【摘要】 目的:结合新辅助化疗探讨颈、胸联合根治术在伴有锁骨上淋巴结转移的乳腺癌患者中的应用。方法:选择12例伴有锁骨上淋巴结转移的乳腺癌患者在术前行2～3周化疗(CAF或CMF方案),发现原发肿瘤及锁骨上淋巴结均缩小后,同时施行乳腺癌根治术和锁骨上淋巴结清除术,术后继续给予综合治疗。结果:联合根治术后,全部病例无手术并发症出现,无肉眼肿瘤残留。共切除锁骨上淋巴结142枚,平均11.8枚,其中转移116枚,平均9.7枚。最多的患者淋巴结切除20/21(+),平均转移率达81.7%。乳腺腋窝清除术中切除淋巴结290枚,平均24.1枚,其中转移204枚。1例患者的病理诊断为右乳腺内下及中下髓样癌,腋下淋巴结为0/19,而锁骨上淋巴结清除术后转移情况为1/4(+),属于跳跃性转移。结论:结合新辅助化疗实行联合根治术,可以最大限度地切除肿瘤及转移淋巴结。更多还原

【Abstract】 OBJECTIVE:To explore the application of neoadjuvant chemotherapy plus combined radical surgery in the treatment of breast cancer patients with supraclavicular lymph node metastases. METHODS: Twelve breast cancer patients with supraclavicular lymph node metastases received 2 or 3 cycles chemocherapy (CMF or CAF regimen). They all reached PR. Then these patients received Halsted surgery and supraclavicular lymph nodes dissection simultaneously. RESULTS: No patient had operation compliance or tumor residual by eyes. After operation, they continued to receive chemocherapy and radiotherapy. In all, there were 142 lymph nodes which had been dissected in these 12 patients, including 116 involved. The average metastatic rate was 81.7%. Among these patients, one was diagnosed as medullary carcinoma.Interestingly, her axillary lymph nodes were 0/19 while her supraclavicular lymph nodes were 1/4.Obviously, it belonged to “jumping metastasis”. CONCLUSION: Neoadjuvant chemotherapy plus combined radical surgery can resect the primary tumors and metastatic lymph nodes maximally.更多还原