To discuss the slection of operation way for breast carcinoma
Li Hongjiang,Luo Ze,Chen Lin,et al.
Department of General Surgery,West China Hospital,Sichuan University,Chengdu610041.
【Abstract】 Objective To discuss the plan of slection of operation way for breast carcinoma.Methods The surgical datum of258patients with breast carcinoma were summarized and the patients were followed up.Results (1)There were better effect in136patients with stageⅠ~Ⅱbreast carcinoma performed mordified radical mastectomy,the overall survival(OS)and relapse free survival(RFS)were100%and92.6%respectively.(2)Two patients with stageⅡbreast carcinoma were performed breast-conserving therapy(BCT),and one of them was relapse in5months after operation.(3)There were no difference of OSand RFS between88patients performed mordified radical mastectomy and20patients performed radical mastectomy in stageⅢbreast carcinoma.(4)There were better effect in5patients with stageⅣbreast carcinoma performed radical operation,the OS and RFS were80%and60%respectively.Conclusion The mordified radical mastectomy was the major operation to treat breast carcinoma patients with stageⅠ~Ⅲ。breast carcinoma.Part of stageⅣpatients could be performed radical operation still.Breast-conserving therapy should be performed under rational conditions of patient and hospital.
Key words Breast carcinoma Mordified radical mastectomy Radical mastectomyBreast-conserving therapy
本组典型例证是:患者,女,47岁,右乳浸润性导管癌T 4 N 2 M 1 ,ER+。右乳包块5年多,溃破4个多月,同时患者已咳嗽3个多月,不能平卧半个多月,右胸部及右上肢肿痛,需要口服***镇痛。体检发现整个右乳被肿瘤占据,约28cm×28cm×18cm,肿瘤溃破约8cm直径范围,皮肤水肿,超出乳腺范围1~3cm,腋窝淋巴结肿大,锁骨上淋巴结肿大,右上肢中度水肿伴疼痛。术前针吸活检为癌,胸片和CT均提示双肺广泛转移,先给予希罗达化疗1个多月,病情无明显缓解。在全麻下行右乳癌姑息性切除术加植皮术(取根治术术式),左乳单纯切除术,术后给予CAF(600mg D1,8 +50mg D1 +750mg D1,8 ,每28天1周期)方案化疗,半月后咳嗽缓解,疼痛缓解,切口愈合好。化疗3个周期后胸片提示双肺转移明显好转,半年后CT提示双肺转移灶基本消失,放疗1个疗程,并长期口服三苯氧胺,患者一般情况较好,带瘤生存38个月,后因病情进展,广泛转移死亡,但病人在这3年多时间中,其生活质量较术前明显改善。可见,姑息性手术可以改善这一类患者的生活质量并有利于术后的综合治疗。
因此,笔者认为:对Ⅳ期患者,也不应轻易放弃外科手术。同时,为了更好地指导治疗,国际抗癌协会建议的乳腺癌TNM分期划分的Ⅳ期乳腺癌应该进一步分为Ⅳ a 期和Ⅳ b 期,Ⅳ a 期乳腺癌应选择根治性手术。Ⅳ b 期应采用姑息性手术 [4] 。作者: yhwzj 时间: 2015-7-4 07:30
很好,值得学习