目的 对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法 选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者,依据随机数字表法进行分组处理。对照组60例给予常规扩皮法,观察组60例给予钝性分离扩皮法,对比两组患者扩皮结果。结果 观察组患者满意度为96.67%,对照组患者满意度为86.67%（χ²=3.927,P=0.048）;观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm²、1 d后（4.89±0.94）cm²以及3 d后（0.21±0.05）cm²,均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²,对比差异有统计学意义（t=22.444、17.243、13.704,P<0.05）;观察组患者一次性送鞘成功率为98.33%,对照组患者一次性送鞘成功率为88.33%,观察组高于对照组（χ²=4.821,P=0.028）;扩皮前两组患者的VAS评分无差异（P>0.05）,扩皮后两组患者的VAS评分均降低,且观察组（1.75±0.54）分低于对照组（3.89±1.22）分,对比差异有统计学意义（t=12.425,P<0.001）;观察组患者不良事件发生率为5.00%,对照组患者不良事件发生率为16.67%,观察组患者不良事件发生率低于对照组（χ²=4.227,P<0.05）。结论 钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率,提高一次性送鞘成功率,减轻患者疼痛感,提高患者满意度。

Objective To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery. Methods From April 2022 to April 2024,120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion,and 60 patients in the observation group received blunt separation skin expansion,which the results of the two groups were compared．Results The patient satisfaction was 96.67% in the observation group,86.67% in the control group（χ²=3.927,P=0.048,P<0.05）．In the observation group,the blood immersion area after catheterization,after 1 d and 3 d were（0.87±0.14）,（4.89±0.94）,（0.21±0.05）cm²,lower than those of the control group [（2.74±0.63）（9.89±2.04）（0.44±0.12）cm²],the comparative difference was statistically significant（t=22.444,17.243,13.704,P<0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%,which was higher than 88.33% in the control group（χ²=4.821,P=0.028<0.05）．There was no difference in VAS scores between the two groups before the intervention（P>0.05）,VAS scores decreased in both groups after the intervention,the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22）,the difference was statistically significant（t=12.425,P<0.001）．The incidence of adverse events in the observation group was 5.00%,and in the control group was 16.67%,which difference was significant（χ²=4.227,P<0.05）．Conclusions Blunt separating skin expansion can reduce the area of blood immersion and the incidence of adverse events,improve the success rate of disposable sheath delivery,reduce patient pain,improve patient satisfaction,and have significant clinical application value．

目的 探讨乳腺癌术后疼痛综合征（PMPS）的发生率及影响因素。方法 选择2021年1月—2023年2月医院收治的82例乳腺癌患者为研究对象,采取手术治疗,统计PMPS发生率,分析PMPS的特征,比较PMPS患者和非PMPS患者的临床资料,采用 Logistic 逐步回归分析。结果 82例中有20例患者术后发生PMPS,发生率为24.39%,其中患侧腋窝45.00%、麻木样疼痛35.00%、中度疼痛60.00%、术后即刻疼痛50.00%、每日发作疼痛50.00%占比较高。PMPS患者和非PMPS患者的体质指数、教育程度、病理分期、肿瘤占位、手术方式、术前使用非甾体抗炎药、术前化学治疗、术后化学治疗比较差异均无统计学意义（P>0.05）。PMPS患者年龄低于非PMPS患者,负性情绪率30.00%高于非PMPS患者8.06%,清扫腋窝淋巴结率95.00%高于非PMPS患者72.58%,术后放射治疗率30.00%高于非PMPS患者6.45%（P<0.05）。年龄、负性情绪、清扫腋窝淋巴结、术后放射疗为PMPS发生的危险因素（P<0.05）。结论 乳腺癌术后较容易发生PMPS,主要表现为术后即刻腋窝疼痛、麻木,发作频率较高,疼痛较重,其中年龄小、术前焦虑、清扫腋窝淋巴结、术后放疗为引发PMPS的危险因素,需加强监测和针对性处理,研究价值较高。

Objective To investigate the incidence and influencing factors of post-mastectomy pain syndrome（PMPS）in breast cancer patients．Methods A total of 82 patients with breast cancer admitted to our hospital from January 2021 to February 2023 were selected as the research objects,and underwent surgical treatment．The incidence of PMPS was counted,the characteristics of PMPS were analyzed,and the clinical data of PMPS patients and non-PMPS patients were compared．Results Among the 82 patients,20 patients had PMPS after surgery,with an incidence of 24.39%．Among them,the affected axilla accounted for 45.00%,numbness pain 35.00%,moderate pain 60.00%,immediate postoperative pain 50.00%,and daily pain 50.00%．There were no significant differences in body mass index,education level,pathological stage of disease,tumor location,surgical method,preoperative use of non-steroid anti-inflammatory drugs,preoperative chemotherapy and postoperative chemotherapy between PMPS patients and non-PMPS patients（P>0.05）．The age of PMPS patients was significantly higher than that of non-PMPS patients,the rate of negative emotion was 30.00%,the rate of axillary lymph node dissection was 95.00%,and the rate of postoperative radiotherapy was 30.00%,which was significantly higher than that of non-PMPS patients（P<0.05）．Age,negative emotion,axillary lymph node dissection and postoperative radiotherapy were independent risk factors for PMPS（P<0.05）．Conclusions PMPS is prone to occur after breast cancer surgery,mainly characterized by immediate postoperative axillary pain and numbness,with a high frequency and severe pain．Young age,preoperative anxiety,axillary lymph node dissection,and postoperative radiotherapy are independent risk factors for PMPS,which need to be strengthened monitoring and targeted treatment．

目的 观察乳腺癌术后辅助化疗联用槐耳颗粒对内分泌激素及生存期的影响。方法 选取我院肿瘤科于2016年7月—2019年7月进行乳腺癌治疗术的80例乳腺癌患者,将患者按照随机数表法分为观察组与对照组,两组各40例。两组患者均给予预防性止吐等常规治疗,对照组予以表柔比星联合紫杉醇静脉注射,观察组在对照组的基础上给予槐耳颗粒,两组患者均治疗6个月,对比两组患者治疗3个月后血清黄体生成素(LH)、卵泡雌激素(FSH)、雌二醇(E₂),对比两组患者生存时间、无疾病进展生存期及1年生存率。结果 观察组与对照组LH、FSH、E₂水平对比均P＜0.05。在治疗后通过电话、视频等对所有患者进行随访,随访期间两组患者均无失访,生存时间、无疾病进展生存期、1年生存率对比均有P＜0.05。结论 在乳腺癌术后辅助化疗期联用槐耳颗粒可有效改善内分泌激素指标,并使生存时间获益。

Objective To observe the effect of adjuvant chemotherapy combined with Huaier granule on endocrine hormone and survival time after breast cancer operation. Methods A total of 80 cases of breast cancer patients underwent breast cancer treatment in the oncology department of our hospital from July 2016 to July 2019 were selected and divided into two groups according to the random number table method. The control group and the observation group had 40 cases each.Two groups of patients were given preventive anti-nausea and other conventional treatment, the control group was treated with epirubicin and paclitaxel intravenous injection, the observation group was treated with Huaier granuleon the basis of treatment of the control group, two groups of patients were treated for 6 months.The serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and estradiol (E₂) were compared between the two groups after 3 months of treatment. The survival time, progression free survival and 1-year survival rate of the two groups were compared. Results The levels of LH, FSH and E₂ in the comparison between two groups were all P<0.05.After treatment, all patients were followed up by telephone or video. During the follow-up period, there was no loss of follow-up in the two groups. The survival time, progression free survival and 1-year survival rate of the two groups were all P<0.05. Conclusion Huaier granule can effectively improve endocrine hormone indexes and survival time in adjuvant chemotherapy period after breast cancer surgery.

目的 探讨分析30岁及以下青年乳腺癌患者术后首次复发转移特点,以期指导术后随访,早期发现转移病灶。方法 回顾性分析2003年1月—2018年8月在梅州市人民医院收治的年龄≤30岁乳腺癌患者73例,所有患者均行根治性手术治疗,分析临床病理特点及术后首次复发转移特点。结果 共纳入23例三阴性(31.5%)、20例luminal B(HER2-)型(27.4%)、12例HER-2阳性型(16.4%)、10例 Luminal B(HER2+)型(13.7%)、4例Luminal A型(5.5%)和4例分型不明(5.5%)。中位随访28.4个月,7例三阴性(7/23, 30.4%)、 6例HER-2阳性型(6/12, 50.0%)、 4例Luminal B(HER2-)型(4/20, 20.0%) 和3例 Luminal B(HER2+)型(3/10, 30.0%)出现复发转移。复发转移患者中,90.0%合并远处转移,75.0%合并内脏转移,其中HER-2阳性型均合并内脏转移;92.3%(12/13)激素受体阴性患者复发转移发生在术后2年内。三阴性患者最常见远处转移部位是远处淋巴结,HER-2阳性型患者最常见远处转移部位是肝,luminal B(HER2+)型患者最常见远处转移部位是肺和骨,luminal B(HER2-)型患者最常见远处转移部位是肺和远处淋巴结。结论 ≤30岁青年乳腺癌患者术后首次复发转移多合并远处转移,激素受体阴性患者容易早期复发,不同分子分型患者具有不同的好发远处转移部位。

Objective We retrospectively investigated the first recurrent pattern after radical surgery in breast cancer patients aged ≤30 years, so as to guide postoperative follow-up and early detection of recurrent lesions. Methods A total of 73 consecutive early breast cancer patients aged ≤30years admitted to Meizhou People's Hospital from January 2003 to August 2018 were included. Retrospective analysis was conducted to analyze the clinicpathologic characteristics and characteristics of first recurrent pattern. Results 23 triple negative(31.5%), 20 Luminal B(27.4%), 12 HER2 enriched (16.4%), 10 Luminal/HER2+(13.7%), 4 Luminal A(5.5%) and 4 undifined subtypes(5.5%) were included. After a median follow-up of 28.4 months, 20 patients relapsed, which included 7 triple-negative(7/23, 30.4%), 6 HER2-enriched (6/12, 50.0%), 4 luminal B(4/20, 20.0%) and 3 luminal/HER2+(3/10, 30.0%) subtypes. 90.0% of patients combined with distant metastasis. 75.0% of patients had visceral metastasis, which included all the recurrent HER-2 enriched patients. 92.3% of hormone receptor negative(HR-) patients had a RFS less than 2 years. The most common metastatic sites in triple-negative, HER-2-enriched, luminal/HER2+ and luminal B subtypes were distant nodes, liver, lung and bone, distant nodes and lung, respectively. Conclusion The first recurrent pattern mainly presented as distant metastasis in breast cancer patients aged≤30 years, with early relapse in patients with HR- diseases. Different molecular subtypes of breast cancer favor different distant metastatic sites.

       目的  对比分析钝性分离扩皮法与常规扩皮法对乳腺癌术后患者经外周静脉置入中心静脉导管（PICC）置管应用效果。方法  选取2022年4月—2024年4月在天津肿瘤医院空港医院接受治疗的120例乳腺癌术后PICC置管患者，依据随机数字表法进行分组处理。对照组60例给予常规扩皮法，观察组60例给予钝性分离扩皮法，对比两组患者扩皮结果。结果  观察组患者满意度为96.67%，对照组患者满意度为86.67%（χ ² =3.927，P=0.048）；观察组患者的穿刺点血液浸湿面积分别为穿刺后即刻（0.87±0.14）cm² 、1 d后（4.89±0.94）cm² 以及3 d后（0.21±0.05）cm² ，均低于对照组的（2.74±0.63）（9.89±2.04）（0.44±0.12）cm² ，对比差异有统计学意义（t=22.444、17.243、13.704，P＜0.05）；观察组患者一次性送鞘成功率为98.33%，对照组患者一次性送鞘成功率为88.33%，观察组高于对照组（χ ² =4.821，P=0.028）；扩皮前两组患者的VAS评分无差异（P＞0.05），扩皮后两组患者的VAS评分均降低，且观察组（1.75±0.54）分低于对照组（3.89±1.22）分，对比差异有统计学意义（t=12.425，P＜0.001）；观察组患者不良事件发生率为5.00%，对照组患者不良事件发生率为16.67%，观察组患者不良事件发生率低于对照组（χ ² =4.227，P＜0.05）。结论  钝性分离扩皮法能够降低穿刺点血液浸湿面积及不良事件发生率，提高一次性送鞘成功率，减轻患者疼痛感，提高患者满意度。

       Objective  To analyze the effect of blunt separating skin expansion and conventional skin expansion in PICC catheterization of patients after breast cancer surgery．Methods  From April 2022 to April 2024，120 patients with postoperative PICC catheterization for breast cancer were selected and grouped according to the random number table method．Sixty patients in the control group received conventional skin expansion，and 60 patients in the observation group  received blunt separation skin expansion，which the results of the two groups were compared．Results  The patient satisfaction was 96.67% in the observation group，86.67% in the control group（χ ² =3.927，P=0.048，P＜0.05）．In the observation group，the blood immersion area after catheterization，after 1 d and 3 d were（0.87±0.14），（4.89±0.94），（0.21±0.05）cm² ，lower than those of the control group ［（2.74±0.63）（9.89±2.04）（0.44±0.12）cm² ］，the comparative difference was statistically significant（t=22.444，17.243，13.704，P＜0.05）．The success rate of disposable sheath delivery in the observation group was 98.33%，which was higher than 88.33% in the control group（χ ² =4.821，P=0.028＜0.05）．There was no difference in VAS scores between the two groups before the intervention（P＞0.05），VAS scores decreased in both groups after the intervention，the score of the observation group（1.75±0.54）was lower than that of the control group（3.89±1.22），the difference was statistically significant（t=12.425，P＜0.001）．The incidence of adverse events in the observation group was 5.00%，and in the control group was 16.67%，which difference was significant（χ ² =4.227，P＜0.05）．Conclusions  Blunt separating skin expansion can  reduce the area of blood immersion and the incidence of adverse events，improve the success rate of disposable sheath delivery，reduce patient pain，improve patient satisfaction，and have significant clinical application value．