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对乳腺癌根治性手术的新认知 本站原创 更新时间: 2011-04-29         
When breast cancer has spread to a patient's lymph system, surgeons traditionally have operated to remove a large number of underarm lymph nodes, to eliminate any trace of the cancer. The procedure is effective, but it can cause permanent complications. Now, a new study shows there is no advantage to taking out so many lymph nodes, and the finding could mean major changes in breast cancer surgery.

 

当乳癌细胞扩散到淋巴腺时,传统的治疗方法是,切除病人腋下下大部分淋巴结,以消灭所有癌细胞。这种手术固然有效果,但是也可能会引起永久性的并发症。现在,一项新的研究显示,切除这么多的淋巴结没有好处。这个发现可能为乳癌外科手术带来重大改变。

When breast cancer spreads to nearby lymph nodes, doctors have two choices: they can remove the main tumor and the one or two lymph nodes closest to it. This is called sentinal node biopsy. Or, they can go with a more aggressive approach and take out a large number of lymph nodes.

 

当乳癌细胞扩散到附近的淋巴结时,医生有两个选择:他们可以切除肿瘤和最靠近肿瘤的一、两个淋巴结。这种手术叫做“前哨淋巴结活检”。另一个选择是更为激进的方法,就是连同大部分淋巴结一起切除的根治性手术。

The more aggressive approach can wipe out the cancer, but complications often include shoulder pain or permanent and painful swelling of the arm.

 

根治性手术可以清除所有的癌细胞,但是通常会有并发症,包括肩痛以及手臂长期肿痛。

Dr. Armando Giuliano at the John Wayne Cancer Institute in the western state of California wanted to see if the cancer could be eliminated with less aggressive surgery. "Removing fewer lymph nodes results in less pain, less morbidity,” he said. “It's an outpatient procedure."

 

加州的约翰韦恩癌症研究所医生阿尔曼多·吉乌利亚诺想知道,能不能用比较缓和的方式清除癌细胞。他说:“切除较少的淋巴结能使痛苦少些,并发症少些,而且这种手术在门诊就可以做。”

The more radical surgery requires a one- or two-day stay in a hospital, and results in greater post-operative pain.

 

接受根治性手术的病人需要住院一天至两天,手术疼痛比较严重。

So Bobbie Saunders was relieved when her doctor offered to perform the less radical procedure when she was diagnosed with breast cancer eight years ago. "I had already experienced a lot of people that had been through the radical, so I was really excited that I was offered this," she stated.

 

因此,8年前,当医生告诉乳癌患者博比·桑德斯,准备为她做比较简单的手术时,她如释重负。桑德斯说:“我接触过很多接受根治性手术的病人。所以当我知道我要做的是这种缓和手术时,我很高兴。”

Dr. Giuliano and researchers at several top cancer centers in the U.S. studied nearly 900 patients whose breast cancer had spread to just one or two lymph nodes. Half had the more radical procedure while the others had the simpler surgery. Both groups had radiation treatments and chemotherapy.

 

吉乌利亚诺医生和美国一些顶尖癌症中心的研究人员研究了近900名癌细胞扩散到一个至两个淋巴结的病患。其中有半数接受根治性手术,另一半接受比较简单的手术。两组病人都做了放疗和化疗。

"The five-year survival [rate] was about 92 percent, regardless of which operation [they had]. And wonderfully, women who had the sentinal node biopsy alone did just as well as the women who had the more radical operation," Dr. Giuliano explains.

 

吉乌利亚诺说:“不论病人做的是哪种手术,存活率都是大约百分之92。令人欣慰的是,接受前哨淋巴结活检和接受根治性手术的妇女治疗的效果相同。”

Researchers say combining chemotherapy and radiation with the simpler surgery accounts for the high success rate of the less radical procedure.

 

研究人员说,较简单的手术与化疗和放疗配合,是这种手术高成功率的原因。

Some experts say the study is likely to change the way surgeons treat early-stage breast cancers that have spread to the lymph nodes. But other cancer specialists -- and their patients -- say they want more proof before changing the standard practice. The study was published in the Journal of the American Medical Association.

 

有专家说,这项研究结果可能会改变对早期乳癌扩散至淋巴结的手术治疗方式。但是也有癌症专家和他们的病人表示,在改变治疗方式之前,他们希望看到更多的证据。