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breast cancer.ppt
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    参见附件(1317KB)。

    乳腺癌

    (breast cancer )

    长医附属和平医院普外科

    崔猛胜

    ?°??

    * èé?ù°(c)ê??(r)D?3￡1/4?μ???D??×á?

    * è"êà1/2????êóD120íò?3/4?(r)*￠éúèé?ù°(c)￡?50íò?àóúèé?ù°(c)?￡

    * ±±?à?￠±±?·??·￠￡?4±?óú???￠·??￠à-?à

    * ?ò1úé?o￡·￠2??ê×???

    á÷DD2??§

    * èé?ù°(c)?à*￠?(r)D?￡??DD?éù1/4??￡

    * 20?êò??°éù1/4??￠20?êò?oó·￠2??ê???ùé?éy￡??à·￠40?"60?ê￡?óè??ò??ü?ê?úoí3/4?3/4-?ú?°oóμ??3/4?(r)?à1/4??￡

    ·￠2?μ????￡??òò??￡o

    *1?￠??3/4-3?3±?êá?￡o3?3±?êá???óú13?ê?￠3/4?3/4-?êá?′óóú55?ê

    * 2?￠éúóy?êá?￡oμúò"ì￥×???2úá?3ùóú35?ê?￠￡(c)40?ê?′?D

    * 3?￠2?èé?é1/2μμí·￠2??ê￡?2?èéê±1/4?3¤?ìoí·￠2??ê3ê?o?à1?

    * 4?￠2ú′?￡o2ú′?oí·￠2??ê3ê?o?à1?

    * 5?￠1/4ò×?ê·￡o3￡-8±?óú?y3￡è?èo

    * 6?￠????￡o*ê??ó?ò?ê3￡?μ?à?*?é?￡?ò(c)??μè

    2?àí

    ???°?à2éó?μ?2?àí·?Dí

    * 1?￠*?1/2tèóD?°(c) ò21/2D?-?"°(c)(μ1/41ü?ú°(c)?￠D?ò??-?"°(c)￡(c)?￡??°(c)??°?3/4??T?ú"ùμ×?¤ò?é??￡×aò?oüéù￡??¤oóoüo??￡

    * 2?￠???ú1/2tèóD?°(c)???ú1/2tèóD?μ1/41ü°(c)?￠???ú1/2tèóD??-?"°(c)?￡°(c)??°???1/4°"ùμ×?¤?ò1/4??ê1/2tèó￡?è?ê????ú

    * 3?￠1/2tèóD?ì?êa°(c) °üà¨èéí*?ù°(c)?￠?è?ù°(c)￡¨óD′óá?áü°í??°?1/2tèó￡(c)?￠D?1ü°(c)?￠?ù?ù?òD?°(c)?￠?3òo?ù°(c)?￠′óo1?ù?ù°(c)?￠á?×′??°?°(c)?￠èéí*êa???ù°(c)?￡·?"ˉ??￡??¤oó1/2?o?

    * 4?￠1/2tèóD?*?ì?êa°(c) °üà¨1/2tèóD?D?ò?°(c)?￠1/2tèóD?μ1/41ü°(c)?￠ó2°(c)?￠μ￥′?°(c)?￠?è?ù°(c)￡¨?T′óá?áü°í??°?1/2tèó￡(c)?￠?ù°(c)?￡′?D?·?"ˉμí￡??¤oó2??￡???Dó2°(c)×??à1/4?￡??1/460%?￡

    * 5?￠????o±1/4?Dí

    ?????ùá?°(c)±??￠?"???ê°(c)?￠èéí*?ùá?°(c)±?

    ×aò?í3/43/4?

    * 1、直接浸润￡o?é1/2tèó?¤*??￠D?′ó1/4??￡D?1/2??¤μè×é?ˉ

    * 2、淋巴转移途径￡oèéí*?￠èé???￠èé*?ía2à?1/460%-70%?òí?2àò???×aò??￡èé?ù?ú2à2????1/4óD30%×óóò*￠éú?úèéáü°í1/2á×aò??￡

    * 3、血运途径转移￡o?é3/4-áü°íí3/43/4?1/2?è??aòo?-"*￡?×?3￡1/4?μ?×aò?2??"?ú·??￠1??￠??

    áù′2±í??

    * 1 、肿块

    ê×·￠?￠×′?à?a?Tòa·￠??μ??Tí′D??×?é3￡?"óúíaé??ó?T￡???′??úèéí·?￠èé??oí?úé??ó?T?￡?àμ￥·￠?￠ó2?￠2"1a"??￠"??ˉ?*1/4??￠*?1/2?2"???￡

    * 2、乳房外型改变

    ￠ù 3/4????÷￡o?×á???1/4°COOPERèí′?￡?ê1??ê?????ê§è￥μˉD?￡??￡à-?¤·??ù???￡

    ￠ú èéí·?"ò?"ò"???￡o?×á???1/4°è?èé1üê????ù???￡

    ￠?1/2??¤?￠:?×á???°???è??¤*?oí?¤??áü°í1ü??ê1?¤*??(r)?×￡??"?ò′|3???μ?×′°1/4?Y￡?D???1/2??¤?ù.

    ￠ü3/4?2?í"?e?￡

    * 3 晚期局部表现

    ￠ù?×?é1ì?¨D?3é?ù?1/2"??1/4×D?"

    ￠ú?àD?1/2á1/2ú°(c)??°?1/2tèó±í??′ó???¤*?￡?±í???a3/4?2??àêy1/4áó2μ?1/2á1/2ú?￡

    ￠??¤·???à￡?×á??òíaéú3¤í"???¤·?￡?D?3é"μ?àà￡??￡?ò×3??a?Dè3/4￡?óD??3??￡

    * 4 转移áü°í×aò??à?aí?2àò???áü°í1/2á×aò?￡?éùóD??×aò?2à?￡???úáü°í1/2á?èê?é￠?ú?￠"??ˉo?￡?ò?oóêy?????à?￠èúo?￡"é??á?éoí?¤*?1/4°é?2?×é?ˉ?3áa?￡íí?ú?é3???é??"áü°í?(r)?×?￠??1?é?áü°í1/2á?×′ó?￡??′|3￡1/4?·??￠1??￠??×aò??￡

    * 5特殊类型的乳癌 ￠ù?×D?èé°(c)?à1/4?óúè?é??ú"ò2?èé?úμ??ê?á?3/4?(r)?￡±í???aèé?ù?÷????′ó￡??¤*?3??a?￠*￠oì?￠*￠èè￡?óìè?èé?ù?×?￡ì?1/4ì￡oèé?ù?×′ó*￠oì*￠ó2￡??à?T3/4??TD??×?é?￡??ààDíèé°(c)*￠?1?ì￡??¤oó1/4"2??￡￠ú èéí*êa???ù°(c)paget2?￡?3?*￠èéí*′ì?÷?￠×?ì??￡ò?oó±í???aèéí*′|3ê?yD?êa???ù??±?￡o*￠oì?￠à￡à??￠3±êa?￠1/2áeè￡?*′?′1/2"ì?1/2?DD?￡3/4?2?óD"ò?T?×?é?￡?¤oóo?￡???D?3ì?èμí?￠×aò?éù1/4??￡

    ????ó?1/4?±e????

    * 诊断

    1?￠?ù3/4Yáù′2ì?1/4ì￡o ?Tí′D?1?á￠μ??×?é￡?ó2?￠2"1a?y?￠±?1/2?2"??￡?óDμ?°éóD"éù?¤?÷"?￠"3/4????÷"?￡íí?ú?éóD??à￡?￠?àD?1/2á1/2ú?￡

    2?￠èé?ùí????￠?a°D?????￠B3??￠o?′?12??μèóDà?óú?????￡

    3?￠2?àí?§?¤êμ?￡

    * 1/4?±e????

    ???ú"òáù′2±í??2"μ?Díμ?2?àyó|oíò???2?ó?ò?1/4?±e

    1?￠èé?ù?òD???éú2?o?·￠óú35-45?ê×óóòμ??D?ê?3/4?(r)￡?2?±??"2à￡?2?3ì3¤￡??à±í???a3/4-?°?úì?í′￡?3/4-oó??ê§"ò1/4??á?￡?"èé?é′￥1/4°?×?é"ò1/2á1/2ú￡??à?úíaé??ó?T?￡?×?é±?1/2?2"??￡?3é??×′??o?￡?óD′￥1/4°±í????á￡?D?￡?éóD?1í′ò???áü°í1/2á2"?×′ó?￡éùêy2?è??éóD1/2?òoD?"ò?aD?ò?òo?￡

    * 2?￠èé?ù?????ùá?

    ?à1/4?óú20-25?êμ??à?ê?(r)D?￡?ó?′?1/4¤??′ì1/4¤óD1??￡?×?ì?à?"óúèé?ùíaé??ó?T￡??àμ￥·￠?￡3ê?2D?"òí??2D?￡?±í??1a???￠"??ˉ1/4"o??￠±?1/2????ú?￡ò×óú?????￡

    * 3?￠èé1ü?úèéí·×′á?

    ?à·￠óú40--50?êμ??3/4?(r)?￡?à*￠óú′óμ1/41ü1/2üèéí·?ò′óμ?2?·??￡á?ì?D?￡?ò×3??a?￡?¨ò"μ??￠×′ê?èéí*?éóDò?3?D??aD?òoì??￡ì?1/4ìóDê±?úèé?????é′￥1/4°?×?ì?￡?êμ?èí￡??éí??ˉ?￡?1?è?×?ìê±oò?éóDèéí·ò?òo?￡X-??èé?ù1ü?ìó°?￠ò?òo??°??§1/4ì2éóDà?óú?????￡

    * 1/2???°?D?èé?ù?×

    èé?ù×é?ˉμ??T3/4úD??×?￠￡?ò?1/2???°?1/2tèó?a?÷?￡

    60%3ê1/4±D??×?￠±í??￡??×?ì′óê±?é3é1/2??¤?ù1??￡

    40%3ê?yD??×?￠??±?￡?±í???aèé?????×?ì￡?±?1/2?2"??￡??éóD?¤*??3á?oíèéí*°1/4?Y?￡ 1/4±D??ú?1?×óDD§￡?μ"?×?ì?éè?óD￡?D?ê?ê???á??￡

    * èé?ù1/2áo?

    1o?*￠?D?￠?à?ê?(r)D??￡

    22?3ì3¤￡?·￠?1?y?￡

    3?é±í???a?×?ì￡??êμ?èí￡?±?1/2?2"??￡?"?

    ?ˉò"°??￡?éì?í′?￡

    4?éóD1/2áo??D?3/4?￠×′￡??11/2áo?óDD§?￡

    TNM·??ú(1988?êDT?(c)￡(c)

    * T ???-·￠??

    T0￡o?-·￠???a2é3?

    Tis:?-?"°(c)

    T1:°(c)á?3¤3/4?≦2cm

    T2:°(c)á?3¤3/4?>2, ≦5cm

    T3:°(c)á?3¤3/4?>5cm

    T4:°(c)á?′óD?2"1/4?,μ"1/2t1/4°?¤·?"òD?±ú,?×D?èé°(c)ò2?úáD

    * N ??óòáü°í1/2á

    N0:í?2àò???áü°í1/2á?T?×′ó

    N1:í?2àò???óD?×′óáü°í1/2á,μ"?éí??ˉ

    N2:í?2àò????×′óáü°í1/2á±?′?èúo?,"òó??ü?§×é?ˉ?3á?

    N3:óDí?2àD?1???áü°í1/2á×aò?

    * M ??′|×aò?

    M0:?T??′|×aò?

    M1:óD??1?é?áü°í1/2á×aò?"ò??′|×aò?

    * ·??ú

    0?ú: TisN0M0

    Ⅰ?ú:T1N0MO

    Ⅱ?ú:T0~1N1M0,T2N0~1MO, T3N0M0

    Ⅲ?ú: T0~2N2MO, T3N1~2MO

    T4è?o?NM0,è?o?TN3MO

    Ⅳ?ú: °üà¨M1??μ?è?o?TN

    ??á??-?ò

    * 3/4???êμê(c)ê?ê?￡??¨ò?"ˉá??￠*?á??￠1/4¤???￠?aò?μè′?ê(c)μ?×?o???á??￡

    * 1?￠ê?ê???á?

    ￠ù3/4-μ??ù??ê?￡¨Radicalmastectomy)￡o???é?D3y"1/42àèé?ù×é?ˉá?í?°(c)?×?ü?§5cm?íμ??¤*??￠èé?ù?ü?§×é?ˉ?￠D?′óD?1/4?ò?1/4°ò????￠??1????ùóD??*3/41/4°áü°í1/2áμèèí×é?ˉ

    * ￠úà(c)′ó?ù??ê?

    (Extensive radical mastectomy)

    ?ú3/4-μ??ù??ê?μ?"ù′?é?í?ê±?D3y2?￠3?￠4à?èí1?oí?àó|μ?à?1/4?1/4?￡?°üà¨D?àa?ú?ˉ3/42??ò?1/4°?ü?§μ?áü°í1/2á?￡êêó?óú￠ò?￠￠ó?úèé?ù°(c)￡?óè??ê?èé?ù?ú2à°(c)?×

    * ￠? ??á1/4?ù??ê?

    (modified radical mastectomy)

    μ￥′?èé?ù?D3y￡?í?ê±×÷áü°í1/2á??3y￡?ê?

    ?D±￡á?D?1/4??￡êêó?óúò????T"òéùóD?éí?

    ?ˉáü°í1/2á???￡êêó?óú￠??￠￠ò?úèé?ù°(c)￡?

    ???°3￡ó?

    * ￠ü?￠è"èé?ù?D3yê?

    (total mastectomy)

    1/2?×÷è"èé?D3y?￡êêó?óú??á??￠1??￠D???

    á?μ?2?è??￡èYò×?′·￠?￡

    * ⑤±￡á?èé*?μ?èé?ù°(c)?D3yê?￡¨Lumpectomyand axillary dissection)

    ×??ó?T?D3y"ò3/4?2?à(c)′ó?D3y1/4óò?????é¨

    ê??￡ê?oó±?D??¨?ú·??￠"ˉá??￡......（后略) ......