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여성 유암에 대한 임상적 고찰

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[한글] 1955년부터 1975년까지 20년동안에 유암으로 진단되어 세브란스병원 외과에 입원해서 치료받은 343예를, 1965년을 기준해서 전반기 129예와 후반기 214예로 분류한 다음, 각각 임상적인 특징, 치료법, 수술후의 원격성적에 대해서 비교분석 조사하였다. 입원환자중 유암환자의 빈도는 최근 10년에 0.15%로써, 전반기의 0.23%보다 감소하였다. 환자의 평균연령은 52세에서 47세로 젊어진 것을 보여주었고, 전, 후반기 모두 종괴촉지가 주소였으나, 병력기간에 있어서는 후반기에서 짧아진 것을 발견하였다. Manchester, 와 Portman씨에 다른 병기의 분류에 의하면 후반기에서 병기Ⅰ의 환자가 증가하였다. 한편 액와부 임파선 전이의 빈도는 종괴의 크기가 크면 클수록 증가하는 밀접한 관계가 있음을 보여주었다. 수술은 전, 후반기 모두 근치유방절제술이 대중을 이루고 있었으나, 후반기에 와서 변형근치유방절제술이 점차 시행되고 있었다. 환자에 대한 추적은 60%에서 가능하였는데 근치유방절제술을 한 환자에서 생존율은 크게 변하지 않았다. 즉 전반기에서는 병기Ⅰ의 5년 생존율은 77% 병기Ⅱ에서는 40% 인데 비해, 후반기에서는 병기 Ⅰ이 7l%1 병기Ⅱ가 46%였다. 한편 후반기에서는 병기에 관계없이 10년 생존율이 43%였다. 수술후 보조적요법은 약 50%의 환자에서 시행하였다. 방사선요법은 생존율의 증가를 나타내지는 못하였으나, 국소재발과 원격전이의 빈도를 감소시켰다. 즉 방사선요법을 받는 환자에서는 수술후 20개월만에 재발하였으나, 받지않은 환자에서는 18개월이었다. 그러나 다른 보조적요법의 효과는 원격추적의 대상이 적어서 결론 내리기 힘들었다.
[영문] During the past 20 years beginning from January, 1955 to December, 1975, 343 patients of the breast cancer were admitted to the department of General Surgery, Severance Medical Center. The patients were divided into two groups according to the time of admission, before and after 1965, in order to compare clinical pictures, type of management, and survival after surgery in each 10 years period. Group Ⅰ consisted of patients and Group Ⅱ consisted of the patients. Even though the number of breast cancer increased in the latest 10 year period, the hospital incidence of breast cancer dropped from 0.23% to 0.15%. Average age of the patient was getting younger from 52 to 47. Palpable mess was the most common complaint in both groups and generally, Group Ⅱ patients have had the mass shorter the Group Ⅰ, before they had a visit to Surgery. The most common location of the mass was in the upper outer quadrant of the breast in both groups. The Manchester and/or the Portman's classification was applied for stagin. The number of stage Ⅰ patients increased in Group Ⅱ comparing with Group Ⅰ. The frequency of axillary node metastasis was significantly correlated when the sixe of the primary tumor was getting bigger. Standard radical mastectomy waa a major operative modality in both groups, however, modified radical mastectomy was gradually increasing in group Ⅱ. Long term follow up was successful in only 60% of both groups. After radical mastectomy the survival wasa not much changed; Group Ⅰ, 5-year survival rate was 77% stage Ⅰ and 40% in stage Ⅱ and in group Ⅱ, 71% and 46% accordingly. Regardless of stage, 10 year survival rate was 43% In Group Ⅱ. Adjuvant therapy was employed postoperatively about a half of the eases. Radiation therapy did not significantly improve survival, however, it is supposed to delay local recurrence or metastasis, Disease free interval was 28 months after radiation and it was 18 months without radiation. No conclusive remark is available on the effect of other adjuvant therapy because of unsatisfactory follow-up.
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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