研究保乳术联合腺体筋膜瓣转移成型术的临床效果.收集2015年3月至2019年7月收治的71例早期乳腺癌患者病例资料,按照治疗方式差异分成联合组(31例)和传统组(40例).传统组行传统手术治疗,联合组予以保乳术联合腺体筋膜瓣转移成型术.比较两组各项手术指标、乳房美容效果、术后并发症发生情况及术后复发率等差异.联合组手术时间以及术后住院时间均短于传统组,且术中出血量少于传统组(均P<0.05).联合组乳房美容优良率高于传统组(P<0.05).联合组术后并发症总发生率低于传统组(P<0.05).两组术后1年复发率比较差异无统计学意义(P>0.05).保乳术联合腺体筋膜瓣转移成型术临床效果优于传统手术,且术后并发症发生率较低,乳房形态较好,不增加复发率,具有临床推广价值.

Objective:To investigate the clinical effect of modified radical mastectomy and axillary lymph node preservation for breast cancer.Methods:A total of 61 patients with negative early breast cancer treated surgical treatment between April 2017 and April 2019.The patients were divided into two groups according to different surgical methods: 35 patients in the improved group received improved radical mastectomy for breast cancer, and 26 patients in the axillary-preserving group received axillary lymph node preserving mastectomy for breast cancer. Clinical data analysis using the statistical software SPSS 24.0, perioperative indicators and QLQ-BR23 score measurement data used (±s) said, comparison between groups use independent sample t test; The statistical data of postoperative complications were tested by χ2 test. The disease-free survival curve was ploted by Kaplan-Meier method, and the difference in survival rate was analyzed by Log-rank test. P<0.05 was considered statistically significant.Results:The operative time, intraoperative blood loss, extubation time and drainage volume in axil-preserving group were less than those in improved group (P<0.05). The complication rate of improved group (34.2%) was significantly higher than that of axillary protection group (11.5%) (P<0.05). Comparison of The QLQ-BR23 scores one year after operation showed that the axillary preservation group was significantly better than the preservation group in body shape assessment, side effects and upper limb symptoms scores, with statistically significant differences (P<0.05). The follow-up period ranged from 14 ~ 38 months, and the median follow-up time was 27 months. There was no significant difference in disease-free survival rate between the two groups (P>0.05).Conclusion:Axillary preservation radical mastectomy for sentinel lymph node negative patients with early-stage breast cancer can reduce the incidence of postoperative complications, improve the quality of life, and has no significant impact on the long-term prognosis, which is worthy of clinical application.

Objective To investigate the relationship between the serum cartilage glycoprotein 39 (YKL-40) and monocyte chemotactic protein-1 (MCP-1) with metastasis and prognosis in breast cancer patients.Methods The enzyme-linked immunosorbent method was carried out to detect the levels of serum YKL-40 and MCP-1 in 64 cases of breast cancer patients and 47 healthy people as control group.Analysis the relationship between indicators and clinical pathologic,survival and prognosis of breast cancer patients.Results The average value of YKL-40 and MCP-1 in Breast cancer patients were respectively (286.3 ±96.7) ng· L-1 and (171.2 ±105.4)μg· L -1,significantly higher than that of healthy people(164.1 ±70.9)ng· L -1and (118.5 ±77.6)μg· L -1 (P <0.01).The e-valuated of YKL-40 was relate to lymph node metastasis (P<0.05),while the promotional of MCP-1 was associated with presence of lymph node metastasis and TNM stages (P<0.05).Kaplan-Meier analysis showed the 3 year survival rate in YKL-40 and MCP-1evaluated group were 46.75% and 53.12% respectively, has significant difference with the normal YKL-40 and MCP-1 groups (76.56%and 81.25%,respectively )(P<0.05).Cox regression analysis showed YKL-40 and MCP-1 were independent risk factors of prognosis of breast cancer,but the relative risk of YKL-40 was even higher than MCP-1(RR =2.87 vs 2.25).Conclusion The breast cancer patients with elevated serum YKL-40 and MCP-1 have high risk of lymph node metastasis.It is helpful to judge the prog-nosis of patients with breast cancer by detect the serum levels of YKL-40 and MCP-1.

目的 分析三阴乳腺癌的临床特征、预后影响因素以及Ki-67在三阴乳腺癌中的表达意义.方法 回顾性分析2006年1月～2011年12月安徽医科大学附属巢湖医院79例三阴乳腺癌患者(三阴乳腺癌组)的临床特点、病理特征以及随访情况,并与同期355例非三阴乳腺癌患者(非三阴乳腺癌组)相比较.结果 三阴乳腺癌组的远处转移率明显高于非三阴乳腺癌组,差异有统计学意义(16.5％比7.0％,P=0.007);三阴乳腺癌组患者的5年无病生存率(DFS)和总生存率(OS)分别为69.4％和73.2％,均显著低于非三阴乳腺癌组(84.8％、89.1％,P=0.020、0.012);进一步分层显示,淋巴结阳性的乳腺癌患者中,三阴乳腺癌组的DFS和OS亦显著低于非三阴乳腺癌组(57.9％比76.4％,P=0.023;65.2％比83.4％,P=0.032);而在淋巴结阴性的乳腺癌患者中,三阴乳腺癌组的DFS显著低于非三阴乳腺癌组(74.7％比89.8％,P=0.039),但OS并无显著差异(82.0％比93.5％,P=0.313).Ki-67在三阴乳腺癌中的表达显著高于非三阴乳腺癌(P＜0.05).结论 三阴乳腺癌的患者具有年轻化、T分期较晚、淋巴结转移率较高等临床特点,其DFS及OS均低于非三阴性乳腺癌患者.其中肿块大小和淋巴结转移状况是影响三阴乳腺癌患者预后的重要因素.Ki-67在三阴乳腺癌中过表达,对三阴乳腺癌的复发转移以及预后有一定意义,是综合评价三阴乳腺癌的临床重要标志物.

Objective To compare the incidence of shoulder dysfunction and upper extremity lymph edema in early postoperative period between SLNB and ALND after sentinel lymph node biopsy for breast cancer patients with sentinel lymph node -negative.Methods Totally 40 patients with breast cancer with sentinel lymph node -negative were randomly divided into SLNB group ( n=20 ) and ALND group(n=20).Results ①In patients with SLNB the circumferences of upper arm in one,two,and four weeks after operation were similar to those before operation(P=0.067,P=0.212,and P=0.698,respectively).While in patients with ALND,the circumferences of upper arm in one or two weeks after operation were significantly bigger than those before operation(P=0.004,P=0.012,respectively),and the circumference in four weeks after operation was similar to that before operation ( P=0 .204 ) .②In patients with SLNB the Neer shoulder joint function scores in one and two weeks after operation were smaller than those before operation (P=0.000,P=0.000,respectively), and the score in four weeks after operation was similar to that before operation(P=0.163).However,in patients with ALND,the scores in one,two or four weeks after operation were smaller than those before operation(P=0.000,P=0.000,and P=0.000,respectively).③Be-fore operation,the Neer shoulder joint function score and outreach angles of shoulder joint between patients with SLNB and ALND were both smaller(P=0.284,P=0.558,respectively).However,four weeks after operation,the scores and angles in patients with SLNB were both higher than those with ALND(P=0.000,P=0.000,respectively).Conclusion For breast cancer patients with sentinel lymph node -negative,SLNB substituting ALND can reduce the incidence of shoulder dysfunction and upper extremity lymph edema in early postoperative period.

目的：观察分析乳腺癌保乳手术治疗的临床疗效。方法选取我院2010年12月至2013年12月收治的88例乳腺癌患者，所有患者均自愿选择保乳治疗(观察组44例)或乳腺癌改良根治术(对照组44例)，具体包括保乳手术、辅助化疗、辅助放疗等。术后随访1~12个月，统计患者手术疗效，并按照乳腺美容评估标准(Rose 标准)对患者保乳手术美容效果进行评价。结果观察组治疗有效率为95.45%，对照组为93.18%；但观察组美容疗效优良率为88.64%，对照组为43.18%。结论乳腺癌保乳手术治疗在改善患者乳腺外观、降低患者肿瘤复发和远处转移上具有显著疗效，患者生活质量和生存质量显著改善，值得临床推广。