【摘要】 目的 比較在乳腺癌Auchincloss改良根治術中使用超聲刀及電刀手術的優、缺點。 方法 2009年6月－2010年7月將176例乳腺癌患者通過信封法隨機分為超聲刀組和電刀組，每組88例，分別比較兩組患者手術時間、術中出血量、淋巴結檢出數目、術后引流量、皮下積液及術后出血量的差異。 結果 手術時間:超聲刀組為（145.72±50.76） min，電刀組為（171.27±66.68） min，兩組差異有統計學意義（P=0.005）；術中出血量:超聲刀組為（71.56±31.34） mL，電刀組為（84.99±36.39） mL，兩組差異有統計學意義（P=0.009）；清掃出的淋巴結個數:超聲刀組為（20.92±9.09）個，電刀組為（17.90±6.74）個，兩組差異有統計學意義（P=0.013）。而在術后平均引流量和術后積液例數方面兩組的差異無統計學意義（Pgt;0.05）。兩組均無術后出血的情況。 結論 在乳腺癌Auchincloss改良根治術中使用超聲刀，較單獨使用電刀能縮短手術時間，減少出血量，并增加淋巴結檢出的數量。【Abstract】 Objective To compare the disadvantages and advantages between modified radical mastectomy with harmonic scalpel (HS) and conventional electro-scalpel (ES) for patients with breast cancer. Methods Between June 2009 and July 2010, 176 patients with breast cancer were randomly divided into two groups including the HS group and the ES group. The operation time, intra-operative bleeding volume, the number of lymph nodes detected, postoperative drainage volume, subcutaneous hydrops, and postoperative hemorrhage volume between the two groups of patients were compared. Results There were significant differences between the HS and ES groups in terms of operation time [(145.72±50.76) minutes vs. (171.27±66.68) minutes, P=0.005], intra-operative bleeding volume [(71.56±31.34) mL vs. (84.99±36.39) mL, P=0.009], and number of lymph nodes detected (20.92±9.09 vs. 17.90±6.74, Plt;0.05). The postoperative drainage volume and subcutaneous hydrops were not significantly different between the two groups (Pgt;0.05). No postoperative hemorrhage occurred in both groups. Conclusion Compared with ES, the use of HS can reduce operation time and intra-operative bleeding volume, and increase the number of lymph nodes detected during modified radical mastectomy.
Objective
To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS).
Methods
Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5.7 months (range, 1-24 months). The pathological examination revealed invasive ductal carcinoma in 55 cases, ductal carcinoma in situ (DCIS) in 15 cases, invasive ductal carcinoma + DCIS in 8 cases, DCIS with infiltration in 10 cases, and occult breast cancer in 1 case. According to tumor staging criterion of American Joint Committee on Cancer (AJCC), 15 cases were rated as stage 0, 51 cases as stage I, 22 cases as stage II, and 1 case as unclear. Finally, 33 patients underwent SSM and 56 patients underwent NSM according to the location and diameter of tumor and the infiltration of tumor to nipple. Secondary breast reconstruction was performed with permanent gel replacement after axillary lymph node dissection in 9 patients with positive sentinel lymph node and 1 patient with occult breast cancer; immediate breast reconstruction was performed with permanent gel in the other patients. All the patients received the chemotherapy or/and radiotherapy according to the National Comprehensive Cancer Network (NCCN) guideline.
Results
Complications occurred in 5 patients undergoing breast reconstruction of permanent gel after NSM, including 1 case of haemorrhage, 2 cases of infection, and 2 cases of local skin necrosis. Primary healing of incision was obtained in the others. No nipple necrosis was observed in patients undergoing NSM. All the patients were followed up 14-88 months (median, 40 months). At 10 months after operation, the aesthetic results were excellent in 40 cases, good in 33 cases, fair in 14 cases, and poor in 2 cases, with an excellent and good rate of 82%. No recurrence or metastasis was found during follow-up.
Conclusion
The SSM or NSM is feasible and oncological safe for patients who are not fit for BCS, with satisfactory aesthetic result.
