Laffargue F, Giacalone P L
Services de Gynécologie-Obstétrique, CHR de Montpellier, Hôpital Arnaud de Villeneuve.
Ann Chir Plast Esthet. 1992 Dec;37(6):646-51.
The modalities and indications for surgery in the treatment of breast cancers have changed considerably over the last 30 years with a succession of exclusive surgery, exclusive radiotherapy, then limited surgery with adjuvant radiotherapy, adjuvant chemotherapy and finally neoadjuvant chemotherapy. With the contribution of all of these treatment modalities, the authors discuss the respective roles of radical surgery and conservative surgery as first-line surgery for invasive breast cancers. After recalling its objectives, first-line surgery is then described in terms of its diagnostic role in the presence of a suspicious node, an patch of mastopathy, nipple discharge or subclinical lesions. The various radical and conservative techniques of primary curative surgery are then described in the context of combined therapy (adjuvant radiotherapy and/or chemotherapy): no longer Halsted's radical mastectomy, by modified Patey's mastectomy with limited lymph node dissection and especially partial mastectomies (quadrantectomy, lumpectomy) with axillary lymph node dissection, alone or combined with radiotherapy. The implications on the cosmetic result and the various modalities of reconstructive surgery are also discussed.
在过去30年里，乳腺癌治疗中的手术方式和指征发生了很大变化，经历了单纯手术、单纯放疗、随后是有限手术联合辅助放疗、辅助化疗，最后是新辅助化疗。在所有这些治疗方式的作用下，作者讨论了根治性手术和保乳手术作为浸润性乳腺癌一线手术的各自作用。在回顾其目标后，接着从其在可疑淋巴结、乳腺病斑块、乳头溢液或亚临床病变存在时的诊断作用方面描述一线手术。然后在联合治疗（辅助放疗和/或化疗）的背景下描述了各种根治性和保乳性一期根治手术技术：不再是霍尔斯特德根治性乳房切除术，而是采用改良派蒂乳房切除术并进行有限淋巴结清扫，尤其是进行象限切除术、肿块切除术等部分乳房切除术并进行腋窝淋巴结清扫，单独或联合放疗。还讨论了对美容效果的影响以及重建手术的各种方式。
