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Objective:To investigate the effect of peer support education on family function of breast cancer patients with breast reconstruction.Methods:Totally 146 patients who received surgical treatment in the department of plastic surgery for breast cancer from June 2017 to June 2019 were randomly divided into the experimental group and the control group by the method of random number table, 73 cases each. The control group received routine education. Patients in the observation group received regular education and peer support education. The intervention time was from admission to 6 months after discharge, and the control group received routine nursing care. Quality of life questionnaire was used to evaluate the quality of life of the patients at six months after operation, family care index questionnaire was used to evaluate the family function of the patients, and comprehend social support scale was used to evaluate the level of social support, then various indicators of the two groups of patients were compared.Results:6 months after operation, the scores of quality of life function and symptom dimension of the intervention group were 6.43±1.54. 5.83±1.47, while control group were 6.02±1.59; 6.39±1.63. There were statistically significant differences between the two groups ( t values were 4.30, 5.01, P < 0.05); family care scores of the two groups were compared, the intervention group was 8.78±2.04. The control group was 8.43±2.05. There were statistically significant differences between the two groups ( t value was 2.02, P < 0.05); the comprehension support score of the two groups was compared, and that of the intervention group was 62.24±14.81. The control group was 55.74±13.58. There were statistically significant differences between the two groups ( t value was 4.26, P < 0.05). Conclusion:Peer support education can improve the quality of life and family care of breast cancer patients with breast reconstruction.
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The preliminary screening of oral cancer mostly depends on the experience of clinicians, The surgical margin of tumor is mostly based on physical examination and preoperative imaging examination. It lacks real-time and objective intraoperative evaluation methods. Indocyanine green (ICG), as a safe and pollution-free organic fluorescent pigments, combined with near-infrared fluorescence imaging can be applied in the screening of early oral cancer, the determination of tumor resection margins, sentinel lymph node biopsy, cervical lymph node dissection, targeted chemotherapy, and other aspects. Near-infrared fluorescence imaging may become a key link in the early diagnosis and accurate treatment for oral cancer in the future.
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Humans , Indocyanine Green , Lymph Nodes , Mouth Neoplasms/therapy , Optical Imaging , Sentinel Lymph Node BiopsyABSTRACT
Objective:To explore the occurrence of symptoms in postoperative patients with oral cancer, and to explore the types and number of symptom groups.Methods:The Anderson symptom assessment scale for head and neck cancer was used to conduct a questionnaire survey on 345 patients after oral cancer surgery. The results of two exploratory factor analysis methods were compared, and the cluster analysis and Spearman rank correlation analysis were combined to determine the symptom group of patients after oral cancer surgery.Results:There were 4 symptom groups in patients with oral cancer, including oral and pharynx symptoms group, dietary and digestive symptoms group, gastrointestinal and emotional symptoms group, and rest activity symptoms group.Conclusions:There are many symptom groups that affect the life of patients with oral cancer in the rehabilitation process after surgery, so the medical staff should carry out targeted intervention mode to achieve better intervention effect.
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Objective@#To explore the clinical effects of free deep inferior epigastric perforator flap carrying lymphatic groin flap for treatment of upper limb lymphedema after radical mastectomy and breast reconstruction.@*Methods@#From October 2014 to December 2016, 10 female patients, aged 37-60 (48±8) years, who had lymphedema in the upper limb after radical mastectomy, were admitted to Department of Oncology Plastic Surgery of Hunan Cancer Hospital. Three patients suffered recurrent erysipelas infections, and 4 patients suffered consistent neuropathic pain in the upper limb. Free deep inferior epigastric perforator flap carrying lymphatic groin flap was used for breast reconstruction and lymphedema treatment. Operation was performed by 2 surgeon groups including recipient site prepare group and flap harvest group. In the 10 patients, the length of the flaps was (26.2±0.3) cm, the width of the flaps was (13.4±0.4) cm, and the thickness of the flaps was (3.4±0.3) cm. All the donor sites in the abdomen were closed directly. The choices of vascular pedicles and vessels in the recipient sites, operation time, complications, operation effects, and follow-up were recorded.@*Results@#(1) Bilateral vascular pedicle was adopted in flaps of 5 patients. Unilateral vascular pedicle was adopted in flaps of 5 patients. The recipient vessels were proximal and distal ends of internal thoracic vessels in 4 cases, the proximal end of thoracodorsal vessels in 3 cases, the proximal end of internal thoracic vessels in 2 cases, and the proximal end of internal thoracic vessels and thoracodorsal vessels in 1 case. (2) The operation time of the patients was 330-480 (406±55) min. (3) Subcutaneous edema was observed in flaps of 2 patients and donor site of 1 patient, which were all healed by dressing change therapy. The other flaps survived successfully. The reconstructed breasts were in good shape and elasticity. Nine patients had different degrees of relief in lymphedema in the upper limb. All 10 patients were followed up for 6 to 28 months, no one had recurrent erysipelas infections, and neuropathic pain in the upper limb was relieved in 2 patients. Only linear scar was left in the donor sites of 10 patients, and the function of abdomen was not affected without related complications.@*Conclusions@#Free deep inferior epigastric perforator flap carrying lymphatic groin flap can simultaneously accomplish breast reconstruction and upper limb lymphedema treatment, which is worthwhile to be popularized in clinic.
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Objective@#To explore the clinical application of the transverse upper gracilis flap (TUG) in breast reconstruction for breast cancer patients.@*Methods@#From March 2010 to September 2016, 15 breast cancer patients received radical or modified radical mastectomy in Hunan Cancer Hospital, 8 cases of breast cancer were in stage Ⅰ and 7 cases was in stage Ⅱ. The age of patients ranged from 37 to 62 years old, (39.5±4.7) years. The TUG flap was used to reconstruct breast at the same time.The donor leg is placed in frog-leg position. Free TUG flap was harvested with gracilis muscular branch of profunda artery as pedicle. To keep tight connection between skin paddle and gracilis muscle, the perforators are not visualized. The flap was transferred to reconstruct breast, and the donor site was directly closed.@*Results@#Mean operative time of unilateral reconstruction was 5 hours and (35± 44) minutes (with the range from 4 hours and 17 minutes to 6 hours and 5 minutes). Mean ischemia time was (52± 9 )minutes (with the range from 40 minutes to 1 hour and 16 minutes). The length of flap was (27.1±0.1) cm. The width of flap was (7.8±0.5) cm. The thickness of flap was (3.4±0.2) cm. The length of pedicle was( 6.8±0.5) cm.The average weight of flap was 350 g (ranged from 285 g to 525 g). All TUG flaps were survived. The shape, texture and elasticity of all reconstructed breasts were satisfactory, and there is no flap contracture deformation happened. Only linear scar left in the donor sites, without sacrifice of the function of thighs. All 15 patients were followed for 9-36 months (16.5 months on average). No local recurrence happened.@*Conclusion@#TUG flap can be safely harvested. It is reliable, with good texture. It is an alternative method for breast reconstruction after radical or modified radical mastectomy.
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Objective@#To explore the clinical application of the transverse upper gracilis flap (TUG) in breast reconstruction for breast cancer patients.@*Methods@#From March 2010 to September 2016, 15 breast cancer patients received radical or modified radical mastectomy in Hunan Cancer Hospital, 8 cases of breast cancer were in stage Ⅰ and 7 cases was in stage Ⅱ. The age of patients ranged from 37 to 62 years old, (39.5±4.7) years. The TUG flap was used to reconstruct breast at the same time.The donor leg is placed in frog-leg position. Free TUG flap was harvested with gracilis muscular branch of profunda artery as pedicle. To keep tight connection between skin paddle and gracilis muscle, the perforators are not visualized. The flap was transferred to reconstruct breast, and the donor site was directly closed.@*Results@#Mean operative time of unilateral reconstruction was 5 hours and (35± 44) minutes (with the range from 4 hours and 17 minutes to 6 hours and 5 minutes). Mean ischemia time was (52± 9 )minutes (with the range from 40 minutes to 1 hour and 16 minutes). The length of flap was (27.1±0.1) cm. The width of flap was (7.8±0.5) cm. The thickness of flap was (3.4±0.2) cm. The length of pedicle was( 6.8±0.5) cm.The average weight of flap was 350 g (ranged from 285 g to 525 g). All TUG flaps were survived. The shape, texture and elasticity of all reconstructed breasts were satisfactory, and there is no flap contracture deformation happened. Only linear scar left in the donor sites, without sacrifice of the function of thighs. All 15 patients were followed for 9-36 months (16.5 months on average). No local recurrence happened.@*Conclusion@#TUG flap can be safely harvested. It is reliable, with good texture. It is an alternative method for breast reconstruction after radical or modified radical mastectomy.
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Objective@#To explore the basic conditions and postoperative quality of life in patients undergoing oral vestibular thyroid surgery.@*Methods@#A total of 128 patients undergoing oral vestibular thyroid surgery were enrolled in the Department of Head and Neck Surgery from March 2015 to April 2018. On the basis of routine thyroid tumor care, we used telephone, WeChat public platform, WeChat group, QQ, and Email. Questionnaires such as information technology and clinic review. Correlation analysis was performed using SPSS 22.0.@*Results@#According to the analysis of SPSS statistical software, the postoperative recovery of the patients is good, and more than 95% of the patients have the feeling of "no" or "a little" for symptoms, and 91.8% (102/111) and 93.6% (104/111) of the patients have the perception of the general health status and life quality of the patients in the past 1 week respectively. Analysis of variance of postoperative life quality of patients, postoperative regression post was significantly correlated with postoperative social cognition, insomnia and economic difficulties of patients. The education level, occupation, marital status and family income of the patients all had significant influences on the postoperative economic status of the patients, and the differences were statistically significant (t=2.66-4.74, P<0.05). In the regression analysis of patients′ life quality, emotional function and physical function were independent risk factors affecting patients′ life quality, with statistical significance (t=-2.072, -5.564, P < 0.05).@*Conclusion@#Endoscopic thyroidectomy via oral vestibule has the advantages of good effect, beautiful appearance and high quality of life, which is worth popularizing and applying.
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Objective@#To investigate the safety and feasibility of the modified transoral endoscopic thyroidectomy vestibular approach (TOETVA) by dissection of mental nerve in clinical practice.@*Methods@#Totally 140 patients underwent the modified TOETVA from the Department of Head and Neck Surgery, Hunan Cancer Hospital from July 2016 to June 2018 were analyzed retrospectively. There were 130 females and 10 males, aging (35.4±9.8) years (range: 11 to 56 years). The operative time, intraoperative blood loss, postoperative hospital stay, postoperative suction drainage, postoperative pain score, postoperative cosmetic satisfaction and postoperative complications (recurrent laryngeal nerve palsy, hypoparathyroidism, infection, pneumoderm, seroma and mental nerve injury) were summarized.@*Results@#Of the 140 patients, 1 patient was transferred to open surgery. Fifty-nine patients underwent thyroidectomy with an operation time of (100.8±18.9) minutes. Sixty-three patients underwent thyroidectomy and central lymphadenectomy with an operation time of (112.1±16.6) minutes. Eighteen cases underwent total thyroidectomy and central lymphadenectomy with an operation time of (185.3±25.9) minutes. The postoperative hospital stay was (3.76±0.98) days. The postoperative drainage was (96.8±36.2) ml. The 24-hour postoperative pain score was 2.66±1.23, the postoperative cosmetic satisfaction was 9.65±0.24. Among the postoperative complications, there were 3 cases of temporary recurrent laryngeal nerve palsy, 2 cases of permanent recurrent laryngeal nerve palsy, 4 cases of temporary hypoparathyroidism but no permanent hypoparathyroidism, 2 cases of infection, 1 case of seroma, 3 cases of pneumoderm, and no cases of mental nerve injury.@*Conclusion@#The modified TOETVA by dissection of mental nerve is safe and feasible.
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Objective@#To explore the clinical outcomes of multiple-paddled anterolateral thigh flap in composite cheek through-and-through defect reconstruction.@*Methods@#From September, 2014 to Feburuary, 2016, 20 patients were performed complicated through-and-through defect reconstruction following oral cancer removal with free multiple-paddled anterolateral thigh flap including 12 cases of buccal mucosa carcinoma, 5 cases of basal cell carcinoma of buccal skin and 3 cases of gingiva carcinoma.The intraoral defects ranged from 6.0 cm×4.0 cm to 8.0 cm×5.0 cm. The cheek skin defects ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm and the flaps ranged from 6.0 cm×4.0 cm to 12.0 cm×10.0 cm in size.Multiple-paddled anterolateral thigh flap was divided into 3 types based on the anatomical variation, including: (1) lateral descending branch type; (2) descending branch + oblique branch type; (3) lateral and medial descending branch type; different methods were applied according to the different types.@*Results@#All the 20 flaps survived totally, including 13 cases of type 1, 5 cases of type 2, and 2 cases of type 3. In all of the 20 cases, the flaps survived well and the donor sites were closed directly.All wounds healed primarily. The follow-up period was 9 to 28 months (13.6 months on average). All patients were satisfied with their facial appearance. Mouth opening ranged from 3 to 5 cm. All patients had normal deglutition and normal oral competence and intelligible speech, although linear scar was left in the donor site. 6 patients received post-operative radiotherapy. 2 patients died of recurrence and all other patients were alive without disease.@*Conclusions@#The multiple-paddled anterolateral thigh flap is suitable for the through-and-through cheek defect reconstruction following oral cancer removal. Satisfying outcome can be achieved. This method is worthy of being popularized. Since the anatomical variation forms exist, flexible strategies for flap harvest and reconstruction are needed.
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The forearm radial flap is a reliable flap for the repair of the defect caused by tongue cancer resection. The clinical data of 11 tongue cancer patients that received this surgery were retrospectively analyzed. The clinical application of this technique is preliminarily discussed.
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Objective@#To evaluate the efficacy of modified bilobed chimeric thoracoacromial artery perforator (TAAP) flap for the reconstruction of hypopharyngeal defect with anterior neck skin loss.@*Methods@#Between May 2013 and September 2015, modified bilobed chimeric TAAP flap was used to reconstruct complex oncologic hypopharyngeal defects in 7 patients, including 6 males and 1 female. Patients′ age ranged from 28 to 65 years old (mean age 50±3.4 years old). The size of hypopharyngeal defect ranged from 5.5 cm×3.5 cm to 12.0 cm×4.5 cm, and the size of anterior neck defect ranged from 8.0 cm×4.0 cm to 10.0 cm×4.0 cm.@*Results@#The size of TAAP flap was from 6.5 cm×4.0 cm to 13.0 cm×5.0 cm.The size of pectoralis major flap was from 8.0 cm×4.5 cm to 11.0 cm×5.0 cm. The length of pedicle was 6.5-8.5 cm.The distance from pivot point of flap to central point of recipient site was 7.0-9.5 cm.All flaps survived thoroughly, the donor site was closed directly in all cases.The mean hospital stay ranged from 14 to 19 days (mean 15.5 days). The follow-up was 14, 15, 20, 18, 30, 25 and 38 months respectively.Patient possessed good appearance of neck surgical sites, and oral diet was restored in all patients.No recurrence, fistula, stenosis/stricture, dehiscence, or swelling occurred, only with scars left on the donor sites, and pectoralis major muscle function was completely preserved in all patients.@*Conclusions@#Modified bilobed chimeric TAAP flap is a good choice for the reconstruction of hypopharyngeal defect with anterior neck skin loss.
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Objective To describe the relationship status of breast reconstruction after mammary gland surgery, and to explore the changes of sexual and emotional experience in breast reconstruction. Methods A semi-structured in-depth interview was conducted in 19 patients admitted to Hunan Cancer Hospital from October 2015 to December 2017 for reexamination in the hospital from 2 to 26 months after breast reconstruction. The Giorigi method was used to analyze data in the phenomenological analysis of qualitative research. Data collection, transfer and analysis are conducted simultaneously, and the method and content of the next interview were constantly adjusted with the existing data analysis results. Results The sex and emotional experience of breast reconstruction after breast surgery could be summarized into 5 subjects. The first was cognition of sexual life . The second was sexual psychological change.The third was physiological changes. The forth was the desire for sexual information. The fifth was breast reconstruction surgery brings the emotional fluctuation of both husband and wife. Conclusions Understanding of breast cancer postoperative breast reformer sexual and emotional experience can help medical personnel through effective communication and evaluation, provide targeted health education and consultation, improve recovery quality of life of patients.
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Objective To evaluate the effect of education on the family function of breast reconstruction after breast cancer. Methods Totally 130 cases of breast reconstruction after breast cancer were selected from January 2015 to August 2017, and 65 cases were divided into observation group and control group by random number table method. The control group received routine education; The observation group and the spouse received synchronous education. In the preoperative and postoperative 3 months, 6 months after the Female Sexual Function Index (FSFI) to assess patients sexual function, the Family Intimacy and Adaptability Scale to assess the patient's family intimacy and adaptability, comparing the indicators of two groups of patients. Results After 6 months of operation, the two groups were compared, and the intervention group was (24.82 ± 3.75) points, and the control group was (22.32±4.75), with statistically significant difference(t=- 3.35, P < 0.05). Comparison of familial closeness and adaptability score of the two groups, the intervention group was (76.80 ± 8.14) points, (59.98 ± 3.56) points; The control group was (68.48 ± 11.46) points, (52.27 ± 9.49) points,with statistically significant difference(t=-4.81,-6.18, P<0.05). Conclusion The simultaneous education can improve the sexual function and familial intimacy and adaptability of breast reconstruction after breast cancer.
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Objective To explore the nursing effect of discharge preparation service on breast reconstruction after breast cancer operation. Methods Totally142 patients with breast cancer were divided into intervention group and control group according to the random number table, 71 cases in each group.The intervention group carried out discharge plan mode,the control group did not carry out discharge plan mode, only routine nursing and telephone follow-up after discharge.To compare the differences of discharge readiness, self-efficacy,quality of life and patient satisfaction score of family caregivers at 2 days after admission,when discharge,2 months,3 months and 6 months after discharge.Results The score of discharge readiness of family caregivers in intervention group,score of self-efficacy,quality of life score and patient satisfaction score of nursing were 29.76 ± 1.06, 35.72 ± 2.06, 69.20 ± 2.76, 30.79 ± 2.23, the control group were 24.85 ± 2.94, 35.72 ± 2.81, 64.55 ± 4.75, 26.99 ± 3.27, the difference between the two groups was statistically significant (t=-13.25--7.13, P<0.05). Conclusions Discharge preparation service can improve the discharge readiness of family caregivers of breast cancer patients after breast cancer reconstruction, their self-efficacy after discharge, their quality of life and nursing satisfaction, so it is worthy of promotion.
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Objective To introduce the clinical experience of relaying anterolateral thigh (ALT)flap in the resurfacing of the donor defect after anteromedial thigh (AMT) flap transfer.Methods From February 2014 to December 2015,16 cases with oral carcinoma underwent radical resection,leaving tongue or mouth floor defects which were reconstructed by AMT perforator flaps.The flap size ranged from 7.5 cm ×4.5 cm to 13.0 cm × 7.5 cm [the patients was 45.6 years (range 31-72 years),body mass index (BMI) range 17.5-24.3 kg/m2].Flaps'width was on average 6.6 cm (ranging from 5 to 9 cm) with flap width-to-thigh circumference ratio being 12.5％ on average (ranging from 9.8％ to 15.7％).The flap donor sites were reconstructed with relaying ALT flap at the same stage,the flap size ranged from 7.5 cm × 4.0 cm to 12.0 cm x 7.0 cm.Results The AMT and ALT perforators existed consistently in all cases of this serie.All free AMT flaps and relaying ALT flaps survived uneventfully.All patients were followed up for 8-24 months with satisfied esthetic and functional results in recipient and donor sites.2-point discrimination distance of AMT flaps ranged from 7 to 14 mm,2-point discrimination distance of relaying ALT flaps ranged from 8 to 15 mm,the function of thighs were not affected.Conclusions The relaying ALT flap is an ideal choice to reconstruct the donor site of free AMT flap.
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Objective@#To explore the clinical application of the profunda artery perforator flap in breast reconstruction of patients with early-staged breast cancer.@*Methods@#Six cases of early breast cancer patients received radical or modified radicaI surgery.The PAP flap was used to reconstruct breast at the same time or in the second phase.Four cases of breast cancer were in stage I and 2 cases was in stage II.@*Results@#The length of flap was (25.2±0.2) cm, the width of flap was (6.4±0.8) cm, the thickness of flap was (2.6±0.2) cm. The length of pedicle was (7.2±0.6) cm, the outer diameter of pedicle was (1.6±0.3) mm.The average weight of flap was 345 g(ranged from 225 g to 575 g). All profunda artery perforator flaps were successful. In one flap fat necrosis occurred and healed with dressing treatment. The reconstructed breasts′ shape, texture and elasticity was good and no flap contracture deformation happened. Only linear scar left in the donor sites, the function of thighs was not affected. All 6 patients were followed up for 2-3 months (2.5 months on average) with satisfied result. No local recurrence happened.@*Conclusions@#PAP flap is suitable to reconstruct breast for breast cancer patients.
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Objective To evaluate operation method in with microscopic flap breast reconstruction after breast cancer case management care blueprint. Methods According to the building of case management care blueprint, according to the questions, plan, action, observation and reflection, improvement of summarizing the research process, formulate, modify with microscopic flap breast reconstruction after breast cancer case management care blueprint, and applied to clinical. Results Through the research of two phase research analyses the results after the intervention. Microscopic flap breast reconstruction after breast cancer patients′ quality of life evaluation, cancer, mental adaptation level, determination of postoperative body image, adjust the importance of breast score in the first stage, respectively (28.54 ± 3.78), (13.56±2.51), (2.71±1.08), (3.00±0.87) points, the second phase, respectively (80.32 ± 5.94), (45.02 ± 3.51), (6.85 ± 0.36), (7.34 ± 0.66) points. Two phase comparison difference was statistically significant (-47.070--21.551, P<0.05 or 0.01). Conclusions Based on the study of action with microscopic flap breast reconstruction after breast cancer case management care blueprint to build, implement the evaluation, plan, service, coordination and monitoring of health care management system, improve the patients′ life quality, standardize nursing process, improve the effect of nursing quality.