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.

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.

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.

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.

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.

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.

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.

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.

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.

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.