20xx年醫(yī)學(xué)專題—乳腺癌診治指南-文庫吧資料
2024-11-04 17:27本頁面
【正文】 局部，改善癥狀。li225。,第二十九頁，共六十三頁。o)（R3）用于乳腺癌區(qū)段切除后殘留的原發(fā)和（或）轉(zhuǎn)移灶。o)方法,放射治療 ⒊乳腺癌根治性放療(f224。,乳腺癌的治療(zh236。目前多以術(shù)前化療取代。)范圍大于手術(shù)范圍（全乳腺 ,內(nèi)乳，腋窩，和鎖骨上下淋巴引流區(qū)。o)方法,放射治療 ⒉乳腺癌術(shù)前輔助放療（R2）照射(zh224。,乳腺癌的治療(zh236。采用先術(shù)后化療后放療的治療方法。ng)后進(jìn)行。照射時間：術(shù)后輔助化療完成(w225。⑶ T34腫瘤和（或）腋窩淋巴結(jié)轉(zhuǎn)移＞4個，除照射鎖骨上區(qū)、腋窩和內(nèi)乳淋巴結(jié)外，還照射全胸壁，包括瘢痕下端和引流口。o)方法,放射治療 ⒈乳腺癌術(shù)后輔助放療 (R1) 照射范圍： ⑴ 腋窩淋巴結(jié)轉(zhuǎn)移，轉(zhuǎn)移淋巴結(jié)＜4個，照射鎖骨上區(qū)、腋窩和內(nèi)乳淋巴結(jié)。,乳腺癌的治療(zh236。準(zhǔn)確性可達(dá)9698% 活檢術(shù)目的是了解腋窩淋巴結(jié)的轉(zhuǎn)移狀況；代替腋淋巴結(jié)清掃術(shù)，避免上肢淋巴水腫。目前很少用于乳腺浸潤癌患者 ⒍乳腺癌前哨淋巴結(jié)活檢 (S6) 在早期乳癌局部注射生物(shēngw249。適用于原位癌或不能耐受根治術(shù)的浸潤癌患者。li225。,第二十五頁，共六十三頁。d224。 ⒋乳腺癌擴(kuò)大根治術(shù)（S4）在乳腺癌根治術(shù)的基礎(chǔ)上，再切除內(nèi)乳淋巴結(jié)。適用于Ⅰ、Ⅱ期和部分Ⅲ期（T3,N1）乳腺癌患者。li225。,第二十四頁，共六十三頁。適用于0、Ⅰ、Ⅱ期乳腺癌。o)后的患者 ⒉乳腺癌改良根治術(shù) (S2) 切除全部乳腺組織、乳房皮膚和皮下脂肪組織⑴Patey Dyson 術(shù) 保留胸大肌，切除胸小肌，腋窩淋巴結(jié)脂肪組織清掃。禁忌用于腫塊位于乳腺中央?yún)^(qū)，或多個原發(fā)灶，或有結(jié)締組織病乳房放療(f224。o)方法,手術(shù)治療 ⒈乳腺癌區(qū)段切除術(shù) (S1) 病變局部切除、病變局部廣泛切除（至少切除腫瘤周圍2cm以上的組織）或乳腺1/4切除。,乳腺癌的治療(zh236。n)（8）,TNM/AJCC分類組成臨床/病理(b236。,乳腺癌的診斷(zhěndu224。,乳腺癌的診斷(zhěndu224。n)AJCC病期（6),pN3: pN3a: Metastasis in 10 or more axillary lymph nodes (at least one tumor deposit 2.0 mm), or metastasis to the infraclavicular lymph nodes pN3b: Metastasis in clinically apparent* ipsilateral internal mammary lymph nodes in the presence of 1 or more positive axillary lymph node(s)。n)AJCC病期（5),pN2: Metastasis in 4 to 9 axillary lymph nodes, or in clinically apparent ** internal mammary lymph nodes in the absence of axillary lymph node metastasis to ipsilateral axillary lymph node(s) fixed to each other or to other structures pN2a: Metastasis in 4 to 9 axillary lymph nodes (at least 1 tumor deposit 2.0 mm) pN2b: Metastasis in clinically apparent* internal mammary lymph nodes in the absence of axillary lymph node metastasis,第二十頁，共六十三頁。n)AJCC病期（4）,pN1: Metastasis in 1 to 3 axillary lymph nodes, and/or in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent** pN1mi: Micrometastasis (0.2 mm but ≤2.0 mm) pN1a: Metastasis in 1 to 3 axillary lymph nodes pN1b: Metastasis in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent** pN1c: Metastasis in 1 to 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent.** (If associated with 3 positive axillary lymph nodes, the internal mammary nodes are classified as pN3b to reflect increased tumor burden),第十九頁，共六十三頁。n)AJCC病期（4）,Pathologic classification (pN)* pNX: Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis histologically, no additional
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