乳癌洞式仿根治术

Hole Style Imitating Radical Mastectomy for Breast Cancer

目的 探索、设计乳癌根治新术式 ,并总结这种新术式 (洞式仿根治术 )的临床效果。 方法 在保留胸大小肌行乳癌根治术的同时 ,于紧靠胸锁关节处 ,沿胸大肌锁骨部和胸骨部肌间沟打开一小洞 ,直视下清扫腋尖组淋巴结及其周围脂肪 ;再经此洞与腋窝会师 ,消除胸小肌后可能残留淋巴结。 结果 为Ⅰ～Ⅲ期乳癌病人施行此术 90例 ,其中腋尖组淋巴结转移阳性者 14例 ,占腋淋巴结转移阳性病例的 3 1 8% ( 14 / 4 4) ,占全组的 15 6% ( 14 / 90 )。在随防的 90例中 ,75例已随访 1～ 6年。除 1例死于术后远处转移外 ,其余 89例至今未见局部复发或远处转移 ,无 1例发生胸肌萎缩 ,效果及功能外观均满意。 结论 乳癌洞式仿根治术 ,既达到腋淋巴结清扫彻底 ,又无胸神经损伤 ,术式设计比Patey氏术和Auchincloss氏术更为合理。腋尖组有转移者效果更显优越性。是治疗乳癌较好的一种新术式。

Objective [WT5”BZ]To search for a new radical mastectomy for breast cancer and evaluate its effect. [WT5”HZ]Methods[WT5”BZ] At the time of saving the pectoris major and the pectoris minor,a small hole was made at the junction of clavicular and aternal portion of the pectoris major,to scaveng the lymph nodes at the top of the axilla and the adjacent fat tissues.The possible remaining lymph nodes behind the P.minor could be removed at the same time through the small hole. [WT5”HZ]Results [WT5”BZ]90 cases suffering from mamary cancer of 1-3 stage received the operation.Among them,14 had top axilla lymph nodes metastasis,accounting for 31.8%(14/44) of axilla lymph metastasis and 15.6%(14/90) of all the patients.75 patients were followed for 1-6 years and 89 of them had no local reccurrence or remote metastasis except for 1 case who died of remote metastasis.No Pectoratioatrophy could be seen.The result was satisfactory. [WT5”HZ]Conclusion [WT5”BZ]Hole style imitating radical mastectomy for breast cancer is a new operative apporach and is more reasonable than that of Patey style or Auchincloss style,especially for those who have metastasis at the top axilla.