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Objective:To investigate the effectiveness, safety, and advantages of modified radical neck dissection by gasless unilateral axillary approach (GUA-MRND) in the surgical management of selected patients with papillary thyroid cancer.Methods:We retrospectively analyzed patients with papillary thyroid cancer who underwent GUA-MRND (endoscopic group, n=16) versus unilateral open modified radical neck dissection (MRND) (open group, n=32) during the period from Jan. 2019 to Jun. 2021, including the differences in surgical efficiency, complication rate, and incisional satisfaction.Results:Compared MRND with GUA-MRND, the patients were younger ( P<0.05) , operative time and postoperative drainage anterior ( P<0.01) were slightly inferior in the latter, but it had obvious advantages in cervical swallowing discomfort and incision satisfaction evaluation ( P<0.05) . There was no significant difference in the incidence of temporary recurrent laryngeal nerve injury, intraoperative and postoperative bleeding, hematoma, infection, lymphatic or chylous leakage and supraclavicular numbness after surgery ( P>0.05) . The number of dissected lymph nodes in area II in the GUA-MRND was lower ( P<0.05) , but it was significantly higher ( P<0.01) in area III. And the average regional cleaning efficiency in the GUA-MRND was level Ⅲ (35.5%) , level Ⅵ (28.59%) , level Ⅳ (23.21%) , level Ⅱ (7.18%) and level Ⅴ (7.12%) , suggested that GUA-MRND had higher efficacy for level III, level Ⅵ and Level IV. Conclusion:GUA-MRND is safe, effective, and has high cosmetic satisfaction in the treatment of selected patients with lateral cervical lymph node metastases from papillary thyroid cancer.
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Objective:To evaluate the efficacy of pecto-intercostal fascial block (PIFB)-pectoral nerve block type Ⅱ (PECS Ⅱ block)-general anesthesia for modified radical mastectomy.Methods:Forty-six patients, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, aged 40-65 yr, scheduled for elective modified radical mastectomy, were divided into 2 groups ( n=23 each) using a random number table method: PECS Ⅱ block-general anesthesia group (group P+ G) and PIFB-PECS Ⅱ block-general anesthesia group (group P+ P+ G). The patients received ultrasound-guided PECS Ⅱ block (P+ G group) or PIFB combined with PECS Ⅱ block (P+ P+ G group) in the pre-anesthesia room. Then the patients were admitted to the operating room, and midazolam, propofol, sufentanil and cisatracurium were used for anesthesia induction, and sevoflurane, remifentanil and cisatracurium were used for anesthesia maintenance. The intraoperative consumption of remifentanil, emergence time and extubation time were recorded. Flurbiprofen axetil 50 mg was intravenously injected as rescue analgesic after operation, and visual analog scale score was maintained ≤3 at rest. The requirement for rescue analgesia and occurrence of nausea and vomiting within 24 h after operation were recorded. Results:Compared with group P+ G, the intraoperative consumption of remifentanil was significantly decreased, the emergence time and extubation time were shortened, the rate of rescue analgesia within 24 h after operation was decreased, the time of first rescue analgesia was prolonged ( P<0.05), and no significant change was found in the incidence of nausea and vomiting in group P+ P+ G ( P>0.05). Conclusions:Compared with PECS Ⅱ block-general anesthesia, PIFB-PECS Ⅱ block-general anesthesia can reduce the amount of intraoperative opioids, inhibit postoperative hyperalgesia and promote early postoperative recovery when used for modified radical mastectomy.
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Objective:To explore the therapeutic effect of Jianpi Huoxue Jiedu recipe on upper limb edema of spleen deficiency and dampness stagnation, blood stasis and toxin internal knot type after modified radical surgery for breast cancer.Methods:From January 2020 to May 2022, a total of 60 patients with upper limb edema of spleen deficiency and dampness stagnation, blood stasis and toxin internal knot type after modified radical surgery for breast cancer were selected and treated in Longyan Hospital of Traditional Chinese Medicine Affiliated to Xiamen University. They were divided into control group and observation group according to random number table, with 30 cases in each group. The control group was treated with routine western medicine comprehensive swelling reduction surgery, while the observation group was treated with a combination of Jianpi Huoxue Jiedu recipe (1 dose/day, warmly-taken in the morning and evening) for one month on the basis of the control group. The clinical efficacy, traditional Chinese medicine (TCM) syndrome score, edema diameter, breast cancer quality of life scale (FACT), and joint range of motion were compared between the two groups after treatment.Results:After one month of treatment, the total clinical effective rate of the observation group (93.33%) was significantly higher than that of the control group (70.00%, P<0.05). After treatment, the TCM syndrome scores (upper limb swelling, pain, fullness, sense of restraint, skin keratinization, itching, heaviness, stuffiness, and fatigue) of both groups of patients decreased compared to those before treatment, and the observation group was lower than the control group (all P<0.05). After treatment, the diameter of edema in the affected limbs was significantly reduced in both groups of patients, and the diameter of 10 cm above the wrist and elbow stripes in the observation group was smaller than that in the control group (all P<0.05). After treatment, the FACT scores of the two groups of patients significantly decreased, and the FACT scores of the observation group were lower than those of the control group (all P<0.05). After treatment, the joint activity of the two groups of patients significantly increased, and the joint activity of the observation group was greater than that of the control group (all P<0.05). Conclusions:The clinical efficacy of Jianpi Huoxue Jiedu recipe combined with western medicine in treating upper limb edema of spleen deficiency and dampness stagnation, blood stasis and toxin accumulation type after modified radical operation of breast cancer is better than that of western medicine alone. It can significantly improve the clinical symptoms, signs, quality of life, and joint mobility of upper limbs of patients, and reduce upper limb edema.
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Objective:To observe the effect of general anesthesia combined with serratus anterior plane block (SAPB) on the quality of life and postoperative pain of patients undergoing breast cancer surgery.Methods:The clinical data of 80 patients with breast cancer undergoing elective modified radical mastectomy admitted to the Affiliated Hospital of Guilin Medical College from January 2020 to March 2021 were retrospectively analyzed. According to different anesthesia methods, they were divided into control group and observation group, with 40 cases in each group. The control group received simple general anesthesia, while the observation group received general anesthesia combined with SAPB. The degree of postoperative pain in the two groups at 3, 6, 12 and 24 h after surgery was evaluated with the Numerical Rating Scale (NRS) score, and the postoperative recovery at 24 h after surgery and quality of life at 3 h and 6 months after surgery were evaluated with the Quality of Recovery-40 (QoR-40) score and the Short Form of Health Survey (SF-36). The serum levels of pain related cytokines[neuropeptide Y (NPY), prostaglandin E2 (PGE2), and 5-hydroxytryptamine (5-HT) ] in the two groups were compared. The complications of the two groups were recorded.Results:The NRS score in the observation group at 6 h and 12 h after operation were lower than those in the control group (all P<0.05). The QoR-40 score at 24 h after operation and SF-36 score at 6 months after operation in the observation group were higher than those in the control group (all P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups ( P>0.05). The NPY, PGE2 and 5-HT levels of patients in the observation group were lower than those in the control group at 24 h after operation (all P<0.05). Conclusions:The use of general anesthesia combined with SAPB in modified radical mastectomy for breast cancer can alleviate postoperative pain and improve long-term quality of life, which may be related to the reduction of pain related cytokine secretion.
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Background: Facial nerve palsy is a common intra-temporal complication of untreated chronic suppurative otitis media (CSOM) causing erosion of the fallopian canal and its pressure effects leading to facial weakness. There is a less favorable outcome in patients of CSOM with diabetes as they are more prone to neural degeneration. In such patients, early surgical decompression of the facial nerve helps in resolving facial palsy to some extent. In our study of 22 patients, we analyzed the prognosis and advantage of doing early surgical facial nerve decompression along with modified radical mastoidectomy in patients of unsafe CSOM with diabetes mellitus. Materials and Methods: We present a retrospective study of 22 patients with a squamosal type of CSOM with diabetes mellitus who came to the outpatient department, from June 2019 to March 2021, with complaints of ear discharge and facial palsy grades 3–5, in whom we did early surgical facial nerve decompression along with modified radical mastoidectomy. We observed the incidence of facial palsy and recovery after facial nerve decompression with limited use of steroids in patients with diabetes mellitus. Results: In our retrospective study of 22 patients with squamosal type of CSOM with diabetes mellitus with complaints of facial palsy, 10 were males and 12 were females. Patients were assessed clinically using House– Brackmann grading: 55% are of grade III, 31% are of grade IV, and 14% are of grade V. About 82% of the patients from our study had lesions at the tympanic segment, 9% patients had lesions at the vertical segment, 4.5% patients had lesion at the first genu, and 4.5% patients had lesion at the second genu. In our study, 95% of the patients from the study improved with early facial nerve decompression along with modified radical mastoidectomy, 55% of the patients improved to grade I, 36% of the patients improved to grade II, and 9% of the patients improved to grade III. Conclusion: In squamosal-type CSOM patients with facial palsy, early facial nerve decompression along with modified radical mastoidectomy within 12 weeks of development of facial palsy provides better results than just modified radical mastoidectomy as it increases recovery rate and reduces the need for post-operative steroids which is an advantage in diabetics.
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At present, the most commonly used treatment methods for breast cancer are modified radical mastectomy (MRM) and breast conserving surgery. Patients undergoing breast conserving surgery can achieve good postoperative appearance and efficacy, while its surgical indications are very strict. Most women suffering from breast cancer cannot avoid the physical and mental trauma caused by the loss of breast after MRM. The promotion of immediate breast reconstruction (IBR) has greatly improved the quality of life of patients after surgery. This paper reviews the progress of indications, influencing factors, various surgical methods of IBR after MRM.
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Objective:To evaluate the effect of pectoral nerve block type Ⅱ combined with esketamine on anxiety and depression in the patients with breast cancer undergoing modified radical mastectomy under general anesthesia.Methods:Eighty-four female patients, aged 18-64 yr, of American Society of Anesthesiologists physical status Ⅰor Ⅱ, with body mass index of 18-25 kg/m 2, undergoing elective first-time modified radical mastectomy for unilateral breast cancer, were divided into 2 groups ( n=42 each) using a random number table method: routine group (R group) and pectoral nerve block type Ⅱ combined with esketamine group (PS group). Sufentanil was used for anesthesia induction and postoperative patient-controlled intravenous analgesia (PCIA) in group R, esketamine was used for anesthesia induction and postoperative PCIA, and type Ⅱ thoracic nerve block was performed under ultrasound guidance after anesthesia induction in group PS, and the rest of the drugs used were the same in both groups.The observer′s assessment of awareness/sedation scale score was recorded at the end of surgery, 30 min after the end of surgery, and at 6, 12 and 24 h after surgery.The Hospital Anxiety and Depression Scale was used to assess patients′ anxiety and depression at 1 day before surgery and at discharge.The intraoperative consumption of anesthetics, emergence time, postanesthesia care unit stay time, pressing times of PCIA, requirement for rescue analgesia, hospital costs, length of postoperative hospital stay, satisfaction scores of surgeons and patients were recorded at discharge.The occurrence of adverse reactions was also recorded after operation. Results:Compared with group R, the observer′s assessment of awareness/sedation scale score were significantly increased at the end of surgery and 30 min after surgery, the consumption of propofol and remifentanil was decreased, the emergence time and postanesthesia care unit stay time were shortened, the incidence of nausea and vomiting was decreased, the Hospital Anxiety and Depression Scale score was decreased at discharge, the incidence of anxiety and depression was decreased, the satisfaction scores of surgeons and patients were increased, and the length of postoperative hospital stay was shortened in group PS ( P<0.05). Conclusions:Pectoral nerve block type Ⅱ combined with esketamine can optimize the efficacy of anesthesia and relieve early postoperative anxiety and depression in the patients undergoing modified radical mastectomy for breast cancer under general anesthesia.
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ObjectiveTo investigate the clinical effect of Shipiyin combined with diosmin in the treatment of lymphedema with spleen Yang deficiency syndrome（SYDS）after modified radical mastectomy and the specific effect on the function of the affected limb. MethodEighty-two patients with lymphedema with SYDS after modified radical mastectomy from outpatient and inpatient department of breast department and oncology department of the First Affiliated Hospital of Hunan University of Chinese Medicine were randomly divided into an observation group（41 cases） and a control group（41 cases）. The control group was given diosmin tablets（0.9 g per time， two times per day）on the basis of conventional treatment，and the observation group was given Shipiyin（one dose per day）on the basis of the control group. The course of treatment was 14 days. The clinical symptoms were observed and the limb circumference，traditional Chinese medicine（TCM） syndrome score，functional assessment of cancer therapy-breast cancer（FACT-B） score，disability of arm， shoulder and hand questionnaire（DASH） score，and joint range of motion were measured to analyze the TCM syndrome therapeutic effect and clinical efficacy. ResultAfter 14 days of treatment， the total effective rate of the observation group was 85.37% （35/41） and that of the control group was 63.41% （26/41） in the TCM symptoms， showing a statistically significant difference （Z=-2.212， P<0.05）. In terms of the clinical efficacy， the total effective rate in the observation group was 82.93% （34/41） and that in the control group was 75.61% （31/41）， indicating a statistically significant difference （Z=-2.061， P<0.05）. Compared with the situations before treatment， the scores of clinical symptoms such as the swelling of the upper limb， pain， sense of heaviness， stuffiness， fatigue， fullness， tightness， and skin keratosis and pruritus in the two groups were significantly lowered （P<0.01） after treatment. Compared with the control group， the observation group could better improve the swelling and fullness（P<0.01），as well as the feeling of pain，heaviness，stuffiness，fatigue，tightness，skin keratosis and pruritus （P<0.05）of the upper limbs of patients. The affected limb circumference， TCM syndrome score， and DASH score decreased significantly， while the FACT-B score and upper limb joint range of motion increased significantly in the two groups after treatment （P<0.01）. Compared with the control group， the observation group showed significantly reduced limb circumference at 10 cm proximal to the elbow striae， lowered TCM syndrome score， elevated FACT-B score（P<0.05）， decreased DASH score and improved range of motion of the upper limb joint （P<0.01） after treatment. ConclusionShipiyin combined with diosmin has better clinical efficacy in the treatment of lymphedema with SYDS after modified radical mastectomy than diosmin alone，which can better improve the clinical symptoms，signs，quality of life and limb functional activity of patients. This provides a new clinical program for the treatment of lymphedema after breast cancer surgery with integrated Chinese and western medicine.
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Objective:To analyze locoregional recurrence (LRR) pattern of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, with and without adjuvant radiotherapy (RT). Methods:A total of 5442 eligible patients with breast cancer from 12 Chinese centers were included. The LRR sites and the effect of RT at different sites on recurrence in patients with and without RT were analyzed. The Kaplan-Meier method was used to calculate the cumulative LRR rate, and the difference was compared by the log-rank test.Results:With a median follow-up time of 63.8 months for the entire cohort, 395 patients developed LRR. The chest wall and supraclavicular fossa were the most common LRR sites, regardless of RT or molecular subtypes. The 5-year chest wall recurrence rates for patients with and without chest wall irradiation were 2.5% and 3.8%( P=0.003); the 5-year supraclavicular lymph nodal recurrence rates for patients with and without supraclavicular fossa irradiation were 1.3% and 4.1%( P<0.001); the 5-year axillary recurrence-free rates for patients with and without axillary irradiation were 0.8% and 1.5%( HR=0.31, 95% CI: 0.04-2.23, P=0.219); and the 5-year internal mammary nodal recurrence-free rates for patients with and without internal mammary nodal irradiation were 0.8% and 1.5%( HR=0.45, 95% CI: 0.11-1.90, P=0.268). Conclusions:The chest wall and supraclavicular fossa are the most common LRR sites of patients with pT 1-2N 1 breast cancer after modified radical mastectomy, which is not affected by adjuvant RT or molecular subtypes. The chest wall and supraclavicular fossa irradiation significantly reduce the risk of recurrence in the corresponding area. However, axillary and internal mammary nodal irradiation has no impact on the risk of recurrence in the corresponding area.
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Patients undergoing modified radical mastectomy (MRM) experience lot of pain and require higher doses of analgesics. The modified pectoral nerves (m-PEC 2) block for post-operative analgesia for patients undergoing MRM has proven highly efficacious and best alternative to avoid high dose opioid induced side effects. The m -PEC 2 block was given to 5 patients undergoing modified radical mastectomy for post operative analgesia, decrease in the VAS score was noted and decrease need of rescue analgesia was seen
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Objective:To investigate the radiation field and dose selection of patients with isolated chest wall recurrence (ICWR) after modified radical mastectomy, and analyze the prognostic factors related to subsequent chest wall recurrence.Methods:Clinical data of 201 patients with ICWR after mastectomy admitted to the Fifth Medical Center, Chinese PLA General Hospital from 1998 to 2018 were retrospectively analyzed. None of the patients received postoperative adjuvant radiotherapy. After ICWR, 48 patients (73.6%) underwent surgery and 155 patients (77.1%) received radiotherapy. Kaplan-Meier method was used to calculate the post-recurrence progression-free survival (PFS) rates and the difference was compared by log-rank test. Multivariate analysis was performed using Cox regression model. Competing risk model was adopted to estimate the subsequent local recurrence (sLR) rates after ICWR and the difference was compared with Gray test. Multivariate analysis was conducted using F&G analysis. Results:With a median follow up of 92.8 months after ICWR, the 5-year PFS rate was 23.2%, and the 5-year sLR rate was 35.7%. Multivariate analysis showed that patients with surgery plus radiotherapy and recurrence interval o F>12 months had a lower sLR rate. Patients with recurrence interval o F>48 months, local plus systemic treatment and surgery plus radiotherapy had a higher PFS rate. Among the 155 patients who received chest wall radiotherapy after ICWR, total chest wall irradiation plus local boost could improve the 5-year PFS rate compared with total chest wall irradiation alone (34.0% vs. 15.4%, P=0.004). Chest wall radiation dose (≤60 Gy vs.>60 Gy) exerted no significant effect upon the sLR and PFS rates (both P>0.05). In the 53 patients without surgery, the 5-year PFS rates were 9.1% and 20.5%( P=0.061) with tumor bed dose ≤60 Gy and>60 Gy, respectively. Conclusions:Local radiotherapy is recommended for patients with ICWR after modified radical mastectomy of breast cancer, including total chest wall radiation plus local boost. The radiation dose for recurrence should be increased to 60 Gy, and it should be above 60 Gy for those who have not undergone surgical resection. In addition, patients with ICWR still have a high risk of sLR, and more effective treatments need to be explored.
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Objective To analyze the dosimetric features of chest wall radiotherapy after modified radical mastectomy for left breast cancer using the beam’s eye view (BEV) in intensity-modulated radiation therapy (B-IMRT). Methods A total of 13 patients treated with modified radical mastectomy for left breast cancer in the Liaocheng People’s Hospital from May 2020 to November 2020 were recruited. They were treated with postoperative radiotherapy using the plans of B-IMRT or tangential fields in intensity-modulated radiation therapy (T-IMRT). The mean dose, conformity index and homogeneity index of the target field, and dose volume parameters of left lung and heart were compared between two groups. Results Compared with those of T-IMRT group, B-IMRT significantly improved the conformity and homogeneity of the target field (P < 0.05), and their mean dose of target field was similar. In addition, V5, V10, V20, V30 and Dmean of the left-side lung, and V5, V10, V30 and Dmean of the heart in B-IMRT group were significantly reduced compared with those of T-IMRT group (P < 0.05). In comparison to those of T-IMRT, B-IMRT decreases V5, V10, V20, V30 and Dmean of the left-side lung by 9.23%, 13.29%, 9.54%, 8.28% and 10.35%, respectively, which decreases V5, V10, V30 and Dmean of the heart by 27.62%, 29.72%, 21.45% and 24.88%, respectively. Conclusion Compared with T-IMRT planning, B-IMRT presents dosimetric advantages in the conformity and homogeneity of the target field in the postoperative radiotherapy of patients treated with modified radical mastectomy for left breast cancer, especially in reducing the radiation dose and volume of the heart and lungs.
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Background: Seroma, a clinically evident subcutaneous collection of serous fluid after breast cancer surgery, developing in approximately 30% of cases. To prevent seroma formation, it is important to estimate individual risk of seroma formation, i.e., the identification of predictive variables will be helpful in designing future trials aimed at reducing the incidence of this seroma. This study intends to find out the association between certain pre-operative, intra-operative, and post-operative factors related to MRM and incidence of seroma formation.Methods: It was an observational prospective on 100 females undergoing MRM at Department of Gandhi Medical College Bhopal, Madhya Pradesh, India. Patients were observed postoperatively for seroma formation and factors affecting it.Results: patients with seroma formation in this study tended to be older age (age, 62.60±10.40 years versus 56.13±10.31 years; p<0.001) and more obese (BMI, 26.95±4.2 versus 24.61±3.61; p<0.001). Higher amount of initial drain volume was directly related to seroma formation. Initiation of arm physiotherapy after surgery (3.14±0.23 days versus 2.17±0.74 days; p=0.043).Conclusions: The incidence of seroma is higher in older and in more obese patients. The incidence is decreased by flap fixation under muscles and early physiotherapy. Furthermore, few interventions in the operative period can help minimize the chances of seroma formation.
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Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients.
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Thoracic epidural anaesthesia is one of the safe and good alternative to general anaesthesia in high risk patients of chronic obstructive pulmonary disease and asthma where general anaesthesia is contraindicated. A 55 years old female patient was scheduled for modified radical mastectomy on account of advanced carcinoma of right breast. The patient was known case of bronchial asthma since 5 years with frequent attacks per week for which she was taking nebulisation with salbutamol and budesonide two times per day. In the pre-operative evaluation, her vitals were within normal limit but on auscultation air entry was reduced all over the chest with bilateral crepts and rhochi present. We did this patient in plaine thoracic epidural anaesthesia without haemodynamic instability. Thoracic epidural anaesthesia and analgesia for mastectomy is feasible, and it offers additional benefits in high-risk patients.
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Introducción.La tasa de incidencia de infecciones del sitio operatorio asociadas a cirugías mamarias varía desde el 6 hasta el 38 %. Se presentan la incidencia local y el perfil microbiológico de las infecciones en una clínica oncológica.Métodos.Se trata de un estudio de cohorte, prospectivo, descriptivo, durante un periodo de un año en el Instituto Médico de Alta Tecnología, IMAT Oncomédica, de mujeres con diagnóstico de cáncer de mama, que presentaron infecciones del sitio operatorio después de la mastectomía. Resultados.Se encontraron 335 cirugías registradas y la incidencia de infecciones del sitio operatorio fue del 3,38 %, todas en mastectomías radicales con reconstrucción. Se obtuvo crecimiento bacteriano en el 77 % de los cultivos, principalmente de cocos Gram positivos, con predominio de Staphylococcus aureus sensible a la meticilina (SAMS). Los bacilos Gram negativos representaron el 40 %. Se administraron cefalosporinas de primera generación como profilaxis antibiótica prequirúrgica, la cual fue correcta en el 31 % de los casos. En el 50 % de las pacientes infectadas se practicó el baño prequirúrgico y se cumplió el protocolo institucional. Conclusiones. La incidencia encontrada de infecciones del sitio operatorio es menor que la reportada en otras series. Staphylococcus aureus sensible a la meticilina fue el microorganismo responsable más frecuente. El cum-plimiento de la profilaxis con cefalosporina y baño prequirúrgico es fundamental para disminuir la incidencia de infecciones del sitio operatorio
Introduction.The incidence rate of surgical site infection associated with breast surgeries ranges from 6% to 38%. We present the local incidence and microbiological profile of infections in an oncology clinic.Methods. Prospective, descriptive cohort study over a one-year period of women diagnosed with breast cancer at Instituto Médico de Alta Tecnología, IMAT Oncomédica, and have developed surgical site infection after mastectomy.Results. 335 registered surgeries were found. The incidence of surgical site infection was 3.38%, all of them in radical mastectomies with reconstruction. Bacterial growth was obtained in 77% of crops. Gram-positive were the main microorganisms responsible, predominantly methicillin-sensitive Staphylococcus aureus (SAMS). Gram-Negative bacilli accounted for 40%. First generation cephalosporins were administered as presurgical antibiotic prophylaxis, which was correct in 31% of cases. In 50% of infected patients, the pre-surgical bath was performed and the institutional protocol was complied with.Conclusion. Our incidence of surgical site infection was lower than reported in other series. SAMS was the most common responsible microorganism. Compliance with cephalosporin and pre-surgical bath prophylaxis is critical to reducing the incidence of operative site infections.
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Humans , Breast Neoplasms , Surgical Wound Infection , Mastectomy, Modified Radical , MicrobiologyABSTRACT
Objective@#To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy.@*Methods@#From September 1997 to April 2015, 2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital. 1898 patients who did not undergo adjuvant radiotherapy were included in this study. The distribution of accumulated LRR was analyzed. The LR and RR rates were estimated by the Kaplan-Meier method, and the prognostic factors were identified in univariate analyses with Log-rank test. Multivariate analysis was performed using Cox logistic regression analysis.@*Results@#With a median follow-up of 71.3 months (range 1.1-194.6), 164 patients had LRR, including supraclavicular/infraclavicular lymph nodes in 106(65%), chest wall in 69(42%), axilla in 39(24%) and internal mammary lymph nodes (IMNs) in 19 patients (12%). In multivariate analysis, age (>45 years vs.≤45 years), tumor location (other quadrants vs. inner quadrant), T stage (T1 vs. T2), the number of positive axillary lymph nodes (1 vs. 2-3), hormone receptor status (positive vs. negative) were significant prognostic factors for both LR and RR.@*Conclusions@#In patients with T1-2N1 breast cancer after modified radical mastectomy, the most common LRR site is supraclavicular/infraclavicular nodal region, followed by chest wall. The axillary or IMN recurrence is rare. The prognostic factors for LR and RR are similar, which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
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Objective To analyze the failure patterns of locoregional recurrence (LRR) and investigate the range of radiotherapy in T1-2N1 breast cancer patients undergoing modified radical mastectomy.Methods From September 1997 to April 2015,2472 women with T1-2N1 breast cancer after modified radical mastectomy without neoadjuvant systemic therapy were treated in our hospital.1898 patients who did not undergo adjuvant radiotherapy were included in this study.The distribution of accumulated LRR was analyzed.The LR and RR rates were estimated by the Kaplan-Meier method,and the prognostic factors were identified in univariate analyses with Log-rank test.Multivariate analysis was performed using Cox logistic regression analysis.Results With a median follow-up of 71.3 months (range 1.1-194.6),164 patients had LRR,including supraclavicular/infraclavicular lymph nodes in 106(65％),chest wall in 69(42％),axilla in 39(24％) and internal mammary lymph nodes (IMNs) in 19 patients (12％).In multivariate analysis,age (＞45 years vs.≤45 years),tumor location (other quadrants vs.inner quadrant),T stage (T1 vs.T2),the number of positive axillary lymph nodes (1 vs.2-3),hormone receptor status (positive vs.negative) were significant prognostic factors for both LR and RR.Conclusions In patients with T1-2N1 breast cancer after modified radical mastectomy,the most common LRR site is supraclavicular/infraclavicular nodal region,followed by chest wall.The axillary or IMN recurrence is rare.The prognostic factors for LR and RR are similar,which indicates that supraclavicular/infraclavicular and chest wall irradiation should be considered for postmastectomy radiotherapy.
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Objective To assess the intervention effect of upper limb rehabilitation exercise video on life quality in patients after modified radical mastectomy. Methods A total of 160 breast cancer patients received modified radical mastectomy were from Shanghai Jiading District Maternal and Child Health Hospital from June 2017 to June 2019.They were randomly divided into control group and observation group with 80 cases in each group.The patients in the control group were trained with routine upper limb rehabilitation exercise, and the patients in the observation group were given video training for upper limb rehabilitation exercise.Quality of life (QOL), anxiety scale and depression scale were used for corresponding evaluations.Satisfaction and compliance scales were also used for evaluation. Results Before intervention, there was no significant difference in each index between the two groups (P>0.05).After intervention, the quality of life in the observation group was better than that in the control group, including life status (21.43±4.83), functional status (19.69±4.72), emotional status (19.83±4.36), social/family status (19.59±3.62) and additional attention (24.73±3.27).There was no statistically significant difference in these parameters before and after intervention in the control group (P>0.05).The scores of anxiety (36.37±5.64) and depression (37.28±4.47) in the observation group were lower than those in the control group, and the differences were statistically significant.The nursing satisfaction of patients in the observation group was much higher than that in the control group (91.25% vs 77.50%), and the proportion of compliance was higher than that in the control group (97.50% vs 68.75%). Conclusion In breast cancer patients received radical mastectomy, video-guided rehabilitation training can improve the quality of life and nursing satisfaction, compliance of rehabilitation, and condition of anxiety and depression.
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Introduction: Modified radical mastectomy (MRM) isassociated with extensive tissue dissection and substantialpostoperative pain. Various modes of postoperative analgesiahave been used to alleviate the suffering of these patients.One of that is wound instillation, in our study we comparedthe effects of bupivacaine and ropivacaine for post-operativeanalgesia when instilled through the surgical drains in patientsundergoing MRM.Material and methods: After obtaining the InstitutionalEthics Committee approval and written informed consent,60 female patients aged between 18 and 60 years withAmerican Society of Anaesthesiologist status I/II scheduledto undergo MRM were enrolled for the study. Patients wererandomised into two groups (30 each), a total of 40 cc of eitherbupivacaine (0.125%) or ropivacaine (0.2%) instilled throughsurgical drains. Visual analogue score and hemodynamicswere compared in the postoperative period every 2 hourlytill 12 hours. Quantitative data were compared by usingunpaired t-test and qualitative data by using Chi-Square testand Fisher’s Exact test.Results: Duration of analgesia was found to be significantlylonger in bupivacaine group (512.37±63.06 minutes) ascompared to ropivacaine (427.97±43.26 minutes) (p<0.0001). Systolic and diastolic blood pressure were high andstatistically significant in bupivacaine group as compared toropivacaine but clinically not significant.Conclusion: Both local anaesthetics, bupivacaine andropivacaine showed near similar pharmacological effectshowever the duration of analgesia was observed more withbupivacaine when instilled through the surgical drains. Woundinstillation, being a non-invasive technique is an effectivemode of providing postoperative analgesia in MRM ascompare to other invasive modalities.