This study examines the knowledge, attitude, and practice (KAP) toward postoperative upper limb exercise among patients undergoing axillary lymph node dissection for breast cancer. A cross-sectional study was carried out at Guangdong Medical University Affiliated Hospital from July 1, 2023, to May 1, 2024. Demographic information and KAP scores regarding postoperative upper limb exercises were collected using questionnaires. A total of 479 valid questionnaires were included. Among the respondents, 178 (37.2

Lymphedema remains a chronic and challenging condition with limited curative options. Recent advances have expanded treatment strategies from comprehensive conservative management to microsurgical interventions, particularly lymphaticovenous anastomosis (LVA). LVA is a physiological surgical method in which functional lymphatic vessels are connected to nearby subdermal venules, enabling lymphatic fluid to bypass obstructed pathways and drain into the venous circulation. The success of LVA depends heavily on the accurate preoperative assessment and localization of functional lymphatic vessels. Contrast-enhanced ultrasound (CEUS) offers a valuable, non-invasive tool for identifying deep lymphatic channels, enabling dynamic evaluation of lymphatic contractility, peristalsis, and lymph flow. Furthermore, CEUS facilitates the identification of appropriately sized recipient veins, thereby reducing operative complexity and shortening surgical duration. We report a case of secondary upper limb lymphedema following breast cancer surgery, in which LVA was successfully performed under CEUS guidance using supermicrosurgical techniques.

BACKGROUND:Chronic radiative chest wall ulcers are common in patients undergoing radiation therapy. If not treated early, then symptoms such as erosion, bleeding and infection will appear on the skin. In severe cases, ulcers invade the ribs and pleura, presenting a mortality risk. Small ulcers can be repaired with pedicle flaps. Because radioactive ulcers often invade the thorax, surgeons need to remove large areas of skin and muscle, and sometimes ribs. Repairing large chest wall defects are a challenge for surgeons.CASE SUMMARY:A 74-year-old female patient was admitted to our department with chest wall skin ulceration after radiation therapy for left breast cancer. The patient was diagnosed with chronic radioactive ulceration. After multidisciplinary discussion, the authors performed expansive resection of the chest wall ulcers and repaired large chest wall defects using a deep inferior epigastric perforator (DIEP) flap combined with a high-density polyethylene (HDPE) patch. The patient was followed-up 6 mo after the operation. No pigmentation or edema was found in the flap.CONCLUSION:DIEP flap plus HDPE patch is one of the better treatments for radiation-induced chest wall ulcers.

To discover the utility of pedicled latissimus dorsi kiss flap for the reconstruction of chest wall defect after mastectomy. This study was a systemic analysis of 12 female patients with breast tumors who were treated at Affiliated Hospital of Guangdong Medical University from January 2018 to December 2019. Among them, three patients had malignant lobular breast tumors, and nine patients had locally advanced breast cancer. After extensive resection of the primary tumor, the chest wall skin, and soft tissue, a large defect was left in the chest wall of each patient. Based on the design and structure of the kiss flap, two semicircular flaps of equal diameter were designed in the latissimus dorsi region, and their blood supply was retained from the same vascular trunk. Two flaps were transferred to the chest wall through a subcutaneous tunnel, and the incision in the donor area was sutured directly. Finally, two equal semicircle flaps were adjusted to fit the defect and then fixed on the chest wall. Referred to the design of the kiss flap, the area of the latissimus dorsi was increased to cover a larger chest wall defect. We have used this flap to reconstruct chest wall defects on twelve patients. Their age ranged from 24 to 62. The largest defect was 20 x 12 cm, and the smallest defect was 15 x 10 cm in diameter. Postoperative follow-up time was 5-9 months (mean time: 6.2 months): Follow-up observations demonstrated that all the flaps were healed well without edema or extravasation and donor area of all cases was closed well. In addition, no local recurrence or distant metastasis was observed in all patients.

目的 探讨早期乳腺癌行保乳术的安全性和有效性.方法 100例早期乳腺癌患者,根据手术方式不同分为保乳术组和改良根治术组,每组50例.改良根治术组患者行改良根治术治疗,保乳术组患者行保乳术治疗.比较两组手术相关指标、术后患侧胸部美观度、并发症发生情况及术后局部复发率、远处转移率、生存率.结果 保乳术组患者的手术时间(112.23±5.65)min、住院时间(6.68±1.74)d、 引流时长(6.67±2.16)d短于改良根治术组的(120.30±9.23)min、(8.52±2.25)d、(8.52±2.25)d,术中出血量(34.23±13.77)ml、引流量(245.25±146.69)ml少于改良根治术组的(47.79±5.23)、(305.86±28.01)ml,差异具有统计学意义(P<0.05).保乳术组患者的术后患侧胸部美观度90％(45/50)高于改良根治术组的0,差异具有统计学意义(P<0.05).两组并发症发生率比较差异无统计学意义(P>0.05).两组术后局部复发率、远处转移率和生存率比较,差异均无统计学意义(P>0.05).结论 在掌握手术指征及保乳技巧前提下,治疗早期乳腺癌采取保乳术不仅保留了乳房,且提高了患者的生活质量,减轻了患者的心理负担,值得在临床中大力推广.

BACKGROUND:In recent years, breast cancer is the most common malignancy in women. The traditional method of surgery is to remove a woman's breast completely, which has a negative impact on her work and life. Today, women have a fiery pursuit to maintain their perfect figure, which has forced breast surgeon to find a new surgical approach to maintain the shape of the breast after surgery.METHODS:This study systematically analyzed and summarized the incision design and repair of glandular defects in early-stage breast cancer patients by oncoplastic breast techniques. By summarizing the methods of oncoplastic breast surgery (OBS) in different quadrants, it could help beginners to master this technology more quickly, so as to provide better help for breast cancer patients.RESULTS:A total of 216 breast cancer patients who underwent OBS from January 2016 to June 2020 at the Affiliated Hospital of Guangdong Medical University were included in this study. In patients treated with the volume-displacement method and the volume-replacement method, 92.6% and 86.2% of patients achieved excellent breast shape, respectively.CONCLUSIONS:OBS is a safe and effective way to treat early-stage breast cancer while obtaining better breast shape, reducing postoperative psychological trauma, and improving quality of life.

Objective:To investigate the clinical effect of the transverse rectus abdominismuscle (TRAM) on reconstruction of the breast.Methods:The clinical data of 23 patients receiving TRAM breast reconstruction in our department from Jan. 2018 to Dec. 2019 were retrospectively analyzed.Results:The operation time of 23 patients ranged from 240 to 360 mins, andthe average time was about 300 mins. Intraoperative bleeding was about 120 to 200 ml, with an average of 170 ml. All the flaps survived successfully, but 2 cases were complicated with local fat necrosis. The postoperative period was between 6 and 12 months. No local tumor recurrence or metastasis was found inall patients during postoperative follow-up, and the breast shape was maintained in good condition.Conclusion:TRAM can make up for the regret of breast loss caused by breast cancer in female patients. It can bring confidence in life and work to female patients, and the technology is safe and reliable, which is worthy of promotion.

目的 探讨超声刀辅助下扁桃体切除术对扁桃体炎患者术后康复情况及疼痛程度的影响.方法 选取2017年8月至2019年8月收治的扁桃体炎患者60例进行研究,以随机数字表法分为对照组与观察组各30例,对照组接受常规手术治疗,观察组采用超声刀辅助下扁桃体切除术治疗,对两组手术效果进行比较.结果 观察组手术、饮食恢复、咽痛等时间相比对照组更短,术中出血量更少(P＜0.05);观察组术后1d、3d、7d的视觉模拟法(VAS)评分均较对照组低(P＜0.05);观察组并发症率为6.67％,明显较对照组的26.67％低(P＜0.05).结论 超声刀辅助下扁桃体切除术可促进扁桃体炎患者术后康复,也能减轻术后疼痛程度,值得推广.

目的 研究腮腺浅叶部分切除术(PSP)对腮腺浅叶良性肿瘤患者腺体功能及复发率的影响.方法 将60例腮腺浅叶良性肿瘤患者根据随机数表法分为2组:对照组30例采取浅叶切除术(SP)治疗,观察组30例采取PSP治疗.比较2组术后腺体功能保留率、复发率及并发症发生率.结果 观察组腺体功能保留率明显高于对照组(96.67％比16.67％,χ2=39.095、P<0.001),并发症发生率明显低于对照组(6.67％比26.67％,χ2=4.320、P=0.038);2组术后复发率比较差异无统计学意义(10.00％比3.33％,χ2=0.268、P>0.05).结论 对腮腺浅叶良性肿瘤患者行PSP治疗,可有效保护其腺体功能,降低并发症发生率,且未增加复发率.

目的:探讨维生素D联合枸地氯雷他定和糠酸莫米松鼻喷雾剂对慢性鼻窦炎(CRS)患者术后的治疗效果.方法:84例CRS患者随机均分为对照组(枸地氯雷他定联合糠酸莫米松鼻喷雾剂治疗)和观察组(枸地氯雷他定、糠酸莫米松鼻喷雾剂联合维生素D治疗),于术后1周、4周及8周时,采用鼻腔鼻窦结局测试-20(SNOT-20)对患者进行症状评分;于术后1周和8周时取鼻黏膜组织染色切片,检测白细胞介素-17(IL-17)水平和计数嗜酸性粒细胞(EOS),流式细胞仪检测患者外周静脉血T淋巴细胞亚群分化簇3(CD3+)和分化簇4(CD4+)水平,采用视觉类比法(VAS)和鼻内镜Lund-Kennedy法评估患者疼痛程度和鼻黏膜水肿、脓涕等症状.结果:2组患者术后未出现严重不良反应,术后8周症状评分均低于术后4周和术后1周,术后4周的症状评分均低于术后1周,且观察组术后4周及8周的症状评分均低于同时段对照组评分(P<0.05);术后8周时,2组患者鼻黏膜组织IL-17、EOS水平、VAS和Lund-Kennedy评分均较术后1周降低,且观察组低于对照组(P<0.05);术后8周时,2组患者外周血CD3+和CD4+水平均较术后1周升高(P<0.05),且观察组高于对照组(P<0.05).结论:维生素D联合枸地氯雷他定及糠酸莫米松鼻喷雾剂治疗方案能缓解CRS术后临床症状,其机制可能与该方案能有效抗炎及调节机体免疫功能有关.

目的 探讨功能性鼻内窥镜术后慢性鼻-鼻窦炎伴鼻息肉患者短期糠酸莫米松盐水盥洗的疗效.方法 选择功能性鼻内窥镜术的慢性鼻-鼻窦炎伴鼻息肉患者86例,采用随机数字表法将其分为观察组和对照组,每组43例.观察组术后给予糠酸莫米松盐水盥洗,对照组术后给予生理盐水盥洗及糠酸莫米松鼻喷剂喷鼻.比较两组患者术前的VAS评分和Kennedy评分;比较两组患者术后3 d和盥洗治疗后的LKES评分和SNOT22评分;分析两组患者的不良反应发生情况.结果 两组患者术前VAS评分、Kennedy评分的比较,差异无统计学意义(P>0.05).两组患者盥洗治疗后的LKES评分、SNOT评分均低于术后3 d,差异有统计学意义(P<0.05);观察组盥洗治疗后的LKES评分(5.07±0.82分)与SNOT评分(13.41±0.74分)低于对照组,差异有统计学意义(P<0.05).观察组有1例患者术后出现鼻腔活动性出血,给予压迫止血处理后可止血.两组其余患者均未见明显不良反应发生,均可顺利完成本研究治疗方案.结论 功能性鼻内窥镜术后慢性鼻-鼻窦炎伴鼻息肉患者短期糠酸莫米松盐水盥洗有助于鼻黏膜的恢复,更好缓解患者临床症状.

Locally advanced breast cancer, which is defined as a malignant breast tumor that invades or adheres to the surrounding tissue, is characterized by the invasion of the chest wall and the skin surface by the tumor. Multiple lymph nodes are invaded and fuse into a mass, causing extensive axillary lymph node metastasis. However, locally advanced breast cancer does not exhibit distant metastasis. At present, in most hospitals in China and the rest of the world, this type of breast cancer is primarily managed through systematic and local treatments. However, a consensus concerning the optimal surgical method for chest wall reconstruction, which for many surgeons is a difficult and confusing procedure, has not been reached. In the past, many breast centers had used skin flap combined with hard mesh titanium alloy plate to repair the large chest wall defects. Although titanium alloy plate can maintain the stability of the chest wall, it may have a negative effect on the follow-up radiotherapy of breast cancer patients, which is a controversial method. In addition, titanium alloy mesh also has the risk of deformation and fracture. These factors will cause some hidden dangers to patient safety. According to the research, the soft mesh not only has the characteristics of satisfactory compatibility and robustness for maintaining the stability of chest wall, but also does not affect the postoperative radiotherapy of patients. Combined with the advantages of soft mesh, Our department treated a case of locally advanced breast cancer with chest wall invasion. Through cooperation between the breast surgery and thoracic surgery departments, a mesh repair plus transverse rectus abdominis myocutaneous (TRAM) combined with deep inferior epigastric perforator (DIEP) procedure was performed to remove the breast tumor and repair the large area of skin defect after surgery, and a relatively satisfactory therapeutic effect was achieved. In this case, we took two novel approaches: first, a 4-layer high-density polyethylene mesh was used to repair the defect; secondly, the inferior epigastric artery perforation was anastomosed with the thoracoacromial artery (end-to-end anastomosis) and the inferior epigastric vein perforation was anastomosed with the axillary vein (end-to-side anastomosis).

Modified breast cancer radical mastectomy is a more common operating method in breast surgery. Traditional modified radical mastectomy focuses on protecting the long thoracic nerve and thoracodorsal nerve while ignoring the protection of the anterior thoracic nerve and intercostobrachial nerve protection, which leads often to patients with upper medial arm numbness, acid swelling, pain, chest atrophy, and other problems. In the modified radical mastectomy of breast cancer, in this case, the author used an elaborative operation to protect the anterior thoracic nerve and intercostobrachial nerve and thoroughly dissected the third-level lymph nodes through the axillary approach.

目的 探讨关节镜下复位内固定治疗胫骨髁间隆突撕脱骨折的疗效.方法 回顾性分析2017年1月至2019年1月本院收治的48例胫骨髁间隆突撕脱骨折患者的临床资料,全部患者均接受关节镜下复位内固定治疗,其中27例患者接受钢丝内固定,21例患者接受空心螺钉固定,手术治疗完成3周后为其应用可调式支具制动4～5周,并开展功能锻炼指导.结果 术后进行6个月的随访,术后3个月,X线片检查显示患者的骨折均得到良好愈合,骨折愈合时间为(4.8±0.8)个月,全部患者的膝关节均具备正常活动度,同时Lachman试验以及前抽屉试验结果均为阴性.无患者出现关节感染僵硬、行走不稳、屈伸受限以及慢性疼痛等严重并发症.术后6个月Lysholm膝关节评分与优良率明显高于术后3个月,比较差异具有统计学意义(P<0.05).结论 关节镜下复位内固定治疗胫骨髁间隆突撕脱骨折的疗效确切,可促使骨折愈合,且并发症少.

目的 评价曲安奈德明胶海绵联合内窥鼻窦术治疗慢性鼻窦炎的临床效果.方法 60 例选自我院2016年4月至2019年4月收治的慢性鼻窦炎患者,按随机数字表法将患者随机分为对照组30例与观察组30例,对照组采用内窥鼻窦术治疗,观察组在内窥鼻窦术中贴敷曲安奈德明胶海绵,比较两组患者治疗效果、术后不良反应及住院时间.结果 观察组治疗总有效率93. 33% ,对照组73. 33% ;观察组不良反应发生率6. 67% ,对照组26. 67% ;观察组住院时间明显短于对照组,两组比较,差异均存在统计学意义(P均＜0. 05).结论 对慢性鼻窦炎患者开展曲安奈德贴敷联合内窥鼻窦术治疗,疗效肯定,安全性高,能够显著提升患者预后,缩短住院时间,且应用方便,值得临床应用与推广.

目的 探讨鼻内镜在阿司匹林二级预防患者鼻出血中的治疗效果.方法 选取2013年1月-2016年12月在该院进行治疗的66例阿司匹林二级预防发生鼻出血患者为研究对象,按随机数字法将其分成观察组和对照组,观察组患者给予鼻内镜治疗,对照组患者给予传统填塞止血治疗,分别对两组患者临床指标、止血效果及并发症发生情况进行统计对比.结果 观察组患者的临床指标情况明显优于对照组患者(P＜0.05);观察组患者止血效果明显好于对照组患者(P＜0.05);观察组患者复发率为0.00％(0/33),明显低于对照组患者的9.09％ (3/33) (P＜0.05);观察组患者并发症发生率为18.18％(6/33),明显少于对照组患者的60.61(20/33)(P＜0.05).结论 鼻内镜在阿司匹林二级预防患者治疗中的应用效果显著,止血迅速,复发率低,治疗安全性高,值得临床推广及应用.

目的探讨老年股骨转子部骨折应用半髋关节置换术疗效及可行性。方法20例老年股骨转子部骨折患者予以人工半髋关节置换术治疗，假体采用骨水泥型。结果术中手术时间短、出血少，能能早期扶拐下床活动。结论半髋置换术治疗股骨转子部骨折短期疗效令人满意。

多发性骨髓瘤属于恶性浆细胞病，主要表现为骨髓内浆细胞出现异常增值。在病理学、影像学上主要表现为溶骨性破坏多发性存在。本文现对多发性骨髓瘤脊柱病变的临床及MRI特点加以综述，以期为临床诊断提供帮助。

目的 探讨胫骨平台骨折手术的临床效果,以供临床参考.方法 选择2009年7月-2012年6月我院收治的胫骨平台骨折患者116例作为研究对象,随机分组.A组接受双钢板内固定手术治疗,B组接受锁定钢板内固定手术治疗.术后随访1年,对比两组患者骨折愈合时间、膝关节HSS评分、术后并发症发生率的差异性.结果 与A组对比发现,B组骨折愈合时间较短,膝关节HSS评分较高,差异具有统计学意义(P＜0.05).对比两组手术并发症发生率发现,组间差异无统计学意义(P＞0.05).结论 双钢板内固定和锁定钢板内固定在胫骨平台骨折的治疗中均可获得满意的疗效,其中锁定钢板内固定在促进骨折愈合和膝关节功能恢复方面具有更大的优势,值得在今后的临床工作中推广应用.

Objective Investigate the clinical effect of proximal femoral nail ( PFNA ) and dynamic condylar screw in the treatment of femoral intertrochanteric fractures, for clinical references. Methods 85 cases with femoral intertrochanteric fractures patients in Aug. 2010 to Jul. 2012 in our hospital were choosed as research objects, randomly grouping. The control group was received PFNA treatment, the observe group was received dynamic condylar screw treatment. All cases were followed up 1 year later. The operation time, amount of bleeding, fracture healing andhip joint Harris score of the two groups were compared. Results Compared with the control group, Compared with the control group, longer surgical patients in the observation group (93.68 ± 14.85)min, greater blood loss (283.96 ± 40.12)mL, fracture healing time is shorter (97.32 ± 9.65)d, has statistically significant differences (P<0.05). Compared of The hip joint Harris score of the two groups has no significant differences. Conclusion PFNA and dynamic condylar screw in the treatment of femoral intertrochanteric fractures has good clinical effect in hip joint recovery. Two operation has advantage respectively, the operation time of PFNA is short and the amount of bleeding is little. The healing time of dynamic condylar screw fracture is short. The appropriate operation mode for femoral intertrochanteric fractures will be choosed in clinical work.