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目的总结Ⅰ和Ⅱ期乳腺癌的病理类型与外科治疗方案。方法对1990年6月~2003年6月收治的137例Ⅰ和Ⅱ期乳腺癌的临床资料进行回顾性分析并进行随访。结果实施Halsted手术40例,腋下淋巴结转移率为37.5%(15/40);实施保留胸大小肌的改良根治术79例,腋下淋巴结转移率为27.9%(22/79);保乳手术18例,腋下淋巴结转移率为11.1%(2/18)。死于肿瘤复发与远处转移17例,其中改良根治术10例(13.2%,10/76),Halsted手术4例(12.1%,4/33),保乳手术3例(16.7%,3/18)。Halsted手术和改良根治术的局部复发率与死于肿瘤复发与远处转移率,差异无统计学意义(P>0.05)。结论改良根治术与Halsted手术的肿瘤复发与远处转移无明显差异,但保乳手术对于女性的躯体完整性损伤小,有待探索,应改进Ⅰ和Ⅱ期乳癌外科治疗方案,加强术后辅助治疗,追求微创化、个体化,结合东方女性的乳房特点,积极推进保乳手术的进程。
Objective To summarize the pathological types and surgical treatment of stage Ⅰ and Ⅱ breast cancer. Methods The clinical data of 137 cases of stage Ⅰ and Ⅱ breast cancer admitted from June 1990 to June 2003 were retrospectively analyzed and followed up. Results Forty-seven cases underwent modified Halsted operation with axillary lymph node metastasis rate of 37.5% (15/40). Modified radical mastectomy with chest and small muscles was performed in 79 cases with axillary lymph node metastasis rate of 27.9% (22/79) 18 cases, axillary lymph node metastasis rate was 11.1% (2/18). 17 cases died of tumor recurrence and distant metastasis, including modified radical mastectomy in 10 cases (13.2%, 10/76), Halsted operation in 4 cases (12.1%, 4/33), breast conserving surgery in 3 cases (16.7%, 3 / 18). There was no significant difference in the local recurrence rate between Halsted surgery and modified radical mastectomy and the tumor recurrence and distant metastasis (P> 0.05). Conclusion There is no significant difference between modified radical mastectomy and Halsted operation in tumor recurrence and distant metastasis. However, breast conserving surgery has less damage to the physical integrity of the female, which should be explored. Surgical treatment of stage Ⅰ and Ⅱ breast cancer should be improved and postoperative adjuvant therapy should be strengthened , The pursuit of minimally invasive, individualized, combined with the characteristics of the Oriental women’s breasts, and actively promote the progress of breast-conserving surgery.