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유암수술식의 시대적 변천

Other Titles
 (A) changing trend in surgical treatment of the breast cancer 
Issue Date
1982
Description
의학과/석사
Abstract
[한글] 유방암의 수술적 치료방법은 여러가지 술식이 소개되어 있으나 최근 외과의들에 있어서 점차 보존적인 수술방법이 선호되어지는 추세이다. 특히 그 중에서도 1960년대까지 거의 유암수술의 대부분에서 시행되던 근치유방절제술이 그후 점차 변형근치유방절제술로 대치되어가고 있는 양상을 보이고 있다. 이에 저자는 유암수술술식의 변화되어가고 있는 추세에 대한 실태에 대해 알아보고자 1976년부터 1980년까지 연세대학교 의과대학 외과학교실에서 유암으로 수술받은 206예의 유암환자를 대상으로 임상적으로 분석관찰하고 1956년부터 1975년까지의 기간과 비교관찰하였으며, 또한 근치유방절제술과 변형근치유방절제술을 비교하여 변형근치유방절제술의 효율성을 알 아보고자 근치유방절제술과 변형근치유방절제술로써 적출된 액와부임파선수를 비교하고 또한 두 수술방법사이의 원격성적을 비교해본 결과 다음과 같은 결론을 얻었다. 1) 유암환자의 연대별 추세는 1955년부터 1965년까지 129예, 1966년부터 1975년까지 214예, 1976년부터 1980년까지 만 5년간 206예의 한자가 유암으로 수술받아 거의 2배씩 증가하였다. 그러나 유암환자의 전체 입원환자수에 대한 비율은 뚜렷한 증가나 감소를 보이지 않았다. 2) 유암환자의 연령분포는 40대가 유암의 호발연령임에는 변화가 없으나 1976년 이후 최근 5년간 50대와 60대의 노년층의 이환율이 다소 증가하였다. 3) 1976년부터 1980년까지 350예의 환자가 유방촬영을 하였으며 이들 중 수술을 받고 병리적진단이 확인된 80예를 중심으로 수술전 유방찰영의 판독내용을 검토한 결과, 39명의 유암환자중 33예가 수술전 유방찰영에서 유암으로 판독되어 84.6%의 진단정확도를 보였다. 4) 유암의 병기는 1975년까지는 Manchester와 PortmaNN의 분류방법을 사용하였으며 1976년 이후는 TNM 분류방식을 택하였는데 최근 5년간 병기Ⅲ, Ⅳ의 환자가 다소 감소하였으나 큰 차이는 없었다 5) 수술술식의 변화는 1975년까지는 근치유방절제술이 전체유암수술의 72.9%를 차지하였으나 1976년이후 5년간은 24.3%로 감소하는 대신, 변형근치예방절제술은 7.9%에서 71.4%로 급격히 증가하였다. 6) 병기별수술술식선택을 비교한 결과, 병기 Ⅰ, Ⅱ에서는 다소 축소된 술식인 변형근치유방절제술이 증가하였고, 병기Ⅲ, Ⅳ에서는 보다 적극적인 수술을 하는 경향을 보였다. 7) 수술술식에 따른 영역임파절절제수를 비교해본 결과, Patey 식의 변형근치유방절제술의 경우 중앙값이 15개, 평균값이 17개이며 근치유방절제술의 경우 중앙값이 16개, 평균값이 17개로 거의 유사한 액와부 임파절팍청범위를 보였다. 8) 수술술식에 따른 원격성적을 비교한 결과 각각의 5년생존율은 변형근치유방절제술군이 63%, 근치유방절제술군이 49%로 변형근치유방절제술군에서 높은 5년생존율을 보였으나 이것은 근치유방절제술군에 병기 Ⅲ, Ⅳ의 환자의 비율이 높기 때문인 것으로 사료된다. 병기별로 다시 5년생존율을 비교해보면 병기 Ⅰ, Ⅱ에서 변형근치유방절 제술군은 각각 91.8%, 56.7%. 근치유방절제술군은 각각 91.7%, 49.1%의 5년생존율을 보여 큰 차이는 보이지 않았다. A changing trend in surgical treatment of the breast cancer Suck Joon Hong, M.D. Department of Medical Science The Graduate School Yonsei University (Directed by Prof. Choon Kyu Klm, M.D.) Although the surgical treatment of the breast cancer remains controversial, the trend among the surgeons is toward more conservative procedures. This retrospective study was undertaken to examine the changing trend and the relative efficacy of the modified radical mastectomy versus standard redical mastectomy in the treatment of breast cancer. It represents md analysis of 206 patients who were treated for breast cancer between the veals 1976 and 1980, at the Yonsei University Medical Center comparing to the results of the past 20 years experiences until 1975. Standard radical mastectomy had been a major operation modality in the past 20 years. 72.9% of breast cancer cases were undergone this type of procedure. However, modified radical mastectomy had teen gradually increasing in recent 5 years, comprising 71.4% of breast cancer patients. The effectiveness of axillary dissection between two types of surgical procedure was assessed by a comparison of the number of the total axillary lymph nodes removed by modified radical mastectomy to that by standard radical mastectomy. In 50 patients treated by standard radical mastectomy, the number of axillary lymph nodes removed ranged with a median of 16 and a mean of 17 per patient. Contrarilly, among the 41 patients undergoing Patey's modified radical mastectomy, total number of axillary lymph nodes removed ranged with a median of 17 and a mean of 15 in each mastectomy specimen. In 106 patients operated by Auchincloss modified radical mastectomy, mean numbers, of lymph nodes removed were 13, and also 13 of median number. The efficacy of the modified radical mastectomy was assessed by a comparison of the survival rates between the two procedures. The 5 year cumulative survival rate of modified radical mastectomy group was somewhat higher than the standard radical mastectomy group, but this difference might be due to the high proportion of stage Ⅲ and Ⅳ patients inm standard radical mastectomy group. After modified radical mastectomy, 91.8% of stage I patients and 56.7% of stage Ⅱl patients survived at 5 years, while 91.7% of stage Ⅱ patients survived at 5 years, while 91.7% of stage I patients and 49.1% of stage Ⅱ patients did survive at 5 years after standard radical mastectomy. Therefore there was no significant difference in the survival rates between the two procedures.
[영문] Although the surgical treatment of the breast cancer remains controversial, the trend among the surgeons is toward more conservative procedures. This retrospective study was undertaken to examine the changing trend and the relative efficacy of the modified radical mastectomy versus standard redical mastectomy in the treatment of breast cancer. It represents md analysis of 206 patients who were treated for breast cancer between the veals 1976 and 1980, at the Yonsei University Medical Center comparing to the results of the past 20 years experiences until 1975. Standard radical mastectomy had been a major operation modality in the past 20 years. 72.9% of breast cancer cases were undergone this type of procedure. However, modified radical mastectomy had teen gradually increasing in recent 5 years, comprising 71.4% of breast cancer patients. The effectiveness of axillary dissection between two types of surgical procedure was assessed by a comparison of the number of the total axillary lymph nodes removed by modified radical mastectomy to that by standard radical mastectomy. In 50 patients treated by standard radical mastectomy, the number of axillary lymph nodes removed ranged with a median of 16 and a mean of 17 per patient. Contrarilly, among the 41 patients undergoing Patey's modified radical mastectomy, total number of axillary lymph nodes removed ranged with a median of 17 and a mean of 15 in each mastectomy specimen. In 106 patients operated by Auchincloss modified radical mastectomy, mean numbers, of lymph nodes removed were 13, and also 13 of median number. The efficacy of the modified radical mastectomy was assessed by a comparison of the survival rates between the two procedures. The 5 year cumulative survival rate of modified radical mastectomy group was somewhat higher than the standard radical mastectomy group, but this difference might be due to the high proportion of stage Ⅲ and Ⅳ patients inm standard radical mastectomy group. After modified radical mastectomy, 91.8% of stage I patients and 56.7% of stage Ⅱl patients survived at 5 years, while 91.7% of stage Ⅱ patients survived at 5 years, while 91.7% of stage I patients and 49.1% of stage Ⅱ patients did survive at 5 years after standard radical mastectomy. Therefore there was no significant difference in the survival rates between the two procedures.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117418
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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