The comparative study of endoscope versus open surgery on nipple sparing mastectomy with immediate reconstruction using prosthesis implantation / 中华外科杂志

Objective@#To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery.@*Methods@#Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 65 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients′ satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ2 test or non-parametric test.@*Results@#There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178±80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237±104) ml, t=-2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62±36) ml, t=3.210, P=0.002). Patients′ satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group.@*Conclusions@#Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.

Effects of carbon nanoparticles-epirubicin suspension on cell proliferation and apoptosis in breast cancer MCF-7 cells / 中华内分泌外科杂志

Objective To explore the effect of carbon nanoparticles-epirubicin suspension on proliferation and apoptosis in human breast cancer MCF-7 cells.Methods MCF-7 cells were cultured with different concentrations of CNP-EPI in vitro.CCK-8 assay was used for determinate inhibition effect of CNP-EPI on the proliferation of MCF-7 cells at different concentration and different time.According to the determination of IC90,5 μg/ml CNP-EPI was selected,and cell morphology and cell apoptosis rates were observed after 24 h.Results The inhibition effect of the CNP-EPI was stronger significantly in CNP-EPI group than in normal control group within 24 h,48 h,72 h when the concentration was from 1 μg/ml to 200 μg/ml (P＜0.01).The inhibition of CNP-EPI on the proliferation of MCF-7 cells was gradually strengthened in a dose-dependent relation within the same time,and the inhibition effect is reduced in the same concentration of drugs with the time extension,but it still has a strong inhibitory effect in 72 h,and the inhibition effect of different concentration of CNP was not obvious on MCF-7 cells.Obvious changes of cell morphology were observed under inverted microscope such as:a lot of dead cells,cell adherent growth poor,cell morphology became round and karyopycnosis etc,in 5 μg/ml CNP-EPI group after 24 h.However,no obvious abnormity of cell norphology was observed in normal control group and corresponding CNP group.Late apoptosis rate was (14.57±2.41) ％,the mortality rate could reach (78.63±-20.55)％ in 5 μg/ml CNP-EPI group after 24 h.The mortality rate and apoptosis rate of cells was higher significantly in CNP-EPI group than in CNP group and normal control group (P＜0.05).Conclusion CNP-EPI can obviously inhibit the proliferation or kill human breast cancer MCF-7cells,and the inhibition effect of CNP-EPI on proliferation of breast cancer cells might be the result of delayed releasing of EPI.

Application of da Vinci robotic surgical system in thyroidectomy / 中华内分泌外科杂志

Objective To discuss the safety and effectiveness of robot-assisted thyroidectomy using Da Vinci system.Methods Endoscopic thyroidectomy assisted by Da Vinci system was performed in 20 patients,including 5 cases of thyroidadenoma,4 cases of nodular goiter,and 11 cases of thyroid carcinoma.The max diameter of thyroid lump is 5.33 cm.Among 9 cases of benign thyroid neoplasm,5 cases underwent unilateral subtotal lobectomy,and 4 cases underwent unilateral near total thyroidectomy.Among 11 cases of thyroid carcinoma,7 cases underwent bilateral near total thyroidectomy,and 4 cases underwent bilateral total thyroidectomy,at the same time,all the 11 cases underwent central region lymph node dissection.Results The robot-assisted endoscopic thymidectomy was successfully carried out in 20 cases.The mean operation time was 206.4 (105～372)min.The mean operative blood loss was 27.3 ml.The draining tube was moved 3 to 6 days after surgery.The mean postoperative hospital stay was 4.9 days.The mean hospital expense was 60 172 yuan RMB.No complication occurred.20 patients were satisfied with the cosmetic effect and compararive curative effect.Conclusions The robot-assisted endoscopic thymidectomy is an efective method for thyroid diseases.The methed can get more clear vision,higher safety,and good cosmetic efect.

Endoscopic subtotal thyroidectomy in treatment of nodular goiter: a report of 72 cases / 中华内分泌外科杂志

Objective To explore effects of endoscopic subtotal thyroidectomy on nodular goiter and its clinical significance.Methods From Jun.2004 to Dec.2009,72 patients with nodular goiter underwent endoscopic subtotal thyroidectomy in Southwest Hospital.Of the 72 cases,22 cases had left-side nodule,31 cases had right-side nodule and 19 cases had bilateral nodules.Single thyroid nodule occurred in 41 cases and multiple nodules in 31 cases.The total number of nodules was 113.The average nodule size was 2.8 cm(ranging from 0.4 to 6.3 cm).Results Of the 72 cases,19 patients underwent bilateral subtotal thyroidectomy and the mean operative time was 97 min(ranging from 80 to 150 min).53 patients underwent unilateral subtotal thyroidectomy and the mean operative time was 65 min(ranging from 25 to 120 min).The mean intraoperative blood loss was 45 ml (ranging from 5 to 120 ml).Of the 72 cases,68 cases were given cervical plexus block regional anesthesia and among them 66 cases(97%)acquired good anesthesia.Temporary hoarse voice occurred in 2 cases and postoperative bleeding occurred in the subcutaneous tunnel of breast in 2 cases.Patients were followed up from 3 to 5years and the cosmetic result was satisfactory.The postoperative review half year later showed that unilateral nodule recurred in 1 case and the recurrence rate was 1.4%.Conclusions Endoscopic subtotal thyroidectomy through anterior chest wall or breast approach under local anesthesia is a safe and effective treatment in nodular goiter.In the process of dissecting thyroid,blunt maneuver and proper use of ultrasonic knife instead of clamping thyroid nodules directly are recommended in order to reduce intraoperative blood loss and enhance safe practice.

Application of endoscopically subcutaneous mastectomy and immediate mammary prosthesis reconstruction / 肿瘤研究与临床

Objective To study the feasibility of endoscopically subcutaneous mastectomy and immediate mammary prosthesis reconstruction.Methods From December 2006 to October 2007，9 breast cancer patients underwent endoscopic skin sparing mastectomy and immediate implanting breast reconstruction，with preoperatively performed systemic TE chemotherapy two to six times.Whether or not the nipple-areola complexes were preserved depended on the results of frozen pathological examination.Results Of 9 patients，bilateral skin sparing mastectomy were performed in two patients，and others underwent single lateral masteetomy with the nipple-areola complexes，at the same time sentinel lymph node biopsy was done in 8 cases of all.Combined level Ⅰ and Ⅱ axillary dissections were carried out vvia the sarne incisions underthe axillaries in 7 patients，and 2 patients spared axillary dissections.8 of them got satisfactory results，one patient did not.The postoperation complications included subcutaneous seromas 1 case，epidermic nipple necrosis 1 case and bleeding of skin flap 1 case.No local reeurrence occurred during the follow-up ranged 1～10 months.Conclusion It is technically safe and feasible that endoscopically subcutaneous mastectomy with immediate mammary prosthesis reconstruction.The technique can minimize skin incision With little trauma,and offers a greater esthetic advantage tomostpatients.

Video-assisted subcutaneous mastectomy and immediate reconstruction / 第三军医大学学报

Objective To explore the feasibility and cosmetic results of video-assisted subcutaneous mastectomy and immediate reconstruction. Methods Two patients who suffered from breast diseases and need to excise the breasts received a video-assisted total subcutaneous mastectomy and immediate reconstruction in our center. Results Both patients felt satisfied on the cosmetic result. According to the operative experience of these two patents combined with review, the key point of the operation was summarized as follows. The incisions on the anterior axillary line were small and concealing. External retraction method was used to establish the working space. Video-assisted operation was combined with euthyphoria. Blunt dissection was combined with electrical surgery unit and ultrasound knife to isolate the breast skin flap. After breast glandectomy was completed, silica gel prosthesis was put into the interspace behind ectopectoralis. Pressure dressing for 3 weeks was done to prevent the prosthesis upward displacement. Conclusion The video-assisted subcutaneous mastectomy and immediate reconstruction is a safe and feasible operation method with the better cosmetic result.

Clinical and pathological analyses of estrogan receptor and progestin recetor expressions in bilateral breast cancer / 第三军医大学学报

Objective To investigate the relationship between clinical and pathological features in order to observe estrogen and progestin receptor(ER and PR) expressions in bilateral primary breast cancer(BPBC). Methods ER and PR expressions in 29 cases of BPBC from 1990 to 2003 and the clinical and pathological features were analyzed retrospectively. Results ER and PR positive expressions were 53 2% and 41 2% in unilateral breast cancer, but 69% and 51% in first primary cancer of BPBC, and 65% and 41 3% in second primary cancer of BPBC, respectively. Invasive lobular carcinoma(ILC) was 11 6% in unilateral breast cancer and 34 4% in first cancer of BPBC and 41.3% in second primary cancer of BPBC. Status of lymph nodes in unilateral breast cancer was similar to that in BPBC. Conclusion There is higher ER expression in BPBC than that in unilateral breast cancer. ILC is significantly related to the carcinogenesis of BPBC. The status of lymph nodes is not related to BPBC.

Hepatic VX2 tumor in rabbits: treated with radio frequency ablation and evaluated with enhanced CT / 中华肝脏病杂志

<p><b>OBJECTIVE</b>To explore and evaluate the effect of radio frequency ablation (RFA) in treatment of hepatic VX(2) tumor in rabbits.</p><p><b>METHODS</b>The hepatoma was treated with RFA in rabbits. The complete necrotic rate of the tumors, pathological changes, CT images and the animals' survival time were observed.</p><p><b>RESULTS</b>(1) ALT in serum increased significantly on the first day and decreased to the control level during 4th-7th day following RFA. (2) On the second week, CT scans showed that complete necrotic foci became larger, and the density of which was asymmetrical. Enhanced CT scans showed no obvious intensification inside; however, ringed intensification appeared along edges of the foci. Biopsy showed that the dark necrotic tissue was surrounded by ringed granulation tissue. Incomplete necrotic tumor foci resembled the complete necrotic foci in no enhanced CT images; however, asymmetrical intensification was observed in enhanced CT scans in the incomplete necrotic foci. Macroscopic observation showed irregular tumor tissue between the necrotic tissue and the peripheral normal tissue. Biopsy showed tumor recurrence in it. (3) Compared with the control, survival time of the animals was longer, and metastases rate in lungs and the fatality rate were lower in the treatment group.</p><p><b>CONCLUSIONS</b>RFA, with little injury, is an effective method in the treatment of hepatoma. Enhanced CT scans are consistent with pathological morphometrics of the tumor foci after RFA. The enhanced CT scan is a valuable check-up, which could be used to observe the therapeutic effect after RFA.</p>

The surgical approach for internal mammary node biopsy in breast cancer / 中国普通外科杂志

Objective To explore surgical approach for internal mammary node biopsy in patients with breast cancer. Methods Modified radical mastectomy and incised intercostal muscles for internal mammary node biopsy was performed on 113 patients. The distance from the internal mammary artery to the lateral sternal border, and the intercostal distance between the two costal cartilage were measured. Anatomical location and maximal diameter of the excised nodes were recorded. Results The internal mammary artery runs through intercostal space along the lateral sternal border. The distance from the internal mammary artery to the lateral sternal border was (10. 9?4. 5) mm, (11.6?2.9) mm, (9.6?3.6) mm and (4.5?3.5) mm in the first, second, third and fourth intercostal space, respectively. The distance between the two costal cartilage was (14. 2?4. 1) mm, (16. 2?4. 2) mm, (13. 9?4. 3) mm and (9.9?3. 6) mm in the first,second, third and fourth intercostal space, respectively. Two hundred and seventy-nine internal mammary nodes were excised from 113 patients. The anatomical location of the internal mammary nodes which embedded in the fatty tissue surrounding internal mammary artery were 41. 2% at the medial side, 51. 6% at the lateral side and 7. 2% in an anterior plane to the internal mammary artery. Metastases in the internal mammary node were detected in 26 patients. The lymph nodes metastasis were detected only in the internal mammary nodes in 5 cases. Conclusion Internal mammary node biopsy via intercostal space is a feasible, minimally traumatic, low-risk procedure.

Complete Endoscopic Subcutaneous Mastectomy and Immediate Reconstruction with Implants for Breast Cancer:Report of 31 Cases / 中国微创外科杂志

Objective To explore the surgical skill, safety, and cosmetic outcomes of complete endoscopic subcutaneous mastectomy and immediate reconstruction with implants for breast cancer. Methods From August 2004 to September 2007, 31 women with breast cancer received complete endoscopic subcutaneous mastectomy and immediate reconstruction with implants in our hospital after neoadjuvant chemotherapy. The operation spaces were established by insufflating carbon dioxide after lipolysis and liposuction in the subcutaneous stratum and retromammary space. Subcutaneous mastectomy was carried out under a complete endoscope, sentinel lymph node biopsy or axillary lymph node dissection, and immediate reconstruction with implants were carried out via axillary small incision. Results The operations were completed in all of the 31 cases. Sentinel lymph node biopsy was performed on 15 cases (including supplemental axillary lymph node dissection in 8), and immediate axillary lymph node dissection was done in 16 cases. No cancer infiltration on tumor surface or into the nipple basement was observed in frozen sections during the operation. In one patient, the nipple was partly necrotic. No other complications were found in this series. Three months after the operation, cosmetic results were good in 22 cases (71.0%), average in 7 (22.6%), and poor in 2 (6.4%). The patients were followed for 3 months to 3 years (over 1 year in 15 patients), during which no one had metastasis or recurrence of the tumor. Conclusions Complete endoscopic subcutaneous mastectomy combined with immediate reconstruction with implants is less traumatic and safe with few complications and good cosmetic result. The method is a good choice for patients with early-stage breast cancer.