目的 探讨膨胀液在乳腺麦默通手术中局部浸润麻醉的可行性.方法 回顾性分析128例在局部浸润麻醉下行麦默通手术治疗患者的临床资料,观察组采用膨胀液行局部浸润麻醉,对照组采用1％利多卡因行局部浸润麻醉.结果 两组患者手术均顺利完成,所有肿物均完全切除,术后切口均无感染,愈合良好.术后3个月复查,乳房无明显疤痕,乳房无局部凹陷、变形,血肿均可吸收.两组患者手术时间、术中术后诉疼痛需要止痛处理例数、患者的满意度比较,差异未见统计学意义(P>0.05),但观察组术中出血量、术后血肿形成、皮下瘀斑低于对照组(P>0.05).结论 麦默通术中采用膨胀液进行局部浸润麻醉,能极大的减少术中、术后出血的机率,减少病人痛苦,缩短病人恢复时间,术后恢复良好,疗效满意,且药品配制简便,不会加重患者经济负担,具有可研究性,值得进一步推广及运用.

近年来,由于人们饮食中高脂肪、低纤维食物增多,喜食辛辣食物和火锅类食品的人增多,肛周疾病的发病率逐年上升[1]肛周疾病保守治疗效果不佳时常需手术治疗.由于肛门部汗腺、皮脂腺、皮下脂肪较丰富,又是细菌极易繁殖的地方,手术部位特殊,术后肠道分泌物极易污染创面,使创面愈合迟缓,这就要求术后及时换药,使病人肛门部保持清洁[2].然而术后的局部换药及处理,常规是没有麻醉和止痛处理的,因此,肛周疾病手术的病人术后常规换药引起的疼痛刺激,成为不少病人的噩梦.本文就术后采用自来水冲洗、温自来水坐浴的办法处理局部创面的临床效果,现报告如下.

Luyuan Tan* Ya Sun* Liling Zhu* Xin Lei Dongya Liang Nanyan Rao Fengxi Su Kai Chen Shunrong Li 1,2 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China; 3Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China; 4State Key Laboratory of Oncology in South China, Guangzhou, People’s Republic of China; 5Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China

Purpose: Totally implantable venous access devices (TIVADs) are widely used in cancer patients. The main purpose of our study is to observe the incidence and identified risk factors of catheter-related thrombosis (CRT) in breast cancer patients with TIVAD. Patients and methods: We performed a retrospective cohort study of consecutive breast cancer patients who received the ultrasound-guided TIVAD implantation for the administration of chemotherapy from 2013 to 2016. The primary outcome was CRT (both symptomatic and asymptomatic detected by ultrasound). Univariable and multivariable logistic regression analyses were used to identify the risk factors for breast cancer TIVAD-related CRT. Results: A total of 209 breast cancer patients with a newly implanted TIVAD for chemotherapy were included in this study. The average time of port duration was 7 months. Of the enrolled 209 patients, 33 patients (15.8%) had CRT, 2 of the 33 cases were symptomatic (1 pulmonary embolism, 1 deep-venous thrombosis [DVT]), the other 31 cases were asymptomatic detected by routine ultrasound examination of the catheter-associated vein before TIVAD removal with all cycles of chemotherapy completed. In total, 19 (57.6%) of CRT patients underwent directly TIVAD removal without any further treatments, 14 patients received anticoagulation treatments for 3-30 days followed by TIVAD removal. No DVT event was observed within at least 1.5 years of follow-up. In the multiple-variable analysis, tumor size >2 cm (OR 2.735, 95% CI 1.042-7.177; P=0.032), positive HbsAg (OR 2.803 95% CI 1.027-7.856; P=0.047) and low-density lipoprotein (LDL) >3.6 mmol/L (OR 2.360, 95% CI 1.059-5.351; P=0.040) were the significant independent risk factors of breast cancer TIVAD-related CRT. Conclusion: CRT is a common complication in breast cancer patients with TIVAD for chemotherapy. Tumor size, HbsAg status and LDL level were independent predictors of breast cancer for TIVAD-related CRT. Removal of the port without anticoagulation treatments might be a feasible choice for asymptomatic TIVAD-related CRT.

目的:探讨乳腺癌化疗患者发生输液港血栓的高危因素,通过干预治疗,减少输液港血栓的发生,尽可能避免因血栓所导致的不良后果.方法:回顾性分析212例乳腺癌患者完成静脉化疗后进行输液港拆除术的临床资料,探讨与输液港血栓发生可能有关的52个临床因素进行统计学分析处理.结果:本次研究212例患者中发生血栓的例数为34例,几率为16.04％.通过单因素分析,本研究筛出对输液港血栓发生影响有统计学意义的6个变量,即肿瘤大小、白细胞总数、荧光原位杂交技术(fluorescence in situ hybridization,FISH)检测结果、化疗方案、化疗类型、乙肝,结合国内外关于血栓的临床危险因素的研究报导,加入年龄、BMI、凝血功能、高血压、糖尿病、输液港存留时间、输液港位置等临床因素,通过逐步Logistic回归对其进行多因素分析,发现白细胞总数、乙肝阳性、纤维蛋白原、FISH阳性及不确定、其它方案化疗的患者差异有统计学意义(P<0.05);白细胞总数、纤维蛋白原的OR值分别是1.584、0.192,乙肝阳性的乳腺癌患者发生输液港血栓的风险是乙肝阴性的乳腺癌患者人群的13.253倍,FISH阳性及不确定的乳腺癌患者发生输液港血栓的风险是FISH阴性的乳腺癌患者人群的37.056、64.632倍,使用其它方案化疗的乳腺癌患者发生输液港血栓的风险是使用蒽环类化疗的乳腺癌患者人群的9.482倍.结论:白细胞总数高、乙肝阳性、纤维蛋白原低、FISH阳性及不确定、其它方案化疗的乳腺癌患者进行输液港置管后,应定期进行颈部血管彩超检查,必要时考虑抗凝治疗,以减少输液港血栓的发生率.

Squamous cell carcinoma of the breast (SCCB) is an extremely rare malignant neoplasm. The diagnosis is established when the malignant cells are entirely of squamous type, and overlying skin malignancies or other primary sites of squamous cell carcinoma have been excluded. These tumors are extremely aggressive and refractory to treatment. We report a case of a 58 year old white female with SCCB managed to date successfully with a extensive partial mastectomy and close observation.

目的:探讨彩超引导下麦默通微创旋切技术在乳腺诊治中的应用方法和经验。方法:在彩超引导下,利用麦默通系统对200例乳腺肿物患者进行微创旋除术。结果:200例患者的乳腺病灶被准确切除,术后获得明确病理诊断,良性病变同时获得治疗,无并发症。结论:麦默通微创旋切技术是一项准确有效、安全、微创的诊治技术。突出优点是微创、准确、安全、无需缝合,住院时间短,康复快,术后无明显瘢痕,集治疗、诊断与美容于一体。