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Objective:To investigate effects of implantation of pectoralis major fascia combined with serratus anterior fatty fascia flap prosthesis on breast reconstruction after early breast cancer surgery.Methods:A total of 62 patients with early breast cancer undergoing breast reconstruction in Dongguan People's Hospital of Guangdong Province from July 2017 to December 2019 were selected and randomly divided into two groups, 31 cases in each group. The control group was treated with pectoralis major fascia covering prosthesis for breast reconstruction, and the observation group was treated with pectoralis major fascia combined with serratus anterior fatty fascia flap covering prosthesis for breast reconstruction. The clinical data of the two groups were recorded, the postoperative aesthetic appearance of breast was evaluated. According to the function assessment of cancer therapy-breast cancer (FACT-B) was used to evaluate the score of quality of life before and after operation, and postoperative complications were also observed.Results:In the control group and the observation group, the intraoperative blood loss was (82.61±12.38) ml, (88.76±13.57) ml, respectively; and drainage tube extubation time was (3.51±0.62) d and (3.64±0.58) d, respectively; there was no statistically significant difference between the two groups ( t value was 1.864, 0.853, respectively, all P > 0.05). The operation time of the observation group was longer than that of the control group [(2.59±0.29) h vs. (1.72±0.32) h, t = 11.217, P < 0.001]. The amount of drainage of the control group was higher than that of the observation group [(215.45±47.69) ml vs. (151.36±31.67) ml, t = 6.233, P < 0.001]; the length of hospital stay of the control group was longer than that of the observation group [(14.51±2.32) d vs. (10.79±1.86) d, t = 6.965, P < 0.001]. The excellent and good rate of postoperative breast appearance of the observation group was higher than that of the control group [96.77% (30/31) vs. 74.19% (23/31), χ 2adjusted=4.679, P = 0.031]. There were no statistical differences in all items including health, emotion, function, society/family and other conditions scores of FACT-B and total scores in both groups before the operation (all P > 0.05); all items scores and total scores of both groups after the operation were higher than those before the operation (all P < 0.001), and the sores after the operation of the observation group were higher than those of the control group (all P < 0.001). The total incidence of postoperative complications was 6.45% (2/31) of the observation group, 22.58% (7/31) of the control group, and the difference was not statistically significant (χ 2adjusted=2.080, P = 0.149). Conclusion:Breast reconstruction with implantation of pectoralis major fascia combined with serratus anterior fatty fascia flap prosthesis after early breast cancer surgery can shorten the postoperative hospital stay, improve the aesthetic appearance of breast, improve the long-term quality of life, and has a high safety.
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Objective:To analyze the risk factors for lymph node metastasis in breast cancer patients with axillary lymph node metastasis after neoadjuvant chemotherapy.Methods:The data of 94 female patients with invasive breast cancer in Dongguan People′s Hospital of Guangdong Province from January 2017 to December 2019 were retrospectively analyzed.All patients planned to receive 4-8 cycles of neoadjuvant chemotherapy.After chemotherapy, modified radical mastectomy was performed.Estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor receptor 2(HER-2) appeared for the first time in Chinese and English abstracts and texts positive patients received endocrine or targeted therapy.The rest patients received 2-4 cycles of adjuvant chemotherapy or radiotherapy according to the situation.Lymph node metastasis after neoadjuvant chemotherapy was analyzed.The relationship between lymph node metastasis after neoadjuvant chemotherapy and clinicopathological features was analyzed.Risk factors for lymph node metastasis after neoadjuvant chemotherapy were analyzed by Logistic regression.Results:After neoadjuvant chemotherapy, the positive rate of axillary lymph node was 74.47%(70/94). The number of positive axillary lymph nodes, ER status, HER-2 status and cell proliferation-associated human nuclear antigen(Ki67), the completion of chemotherapy cycle, the pathological remission of axillary lymph nodes after chemotherapy and the T stage of tumor after neoadjuvant chemotherapy were associated with lymph node metastasis in patients with positive axillary lymph nodes after neoadjuvant chemotherapy(χ 2=30.053, 10.233, 6.303, 7.666, 18.162, 10.148, 12.418; all P<0.05). More than 3 positive axillary lymph nodes( OR=2.788, 95% CI 1.253-5.318), ER positive( OR=3.298, 95% CI 1.744-7.837), Ki67 positive( OR=2.469, 95% CI 1.184-4.301)and pathological pPR( OR=4.197, 95% CI 2.168-13.788) were independent risk factors for lymph node metastasis after neoadjuvant chemotherapy(all P<0.05). Conclusion:Axillary lymph node-positive breast cancer patients have a high positive rate of axillary lymph nodes after neoadjuvant chemotherapy.More than 3 positive axillary lymph nodes before operation, ER positive, Ki67 positive, and axillary lymph node pPR after neoadjuvant chemotherapy are independent risk factors for lymph node metastasis after neoadjuvant chemotherapy.
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<p><b>OBJECTIVE</b>To investigate the clinical application of 256 multi-slice spiral computed tomography angiography (MSCTA) technique in the preoperative evaluation of mesenteric angiography in order to provide a reference to vessel anatomy and dissociation in laparoscopic radical operation for colorectal carcinoma.</p><p><b>METHODS</b>Clinical data of 50 patients with colorectal cancer who underwent preoperative MSCTA+FDCT and laparoscopic curative operation at our hospital from October 2013 to March 2015 were collected (MSCTA group). The evaluation item was visualization of mesenteric artery, which was compared with the findings under laparoscopic surgery. Meanwhile, another 50 colorectal cancer patients undergoing laparoscopic radical operation by the same surgeon team without preoperative MSCTA examination were used as control(control group). Clinical data were compared between the two groups.</p><p><b>RESULTS</b>MSCTA precisely and correctly demonstrated anatomy and variations of the mesenteric artery and relative nutrient vessel in carcinoma. The angiography reconstruction images were consistent with the visual anatomy and variation from laparoscopic findings, whose diagnostic conformity rate of 100%. As compared to control group, operative time was shorter [(195.0±23.2) minutes vs.(218.0±19.6) minutes, t=8.326, P=0.015], and blood loss was less[(168.1±18.8) ml vs. (206.5±14.3) ml, t=-19.369, P=0.002] in MSCTA group. Differences of number of harvested lymph node, postoperative complication morbidity, postoperative hospital stay and hospitalization cost were not significant between two groups(all P>0.05).</p><p><b>CONCLUSION</b>Preoperative MSCTA can demonstrate anatomy and variations of the mesenteric artery precisely and correctly, thus it is beneficial to shorten the operation time and to reduce blood loss.</p>
Subject(s)
Humans , Angiography , Colorectal Neoplasms , Diagnostic Imaging , General Surgery , Image Processing, Computer-Assisted , Laparoscopy , Lymph Nodes , Mesenteric Arteries , Diagnostic Imaging , Operative Time , Tomography, Spiral ComputedABSTRACT
BACKGROUND: Ischemia/reperfusion injury in liver is a common pathological process in liver transplantation and lobectomy of liver. Studies have demonstrated that exogenous alkaline phosphatase can reduce toxic effect of endotoxin through dephosphorylation. OBJECTIVE: To establish rat models of ischemia/reperfusion injury in liver and observe the protective effect of calf intestinal alkaline phosphatase (CIAP) preconditioning on ischemia/reperfusion injury. DESIGN, TIME AND SETTING: Randomized controlled animal trial was performed at the laboratory of Department of Digestion, Nanfang Hospital from April to November 2007. MATERIALS: Seventy-two SD rats were selected for models of ischemia/reperfusion injury in liver. METHODS: The rats were randomly divided into 3 groups (n=24). In the sham operation group, only the abdominal cavity was open, but not ligated; in normal saline control group, liver blood flow was blocked for 20 minutes, and 1 mL normal saline was injected from tail vein at 5 minutes prior to reperfusion; in CIAP preconditioning group, liver blood flow was blocked for 20 minutes, and 0.5 U/g CIAP was injected from tail vein at 5 minutes prior to reperfusion. MAIN OUTCOME MEASURES: Six animals were sacrificed after ischemia/reperfusion for 1, 3, 6 and 12 hours, respectively to determine the level of serum lipopolysaccharide (LPS) by end-point chromogenic assay; the levels of tumor necrosis factor (TNF-?), interleukin-6 (IL-6) and IL-10 in the serum were detected by ELISA and the filtration of polymorphonuclear neutrophils was measured with myeloperoxidase (MPO) enzyme method. The morphological changes of hepatic tissue were observed using HE staining. RESULTS: The levels of LPS, TNF-?, IL-6, and MPO in the serum were significantly higher in normal saline and CIAP groups than in sham operation group (P