تدبير سرطان الثدي الالتهابي
Abstract
شملت هذه الدراسة الاسترجاعية 25 مريضة مصابة بسرطان الثدي الالتهابي راجعن مشفى الأسد الجامعي باللاذقية في الفترة الزمنية من 1\2\2005 حتى 1\2\ 2013. تراوحت أعمار المريضات بين (49-61) سنة وبمتوسط قدره 55 سنة.كانت أهم الأعراض و العلامات السريرية، والتي شكلت المعيار الأساسي في تشخيص سرطان الثدي الالتهابي هي: احمرار جلد الثدي 100%, وذمة في جلد الثدي100%, ضخامة العقد اللمفية الابطية 100%, انكماش الحلمة بنسبة96 %,حرارة موضعية في الثدي 92%, سماكة في جلد الثدي بنسبة 84%,علامة قشر البرتقال88%, ألم الثدي 88%, جس كتلة في الثدي 80%.كانت أغلب المعايير الشعاعية لتشخيص سرطان الثدي الالتهابي كما يأتي: زيادة في سماكة الجلد بنسبة 100%, زيادة في كثافة نسيج الثدي في الجهة المصابة بنسبة 100% , عدم تناظر في الأوعية اللمفية تحت الجلد في الجانبين 33.33%. كانت80 % من الحالات في المرحلة stage IV. جميع المريضات خضعن للعلاج الكيماوي ثلاثة أشواط على الأقل قبل الجراحة,ثم اُجري لهن جميعاً استئصال الثدي الجذري المعدل مع تجريف للعقد اللمفية الإبطية.كما تم تقريب حواف الجرح بشكل مباشر بعد التسليخ الواسع للجلد لدى 19 مريضة أي بنسبة 76%.
4 مريضات احتجن لسدائل جلدية لتغطية الجرح وإغلاقه أي بنسبة 16% . ومريضتان 8% احتاجتا لسديلة عضلية جلدية باستخدام العضلة العريضة الظهرية.
A retrospective study included 25 cases with inflammatory breast cancer. The patients were admitted to AL-Assad University Hospital, Lattakia, Syria (average age 55, and range 49-61 years old). The most common clinical signs and symptoms were: erythema 100%, edema 100%, enlarged axillary nodes 100%, Nipple flattened/inverted 96%, warm Breast 92%, Ridges/thickening of breast 84%, Peau d’orange 88%, painful/tender Breast 88%, and Mass 80%. Mammography findings were: an increase in skin thickness 100%, an increased tissue density in the involved breast 100%, and an asymmetric widening of the sub-cutaneous lymphatic vessels 33.33%. 80% of cases were diagnosed as stage IV. All patients received primary neoadjuvant chemotherapy for three cycles. After that a modified radical breast mastectomy and axillary lymph nodes dissection were performed for all patients. The wound edges were closed primarily after dissecting the skin in 76%, for 4 patients 16% a split-thickness skin grafts were performed, and for 2 patients 8% a Latissimus dorsi pedicled myocutaneous flap was performed.
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