Ghossain Antoine, Ghossain Michel A
Department of General Surgery, Hôtel-Dieu de France, University Hospital, Beirut, Lebanon.
J Med Liban. 2009 Apr-Jun;57(2):65-71.
The operation described by Halsted, in 1894 and called radical mastectomy, represents a milestone in the treatment of breast cancer. It consisted of removal of the breast, muscles and axillary lymph nodes. The pre-Halsted era saw attitudes ranging from the willful abstention to brutal treatments by cauterization or amputation. The introduction of anesthesia and asepsis enabled more advanced surgical attempts. The stratification of patients into operable and nonoperable categories has improved surgical outcome. After attempts to extend Halsted procedure (by extended or super-radical mastectomies) proved to be of little benefit, a minimally-invasive trend emerged gradually. It started with modified radical mastectomy that spares the muscles and was then followed by breast conservative surgery that leaves breast tissue behind. Then sentinel lymph node mapping was introduced with the hope of reducing the extent of axillary dissection. Finally, skin sparing mastectomy appeared in order to conserve skin and facilitate breast reconstruction.
1894年由霍尔斯特德描述的手术，即根治性乳房切除术，是乳腺癌治疗的一个里程碑。该手术包括切除乳房、肌肉和腋窝淋巴结。在霍尔斯特德时代之前，人们对乳腺癌的治疗态度不一，从故意放弃治疗到采用烧灼或截肢等野蛮治疗方法。麻醉和无菌技术的引入使得更先进的手术尝试成为可能。将患者分为可手术和不可手术两类改善了手术效果。在试图扩大霍尔斯特德手术（通过扩大根治性或超根治性乳房切除术）被证明益处不大之后，逐渐出现了微创趋势。这一趋势始于保留肌肉的改良根治性乳房切除术，随后是保留乳房组织的乳房保守手术。然后引入了前哨淋巴结定位，希望减少腋窝清扫的范围。最后，出现了保留皮肤的乳房切除术，以保留皮肤并便于乳房重建。
