Noguchi M, Sakuma H, Matsuba A, Kinoshita H, Miwa K, Miyazaki I
Jpn J Surg. 1983 Jan;13(1):6-15. doi: 10.1007/BF02469683.
An operative method of extended radical mastectomy involving intrapleural en bloc resection of the internal mammary lymph nodes by sternal split was proposed. The operation enables complete resection of axillary and internal mammary lymph nodes. Seventy patients with primary breast cancer underwent the extended operation and two patients with recurrence in the internal mammary lymphnode chain following standard radical mastectomy underwent resection of internal mammary lymphnodes by sternal split, with no fatalities and no increase in postoperative disabilities. Metastases to the internal mammary lymphnode chain were histopathologically found in 14 of 70 patients with primary breast cancer and in two with recurrence in the internal mammary lymphnode chain, following standard radical mastectomy; The location of the metastatic internal mammary lymphnodes was from just below the subclavicular vein to the third intercostal space along the internal mammary vessels. Cancer cells were seen not only in the lymphnodes, but also in lymphatics of areolar tissue near the node or in lymphatics between the parietal pleura and endothoracic fascia in patients with primary breast cancer. And cancer invasion to parietal pleura was seen in patients with recurrence in the internal mammary lymphnode chain following standard radical mastectomy. All these findings indicate the rationality of our extended procedures.
提出了一种扩大根治性乳房切除术的手术方法，即通过胸骨劈开进行胸膜内整块切除乳房内淋巴结。该手术能够完整切除腋窝和乳房内淋巴结。70例原发性乳腺癌患者接受了扩大手术，2例在标准根治性乳房切除术后乳房内淋巴结链复发的患者接受了胸骨劈开乳房内淋巴结切除术，无死亡病例，术后残疾也未增加。70例原发性乳腺癌患者中有14例以及2例在标准根治性乳房切除术后乳房内淋巴结链复发的患者经组织病理学检查发现有乳房内淋巴结链转移；转移的乳房内淋巴结的位置是沿着乳房内血管从锁骨下静脉下方至第三肋间间隙。在原发性乳腺癌患者中，不仅在淋巴结中可见癌细胞，在淋巴结附近乳晕组织的淋巴管或壁层胸膜与胸内筋膜之间的淋巴管中也可见癌细胞。并且在标准根治性乳房切除术后乳房内淋巴结链复发的患者中可见癌侵犯壁层胸膜。所有这些发现表明我们扩大手术程序的合理性。
