BackgroundIn order to explore the surgical safety and the reliability of axillary staging of single-port endoscopic-sentinel lymph node biopsy, we combined it with indocyanine green that was excited by near-infrared fluorescence endoscopy and carbon nanoparticles as a tracer and compared this method to conventional open sentinel lymph node biopsy.MethodsThis is a retrospective and observational study, there were 20 patients in each group and the total sample size was 60: Group 1, single-port endoscopic-sentinel lymph node biopsy combined with indocyanine green and carbon nanoparticles; Group 2, single-port endoscopic-sentinel lymph node biopsy with carbon nanoparticles only; Group 3, conventional sentinel lymph node biopsy with indocyanine green and carbon nanoparticles. Sentinel lymph node detection and upper extremity function were determined to measure the safety and efficacy of the novel single-port endoscopic-sentinel lymph node biopsy (SPE-SLNB) technique to the standard conventional sentinel lymph node biopsy technique.ResultsThe detection rate of sentinel lymph nodes was 100% in Group 1, 100% in Group 2, and 95% in Group 3. There were no significant differences in upper arm function and pain scores between the three groups.ConclusionThe novel technique of combining indocyanine green and carbon nanoparticles with single-port endoscopic-sentinel lymph node biopsy achieved a similar detection rate and mean number of sentinel lymph nodes as conventional sentinel lymph node biopsy. Traditional open surgery requires two different incisions for breast surgery and SLNB. While the most important advantage of SPE-SLNB is that two procedures can be effectively performed through a single-port in the axilla Therefore, for patients who meet the indications, single-port endoscopic-sentinel lymph node biopsy is as safe and reliable as conventional sentinel lymph node biopsy but has the aesthetic advantage of only one incision.

Background In the surgical treatment of breast cancer, the goal of surgeons is to continually create and improve minimally invasive surgical techniques to increase patients’ quality of life. Currently, routine breast-conserving surgery is often performed using two obvious incisions. Here, we compare the clinical efficacy and aesthetic outcomes of a novel technique using one incision, called ‘single-port insufflation endoscopic breast-conserving surgery’ (SIE-BCS), vs. conventional breast-conserving surgery (C-BCS) in patients with early-stage breast cancer. Methods A total of 180 patients with stage I or stage II breast cancer participated in this study, of whom 63 underwent SIE-BCS and 117 underwent C-BCS. Logistic regression analysis was conducted to assess the risk of local recurrence and metastasis. Aesthetic outcomes were evaluated using the BREAST-Q scale. Results The mean operation time was significantly longer for SIE-BCS (194.9 ± 71.5 min) than for C-BCS (140.3 ± 56.9 min), but the mean incision length was significantly shorter for SIE-BCS than for C-BCS (3.4 ± 1.2 cm vs. 8.6 ± 2.3 cm). While both surgeries yielded similar BREAST-Q ratings for satisfaction with breasts and sexual well-being, SIE-BCS was associated with significantly better ratings for physical well-being (chest area) and psychological well-being. Additionally, SIE-BCS was associated with decreased rates of adverse effects of radiation. The preliminary analysis showed that SIE-BCS did not increase the risk of local recurrence or metastasis. Conclusion The novel single-port insufflation endoscopic assisted BCS technique is feasible, safe, and improves patients’ postoperative comfort and psychological well-being, as compared to the conventional technique.

Introduction Breast cancer is the most prevalent cancer and the leading cause of cancer-related death in women. Conventional open mastectomy (C-OM) is one of the most common procedures for breast cancer, which involves the removal of the nipple-areola complex and a large proportion of the breast skin, leading to poor cosmetic effect and restriction of upper extremity function. Single-port insufflation endoscopic nipple-sparing mastectomy (SIE-NSM) could conceal the incision along the wrinkles in the axilla, preserve all the breast skin and nipple-areola complex and provide a better cosmetic outcome and quality of life. This trial aims to investigate the oncological safety between SIE-NSM and C-OM in early breast cancer patients. Methods and analysis This is a single centre, non-blinded, randomised controlled trial (RCT) and will be conducted at Beijing Friendship Hospital. Patients will be enrolled in the inpatient ward. Breast surgeons will notify patients who meet the inclusion and exclusion criteria with the instruction of this RCT. Patients will be randomly assigned to C-OM or SIE-NSM with a 3:1 allocation as per a computer-generated randomisation schedule. Patients will be followed-up for 12 months for analysing surgical outcomes. The primary outcome is the local recurrence rate at a 12-month follow-up. The secondary outcome is the distant metastasis rate, cosmetic satisfaction score and psychosocial well-being score after a 12-month follow-up. To ensure the accuracy of the cosmetic satisfaction score and psychosocial well-being score, the standard scale, Breast-Q score, will be applied. Ethics and dissemination This study will be conducted according to the medical ethics committee of the Beijing Friendship Hospital and according to the principles of the Declaration of Helsinki. All patients will receive clear instruction of their disease and treatment plan. Informed consent will be obtained from all patients when they agree to comply with our research plan. The results will be disseminated at academic presentations and publications in peer-reviewed journals. The raw data will be confidentially stored in our electronic data capture database. Data will not be shared unless an appropriate data request is submitted after the trial completion and peer-review journal publication. Trial registration number NCT04461847.

目的:探讨吲哚菁绿(ICG)分子荧光影像技术在单孔法腔镜前哨淋巴结活检术中的应用价值.方法:选取2019年3月至2019年12月收治的行腔镜前哨淋巴结活检术的20例早期乳腺癌患者,均以ICG联合纳米碳混悬注射液作为示踪剂.手术切除的前哨淋巴结送术中冰冻病理检查及常规石蜡病理检查.比较前哨淋巴结检出率、前哨淋巴结转移数量及ICG单独显影、纳米碳单独显影、ICG+纳米碳同时显影的前哨淋巴结数量.结果:ICG、纳米碳、ICG+纳米碳前哨淋巴结检出率分别为100.0％、95.0％、100％;前哨淋巴结检出数量分别为89枚、77枚、97枚,前哨淋巴结检出数量平均为(4.45±1.86)枚、(3.85±1.98)枚、(4.85±2.22)枚,ICG组与纳米碳组差异有统计学意义(P<0.05),ICG+纳米碳组与纳米碳组之间差异亦有统计学意义(P<0.001).20例患者中3例检出前哨淋巴结转移,转移前哨淋巴结7枚;7枚转移前哨淋巴结均被ICG检出,纳米碳仅检出其中2例患者共5枚转移前哨淋巴结.结论:ICG与单孔法腔镜前哨淋巴结活检术结合应用,具有较高的前哨淋巴结检出率及淋巴结检出数量,且前哨淋巴结假阴性率可能较低.

目的 探讨对伴有乳房下垂的乳腺癌病人使用改良延长内上蒂缩乳上提手术.方法 回顾性分析2018年4 月至2018年10 月首都医科大学附属北京友谊医院乳腺甲状腺外科收治的3例外上象限或外侧肿瘤直径较大且伴乳房下垂的乳腺癌病人行改良延长内上蒂缩乳上提手术的相关并发症和术后BREAST-Q评分.结果 3例病人病人术后均未出现脂肪液化、乳头乳晕复合体缺血坏死并发症.术后6个月BREAST-Q评分平均值与术前对比,生理状况评分为96.7分vs.66.7分,对乳房满意度评分为100.0分vs 64.7分,社会心理状态评分为100.0分vs.84.3分,性心理健康状态评分为97.7分vs.88.0分,术后乳头满意度均为满分20分.随访时间分别为13.7个月、16.6个月、19.3个月,均未见复发事件.结论 改良延长内上蒂乳房缩小术适用于外上、外侧象限病灶直径较大的病人,可以相对简便地修复术后局部缺损,同时改善乳房下垂,提高病人对乳房外观的满意度.

Abstract Purpose Indocyanine green (ICG) is an efficient tracer method used in sentinel lymph node biopsy (SLNB). The application of single-port endoscopic-assisted technology in the field of breast cancer is widely accepted. In order to explore the surgical safety of single-port endoscopic-SLNB (SPE-SLNB) and the reliability of axillary staging, we combined it with ICG that was excited by near-infrared fluorescence endoscopy and carbon nanoparticles (CN) as a tracer and compared this method to conventional open SLNB (C-SLNB). Methods Sixty patients with early breast cancer were recruited and divided into three groups. Twenty patients who underwent SPE-SLNB combined with ICG and CNs were placed in group A. Twenty patients who underwent SPE-SLNB with CNs only were placed in group B. Twenty patients who underwent C-SLNB with ICG and CNs were placed in group C. Results The detection rate of SLNs was 100% in group A, 100% in group B, and 95% in group C. In total, 97 SLNs were detected in group A, 65 SLNs were detected in group B, and 98 SLNs were detected in group C . Conclusion The novel technique of combining ICG and CNs with SPE-SLNB and the utilization of the endoscopic fluorescence imaging system achieved the same detection rate and mean number of SLNs as C-SLNB. Therefore, for patients who meet the indications, SPE-SLNB is as safe and reliable as C-SLNB.

Objective: To examine the clinical application value of single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer. Methods: From February 2014 to July 2019, the clinic-pathological data of 34 early breast cancer patients received single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation at Department of General Surgery, Beijing Friendship Hospital, Capital Medical University were retrospectively analyzed and followed up. All the patients were female, with an age of 46(11) years (M(QR)) (range: 26 to 64 years). The radical cure degree of operation, cosmetic effect after operation were evaluated. The satisfaction to operation and personal quality of life after operation was accessed by BREAST-Q scale. Results: All surgical procedures were successfully completed. The operation time was (313.4±11.7) minutes (range: 200 to 485 minutes). The blooding-liquid was (33.8±3.3) ml (range: 10 to 100 ml). There were 5 cases (14.7%) of nipple areola necrosis after operation, of which 1 patient received taking the prosthesis out because of prosthesis exposure. There was no capsular contracture or postoperative bleeding case. The follow-up time was 35(17) months (range: 12 to 77 months), and there was one case suffering local recurrence and metastasis, and another suffering metastasis. The scores of postoperative breast satisfaction, psychosocial status, chest wall status and sexual health were 78.32±2.57 (range: 55 to 100), 89.12±2.30 (range: 82 to 100), 91.47±1.33 (range: 43 to 100), and 78.50±2.68 (range: 39 to 100). Conclusion: Single-port inflatable endoscopic nipple sparing mastectomy with immediate reconstruction using prosthesis implantation in the treatment of early breast cancer can achieve provided curative and cosmetic effect on patients with breast cancer, with good patients' postoperative quality of life and satisfaction.

目的 探讨单孔充气法腔镜保乳手术在早期乳腺癌治疗中的临床应用价值.方法 回顾性分析2018年1月至2019年1月首都医科大学附属北京友谊医院普外科收治的行单孔充气法腔镜保乳手术的66例早期乳腺癌病人的临床资料,并进行随访,对手术根治性、术后美容效果,以及病人的生活质量和满意度进行评估.结果 66例病人均顺利完成手术,无中转开放病例,19例病人行腋窝淋巴结清扫.手术时间为(194.9±70.6)min,术中出血(24.3±19.1)mL.手术切口长度为(3.3±1.2)cm,术后均未出现切口感染.术后中位随访时间为21(18～26)个月,均无肿瘤局部复发或远处转移.通过BREAST-Q量表进行评价,术后乳房满意度、放疗副反应、社会心理状态、胸壁状态、性健康程度评分分别为:(73.8±18.4)、(61.6±17.3)、(84.9±16.4)、(80.2±16.5)、(61.7±28.1)分.结论 单孔充气法腔镜保乳手术治疗早期乳腺癌病人,可获得较好的根治和美容效果,病人术后生活质量和满意度较高.

乳房皮下腺体切除术治疗早期乳腺癌已在临床上广泛开展,但手术瘢痕影响外观且对上肢活动产生限制.腔镜技术则可以有效缩短切口长度、隐藏切口,在对美容效果要求较高的乳腺外科中有较为广阔的应用空间.将腔镜技术与乳房皮下腺体切除术相结合,采用单孔充气法将乳房和腋窝的切口合二为一,缩短为一长度仅为2.5 cm的单孔切口,在保证肿瘤安全性的同时,实现了美容效果的最大化.

目的 探讨吲哚菁绿荧光造影在即刻乳房重建术中在扩张器或假体选择中的应用.方法 前瞻性选取2018年11月至2019年3月首都医科大学附属北京友谊医院收治的以早期乳腺癌行腔镜皮下腺体切除术联合即刻乳房重建手术(置入假体或扩张器)的12例患者,应用吲哚菁绿荧光造影技术,评估乳头乳晕复合体的供血模式和坏死风险,进行置入物选择,观察术后乳头乳晕复合体坏死情况.结果 吲哚菁绿荧光造影结果显示,乳头乳晕复合体坏死低风险(V2、V3供血模式)的10例患者,均选择直接置入假体,术后仅1例患者出现1级乳头乳晕复合体坏死;吲哚菁绿荧光造影结果显示,乳头乳晕复合体坏死高风险(V1供血模式)的2例患者,1例直接置入假体后,出现5级乳头乳晕复合体坏死,1例置入扩张器后,在第1次注水后出现4级乳头乳晕复合体坏死.结论 吲哚菁绿荧光造影可应用于评估乳头乳晕复合体的供血模式和坏死风险,从而指导即刻乳房重建术中假体或扩张器作为置入物的选择.

全科医学作为中国医疗新兴的学科,是以社区为单位,整合临床医学、预防医学、康复医学、人文社会学科为一体的综合医学学科,是适应大众群体获取健康咨询及疾病就诊的重要渠道.近年来,医患关系不断紧张,医疗纠纷不断增加,已经成为不争的事实,但全科医学整体发展基础薄弱.基于国家的财政支持,规范教学管理制度、搞好基地建设、全面提升自身能力是帮助全科医学生在复杂医疗环境下发展自己,适应迅速改变的卫生保健环境并进行医疗实践的能力,实现自己行业价值的关键.