乳腺癌再手术的探讨  

Reoperation for breast carcinoma

作　　者：竺东长[1] 姚臻祥[1] 吴凯南[1] 吴诚义[1] 孙治君[1] 甘长清[1] 苏新良[1] 

机构地区：[1]重庆医科大学附属第一医院普外科,重庆400016

出　　处：《外科理论与实践》2004年第2期118-120,共3页Journal of Surgery Concepts & Practice

摘　　要：目的探讨乳腺癌手术后局部复发、腋窝淋巴结转移或可疑转移者的预防及再手术的可行性。方法对1994年6月～2003年4月我院收治的再次手术的23例乳腺癌病人临床资料加以分析并随访。结果全组病例腋窝淋巴结再清扫17例有淋巴结转移,占74%。其中,12例原改良根治术中淋巴结阳性者8例;4例原Halsted根治术淋巴结阳性者3例;4例原单纯乳房切除术中,淋巴结阳性3例;原象限切除加腋窝淋巴结清扫和象限切除术各1例,淋巴结均有阳性发现;原单纯乳房切除加前哨淋巴结活检术中,淋巴结阳性1例。再次手术者中,发现原切口疤痕或胸肌有残留或复发癌6例。17例曾行腋窝清扫病人中,经手术再清扫共得淋巴结283枚,平均每例16.6枚。结论恰当的手术方式、规范化的切除范围、精细的手术操作和无瘤技巧是预防和减少局部复发转移的重要措施。对局部复发、腋窝淋巴结转移或可疑转移者再补作手术有助于控制和减少局部病情的发展,改善病人的生存质量。Objective To study the ways to avoid recurrencc and feasibility to reoperate should recurrence or axillaries lymph node metastasis do occur after operative. Methods From June 1994 to April 2003, 23 cases of reoperation were carried out for relapse of breast cancer. Results Of all the 23 cases, axillary lymph node dissection was reapeted, 17 cases (74%) were found to have positive lymph nodes. Of 12 cases with previous modified radical mastectomy , 8 had positive with axillary lymph nodes. Three of 4 cases of Halsted operation had positive lymph nodes. Of 4 cases of previous simple mastectomy , 3 were node-positive. One case with previous quadrantectomy plus axillaries dissection have underwent radical mastectomy (1 case) and another case of previous quadrantectomy reunderwent modified radical mastectomy both were found to positive nodes. One case with previous simple mastectomy plus sentinel lymph node biopsy was node-positive during reoperation. Six other cases undergoing reoperation were found to have remnant carcinoma in the primary incision or in the thoracic muscles. Of 17 cases having undergone axillary during the first operation, 283 lymph nodes (with the mean value of 16.65 per case) were dissected out. Conclusions The important points in preventing or reducing recurrence include: standardized and appropriate operative procedure, subtle manipulation and non-touch operative technique. The reoperation in breast cancer cases with local recurrence or axillary metastasis contributes to local lesion and improve survival and the quality of life.

关 键 词：乳腺癌 再手术 局部复发 淋巴结转移 

分 类 号：R737.9[医药卫生—肿瘤]