reports and RNA immunoprecipitation (RIP) were used to verify gene targeting relationships.RESULTS:ERβ2 was up-regulated in TNBC tissues and promoted the growth, migration, and invasion of TNBC cells. ERβ2 regulated hsa_circ_0000732 expression by binding to SCARF1 promoter. Knockdown of hsa_circ_0000732 inhibited TNBC cell proliferation, migration, and invasion by upregulating miR-1184.CONCLUSION:Our present study found that ERβ2 is upregulated in some TNBC cells and promotes TNBC cell growth, migration and invasion by regulating hsa_circ_0000732 targeting miR-1184. The special role of ERβ2 in TNBC may be the breakthrough of a targeted treatment strategy for TNBC.

目的 探讨超声刀联合双极电凝镊在腔镜辅助甲状腺微创手术(minimally invasive video-assisted thyroidectomy,MIVAT)中的应用价值.方法 回顾性分析2018年6月～2021年6月MIVAT术中快速冰冻病理证实甲状腺微小乳头状癌53例资料.前32例使用超声刀操作(超声刀组),后21例使用超声刀联合双极电凝镊(联合组).2组年龄、性别、肿物大小以及位置均无统计学差异(P>0.05).2组手术均由同一组医生完成.比较2组手术时间、术中出血量、术后24 h引流量、术后住院时间、中央区淋巴结清扫数量、术后并发症.结果 2组手术均顺利完成,联合组术中出血量、术后24 h引流量、术后住院时间均明显少于超声刀组[(14.5±3.8)ml vs.(26.7±9.6)ml,t=-6.421,P=0.000;(21.2±6.3)ml vs.(43.0±8.0)ml,t=-10.488,P=0.000;(1.9±0.9)d vs.(3.6±1.1)d,t=-5.991,P=0.000].术后暂时性声音嘶哑联合组0例,超声刀组3例,2组差异无统计学意义(P=0.269).2组手术时间、中央区淋巴结清扫数量差异无统计学意义(P>0.05).术后随访4～38个月,平均22个月,未发现肿瘤复发.结论 超声刀联合双极电凝镊明显减少术中出血,降低神经损伤风险,是安全施行MIVAT甲状腺癌手术的理想工具.

We aimed to explore the clinical efficacy of breast-conserving surgery and modified radical mastectomy on the quality of life (QoL) in patients with early breast cancer.A total of 100 patients treated with breast-conserving surgery (BCS) were recruited in the BCS group, and 100 patients treated with modified radical mastectomy (MRM) in the MRM group.Our results showed that patients had significantly shorter operation time and hospital stay, smaller incisions, and less intraoperative blood loss in the BCS group than in the MRM group.The total complication rate was significantly lower in the BCS.The rate of good-toexcellent aesthetic outcomes in the BCS group was significantly.At one year and three years after surgery, the QoL in the BCS group was significantly higher than that in the MRM group (P<0.0001).In conclusion, BCS is as effective as MRM in early breast cancer, but confers better perioperative and aesthetic outcomes, higher QoL, and lower postoperative complication rate.

目的 总结多学科诊疗模式下巨大甲状腺肿手术的体会. 方法 回顾性分析2018年6月～2022年1月同组医师对37例巨大甲状腺肿行手术治疗的临床资料,术前影像科协助评价邻近器官受压情况,麻醉科评估气管狭窄插拔管难度,耳鼻喉科协助判断气管软化及术后气管切开风险,外科重症监护室(Surgical Intensive Care Unit,SICU)、内分泌科、心内科、呼吸科有针对性进行围手术期管理,个体化选择麻醉方式,外科精细操作,行甲状腺腺叶全切或近全切除手术,术后观察有无呼吸困难、声音嘶哑、低钙血症、出血等并发症发生. 结果 手术顺利完成,单侧甲状腺叶近全或全切除26例,双侧甲状腺叶近全或全切除11例,其中气管悬吊9例.手术时间50～125 min,(82.7±22.2)min;术中出血量20～150 ml,(63.8±29.8)ml.术后暂时性甲状旁腺功能减退和暂时性声音嘶哑各1例.门诊随访2～43个月,平均18个月,未见腺肿复发. 结论 巨大甲状腺肿手术需要多学科协作,充分术前评估准备,精细操作,严格围手术期管理,避免窒息的发生.

Background: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND). Methods： From January 1, 2003 to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection). 996 eligible patients were enrolled. Results： The final cohort of 996 patients was followed for an average of 198 months. The events other than death differed significantly between the two cohorts（p=0.0311） (46.3% in MALND and 53.2% in CALND, respectively). The sum of the events other than death and deaths from other causes was much more in CALND （59.6%）than in MALND (53.4%）（p=0.0494）. The 17-year DFS rates were 36.7 percent for MALND group and 33.6 percent for CALND group，respectively. There was a significant difference between the groups ( p =.0306). The OS rates were 53.2 percent after MALND and 46.0 percent after CALND ( p = .0119). The MALND patients had much less axillary pain (p =. 0000), numbness or paresthesia (p = .0000) ，arm mobility (p =. 0000), and arm swelling on operated side (p = .0000). The aesthetic appearance of axilla in MALND group was much better than that in CALND group (p =. 0000) at an average follow-up of 17-year. Conclusions： The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed.

目的 探讨经环乳晕切口联合乳腔镜腋窝淋巴结清扫实施乳腺癌保乳手术(breast conserving surgery,BCS)及腋窝淋巴结清扫的治疗效果和美容结果.方法 2016年1月至2019年1月,98例早期乳腺癌患者实施BCS,其中46例行环乳晕切口加乳腔镜腋窝淋巴结清扫术,并与同期52例经肿块表面切口联合传统腋窝淋巴结清扫的保乳手术比较,2组手术时间、术中出血、放置引流管时间、住院天数等手术观察指标;根据术后6个月以上乳房外观评价不同手术方式的乳房美容效果.结果 2组病例的肿瘤直径、肿瘤位置、肿瘤与乳头乳晕复合体(nipple-areola complex,NAC)距离、淋巴结转移、病理类型、临床分期、分子分型的比较,差异无统计学意义(P>0.05),肿瘤表面切口组手术时间较短(P<0.05),术中出血、放置引流管时间、住院天数比较,差异无统计学意义(P>0.05).美容效果比较,环乳晕切口组在质地与弹性、对称性、患侧乳房凹陷程度、皮肤颜色、手术瘢痕及乳房顺应性差值得分高于肿瘤表面切口组,差异有统计学意义(P<0.05).总分>24分的优良率在环乳晕切口组(78.3％,36/46)明显高于肿瘤表面切口组(51.9％,27/52),差异有统计学意义(P<0.05).结论 环乳晕切口切除肿瘤,能够达到与肿瘤表面切口相同的保乳治疗效果,结合乳腔镜腋窝淋巴结清扫技术,提高了早期乳腺癌保乳手术效果和患者术后生活质量,获得了最佳的美容效果.