Objective:To evaluate the clinical efficacy and safety of capecitabine plus transtuzumab in older patients with Her-2 positive metastatic breast cancer(MBC). Method:Thirty two older patients(≥65 years)with Her-2 over expressing recurrent or metastatic breast cancer(MBC) confirmed by pathology enrolled into the study. The patients received capecitabine 1250 mg/m2 twice daily,1-14 days,combined with intravenous transtuzumab 8 mg/kg body weight on day 1(loading dose),followed by 6 mg/kg every 3 weeks,and were evaluated efficacy every 2 cycles. Result:Complete remission( CR)was 2 cases(6.2%),PR was 10 cases(31.3%),11 cases had stable disease(SD)lasting at least 6 months(34.4%)and 9 cases(28.1%)got progressive disease(PD). The total effective rate was 37.5%(12/32),the clinical benefit response rate(CR+PR+SD)was 71.9%(23/32). The median time to progression(TTP)was 8.5 months. The safety profile of the combination was favorable. The main side effects were hand-foot syndrome,diarrhea and stomatitis which were all tolerable. Only one patient suffered from symptomatic chronic heart failure,which improved after discontinuation of transtuzumab. There were no treatment-related deaths. Conclusion:The combination therapy of capecitabine plus transtuzumab is effective and tolerable for older patients with Her-2 positive MBC,it is a safe and active palliative treatment option.

Objective: To study the distribution of positive axillary lymph node(LN) of the breast cancer patients with false negative (FN) sentinel lymph node(SLN) and seek the possibility of a new operating type which could reserve the axillary functions but could not omit positive LN beyond the axillary lymph node dissection(ALND)and SLN.Method: A total of 80 breast cancer patients with negative SLN were performed ALND simultaneously. Axillary specimens were divided into two sections of the upper and the lower according to the highest branch of nervi intercostobrachiales, and were taken for pathological examination respectively.Result:Five cases were proved to be FN SLN by pathology after operation. The total of 9 positive LN were located in the lower section of axilla.Conclusion:This study demonstrated that the positive LN omittance in patients with FN SLN are all located in lower section of axilla, and can be completely remove by complementary low level ALND which can preserve the axillary functions including nervi intercostobrachiales.

目的 探讨保留皮肤及乳头、乳晕的乳腺癌改良根治术后即刻背阔肌重建的可行性、适应证及效果.方法 自2012年2月～2013年3月对经选择的32例乳腺癌患者行保留皮肤及乳头、乳晕的乳癌改良根治术,同时即刻应用扩大背阔肌皮瓣联合或不联合假体行乳房重建,术后根据重建乳房美观度评价外观效果.结果 32例重建手术均取得成功,其中单纯扩大背阔肌重建21例,联合假体11例,5例(15.6％)出现可处理的术后并发症.28例患者术后辅助化疗.经过3～15个月随访,局部复发率为0.重建乳房形态自然,术后外观评价优良率为96.8％.结论 合理选择病例行保留皮肤及乳头、乳晕的乳腺癌改良根治术后即刻扩大背阔肌重建是安全可靠的,切口隐蔽,能同时满足肿瘤治疗及形体美观的要求.

目的:探讨超声引导下射频消融治疗甲状腺良性结节的临床效果。方法:回顾性分析2009年6月—2010年9月46例甲状腺良性结节行超声引导下射频消融治疗效果。全组男15例,女31例;平均年龄32(19～56)岁,术前超声检查皆为甲状腺单发结节,结节位于右侧甲状腺21例,峡部6例,左侧甲状腺19例;其中实性18例,囊实性16例,囊性12例,病变区无明显沙砾样钙化,颈部无淋巴结肿大,甲状腺功能正常。术前结节穿刺病理诊断均为结节性甲状腺肿,肿瘤大小0.9～2.6 cm。结果:46例均成功行射频消融手术,术中无明显并发症发生,1例出现穿刺部位感染。经过6个月随访,22例(47.8%,22/46)患者结节全部吸收,12例(26.1%,12/46)结节体积较术前缩小≥50%。结论:超声引导下射频消融治疗甲状腺良性结节具有疗效好、微创优势明显,是一种值得推广的手术方法。

<正> 超声刀(Ultrasonically activated shears,UAS)是一种新的止血设备,它可以有效地闭合3mm以下的各种血管,且组织粘连和焦痂少,热传导范围小。2009年1月～2009年6月我科对46例甲状腺良恶性疾患采用UAS下颈部小切口甲状腺大部或全切

目的探讨甲状腺微小乳头状癌的手术范围及临床疗效。方法回顾性分析2002年1月至2006年9月手术及病理证实的甲状腺微小乳头状癌56例的临床资料。结果行甲状腺患侧全切和峡部、对侧次全切15例,甲状腺患侧叶全或次全切除41例,随访2~6年,仅1例复发,其余均未见复发和转移。结论甲状腺微小乳头状癌具有低侵袭性,患侧叶切除全切和峡部、对侧次全切除是可行的。

随着社会的不断进步,生活水平的不断提高,乳腺疾病患者对生活质量的要求也越来越高.许多女性患者(包括一部分农村女性和50岁以上女性)在治疗乳腺良性肿瘤时要求既要完整切除病灶又要保持乳房的完美外形.为适应这一新的需要,满足广大女性对美的追求,本科于2005年3月至2007年6月对51例乳腺良性肿瘤(均为单个肿瘤)进行腔镜手术,效果满意,现总结如下.

目的通过与不保留肋间臂神经(ICBN)的病例患肢前臂内侧皮肤感觉障碍、肩关节活动范围及心理创伤的严重程度进行比较,评价乳癌手术中保留ICBN的疗效。方法2005年共行乳癌手术113例,其中保留ICBN的有21例,均为Ⅰ～Ⅱ期乳癌,在同期中67例Ⅰ～Ⅱ期不保留ICBN的乳癌病例中随机抽取21例,比较2组患肢前臂内侧皮肤感觉障碍范围、肩关节活动范围及心理创伤程度。结果保留ICBN的病例皮肤感觉障碍发生率及发生范围明显低于不保留ICBN者,两者比较有显著差异性(P<0.05);患肢肩关节活动稍好于不保留ICBN者,但无统计学差异(P>0.05),抑郁发生率低于不保留者(P<0.05)。结论乳癌手术保留ICBN的疗效优于不保留ICBN者。

Objective To explore the clinical results and operation experiences for benign breast mass by ultrasound guided mammotome minimally invasive biopsy system (MMIBS). Methods 212 benign breast masses in 186 patients were resected by ultrasound guided MMIBS. Clinical data of 186 patients were retrospectively analyzed. Results Needle position in 186 patients was visualized. Lesions were completely removed in 134 cases of 186 (72%) patients. The complete resection rate for tumors on major pectoral muscle or near areola were 31.5% (6/19) and 33.3% (4/12) respectively. Identified by postoperative ultrasound, 118 out of 134 patients (88.0%) with tumor sizes 0.5 to 2.5 cm and 16 out of 38 patients (42.1% ) with sizes 2.5 to 3.0 cm were completely removed. No lesions larger than 3.0 cm were completely removed. All 52 cases in which the tumors were not completely removed by MMIBS were converted to open surgery. Ultrasound follow-up after 4 weeks showed that all the 134 cases that had had masses completely removed had no residual masses, whereas 6 months after operation, 16 out of the 112 cases proved tumor recurrent necessitating open reoperation in 6 cases and second MMIBS operation in 10 cases, among them one case recurred after six months and received open operation. Conclusions For small benign breast mass, MMIBS has therapeutic effect with significantly minimal invasion.

目的 观察紫杉醇对大肠癌细胞系CX1细胞的杀伤作用,并探讨MAPKs/ERK信号传导通路抑制剂PD98059对其的影响.方法 通过MTT法比较紫杉醇和紫杉醇+PD98059分别作用于CX1细胞后的药物敏感度,并应用流式细胞术对二者作用下的细胞进行细胞解析,观察细胞周期变化.结果 大肠癌CX1细胞在紫杉醇作用72 h后,IC50为2.14 × 10-7mol/L,而在紫杉醇联合PD98059作用72 h后,IC50为6.91×10-9mol/L.通过细胞的周期解析发现紫杉醇和PD98059共同作用的细胞其凋亡比例为31.41%,远远高于紫杉醇单独作用引起的凋亡(15.60%),二者之间差异有统计学意义(P＜0.05).而未加药及单加PD98059的CX1细胞其凋亡细胞只占5.27%及5.61%,二者之间差异无统计学意义(P＞0.05).结论 紫杉醇可以诱导大肠癌细胞凋亡,而针对MAPK/ERK信号通路的抑制剂PD98059可增强紫杉醇的凋亡作用.

Objective: To discuss the method of decreasing the risk of the injury on laryngeal nerve in the thyroid gland operation.Methods:We could get the conclusion from the analysis of the reason why the patients' recurrent laryngeal nerve get injured. In the analysis the 375 cases were picked among the patients undergone the thyroid gland operation from Sep.2005 to Jan.2007. Results:Among the 375 cases there were 5 patients whose recurrent laryngeal nerve was injured,among which there are three thyroidectomies,one Hashimoto thyroiditis and one thyrocarcinoma. In all these five cases,the injuries were all on the site of abduction when they were observed seen through the laryngoscope. After fifteen days to three months' hormonal and neurotrophic treatment,the patients could recover completely and the vocal cord could also got over which could be examined through the laryngoscope. Conclusions:The majority of the recurrent laryngeal nerve’s injuries can be avoided,it is important to know the nerves anatomical structure and its variation well for the operators,the operators should firstly understand the visual field and the histiostructure of the operation region especially of the recurrent laryngeal nerve.

Objective:To explore the effects and method of modified radical mastectomy by reserving nipple with endoscope-assistant for breast cancer.Methods:from Sept.2004 to Apr.2006,24 cases of breast cancer were performed by modified radical mastectomy by reserving nipple with endoscope-assistant.Results:All patients were treated with no obvious complication.Nether neither local nor distant recurrence had been found for a longest follow-up period of 18.6 months and a median follow-up period of 9.2 months.Conclusion:modified radical mastectomy by reserving nipple with endoscope-assistant is recommended for early breast cancer patients.

Objective: To analyze results of cytological examination in rinse solution of axillary raw surface for breast cancer patients with mastoscopic axillary nodes clearance (MANC) and to provide the evidence of the operation for its safety. Methods: The cytological examination in axillary rinse solution was done in 66 breast cancer patients with lymphatic metastases. Among these patients, there were 32 cases with MANC and 34 cases with general axillary nodes clearance (GANG). The relation between cytological examination and clinical parameters was analyzed. Results: The positive rate of exfoliated tumor cells in patients with MANC and GANG groups was 37.5% and 29.6% respectively. Through hot hypotonic solution soaking chemotherapy, the positive rate of exfoliated tumor cells in patients with MANC and GANG groups was reduced to 6.25% and 2.94% respectively. The detection rate was 56.2% when the number of metastatic lymph node beyond 3, and the rate was 18.7% when the number below 3 in the MANC group (P<0.05). Conclusions: MANC is a minimally invasive and clinically feasible procedure. It manifests the functional and cosmetic effects. The detection rate of exfoliated cell is related to the numbers of lymphatic metastases of the tumor. It is necessary to kill exfoliated tumor cells in operation.