面部基底细胞癌较低复发率手术方案探讨和临床病理分析

发布时间：2018-02-11 05:21

本文关键词： 基底细胞癌病理分型切缘术中冷冻复发　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨面部基底细胞癌发病机制、临床表现、病理分型与组织学特点,分析面部基底细胞癌手术切缘情况和预后的影响因素及不同创面修复方式的美学效果。方法:回顾性分析310例自2009年1月-2012年1月经安徽省立医院烧伤整形外科手术病理科确诊的基底细胞癌,依据病理诊断及术后五年随访情况分为切缘阳性和阴性组,复发与无复发组。采用HE染色法和En Vision法分析各病理分型患者的组织学特点,纳入研究的影响因素为性别、年龄、病程、肿瘤部位、直径、病理分型;结局指标为首次术中冷冻切缘阳性率、术后随访5年复发率。利用卡方检验,logistic回归模型分析各纳入研究因素与术中冷冻切缘阳性的关系。运用Kaplan-Meier生存分析描绘基底细胞癌生存曲线,COX风险比例回归模型多因素分析各纳入研究因素与术后随访5年复发的关系。结果:310例面部基底细胞癌患者首次术中冷冻切缘阳性47例。手术切缘3mm,4mm,5mm组分别为110例,100例,100例。结节型138例,浅表型67例,浸润型77例,硬斑病样型28例。颞部70例,眶周50例,鼻部100例,面颊56例,下颌34例。肿瘤直径为2.0~27.0mm。病程4~48m。术后五年随访22例复发。310例BCC手术后创面112例直接缝合,168例皮瓣转移修复,30例皮片移植。Logistic多元回归示病理分型、肿瘤直径是首次术中冷冻切缘阳性率的主要危险因素以浸润型(OR=4.488,95%CI=1.975~10.355,P0.05),硬斑病样型(OR=5.019,95%CI=2.025~16.629,P0.05),肿瘤直径15mm以上(OR=2.013,95%CI=1.196~8.475,P0.05)切缘阳性风险高;COX多因素分析病理分型、肿瘤直径是术后复发的主要危险因素,以浸润型(HR=3.437,95%CI=1.018~11.605,P0.05),硬斑病样型(HR=5.912,95%CI=1.548~22.579,P0.05),肿瘤直径15mm以上(HR=3.142,95%CI=1.221~12.330,P0.05)复发风险高。在不同切缘下,结节型、浅表型基底细胞癌切缘阳性率及复发率差异无统计学意义(P0.05),年龄、病程、性别、肿瘤位置与切缘阳性及复发的关系无统计学意义。结论:病理分型、肿瘤直径是影响基底细胞癌手术切缘安全及复发的主要因素。直径10mm以内的面部结节型基底细胞癌,3mm手术切缘可达理想手术效果。
[Abstract]:Objective: to investigate the pathogenesis, clinical manifestations, pathological classification and histological features of facial basal cell carcinoma (BCC). To analyze the influencing factors of surgical margin and prognosis of facial basal cell carcinoma (BCC) and the aesthetic effect of different wound repair methods. Methods: 310 cases of burn plastic surgery in Anhui Provincial Hospital from January 2009 to 2012 were analyzed retrospectively. Basal cell carcinoma diagnosed by surgery and pathology, According to the pathological diagnosis and 5 years follow-up after operation, the patients were divided into positive group and negative group, recurrence group and non-recurrence group. The histological characteristics of patients with different pathological types were analyzed by HE staining and en Vision method. The influencing factors of the study were sex and age. Course of disease, tumor location, diameter, pathological type, the outcome index was the positive rate of freeze-cutting margin during the first operation. The recurrence rate was followed up for 5 years. Logistic regression model was used to analyze the relationship between the factors involved and the positive margin of cryopreservation. The survival curve of basal cell carcinoma was described by Kaplan-Meier survival analysis and Cox risk ratio regression model was used to analyze the relationship between the factors involved and the positive margin of frozen incision during operation. Multivariate analysis was used to analyze the relationship between the factors involved in the study and the recurrence after 5 years follow-up. Results 47 cases were positive in the frozen margin in 310 cases of facial basal cell carcinoma during the first operation, 100 cases in the group of 3 mm to 4 mm and 5 mm in the operative margin, and 138 cases in the nodular type. There were 67 cases of superficial type, 77 cases of infiltrating type, 28 cases of hard spot like type, 70 cases of temporal region, 50 cases of periorbital, 100 cases of nose, 56 cases of cheek. 34 cases of mandible. The diameter of tumor was 2.0 ~ 27.0 mm. The course of disease was 4 and 48 m.Twenty five years after operation, 22 cases of recurrence and 310 cases of wound surface after BCC operation were followed up. One hundred and one hundred and twenty-eight cases of skin flap were repaired by direct suture of skin flap. Logistic multivariate regression analysis showed the pathological type of 30 cases. The tumor diameter was the main risk factor of the positive rate in the first operation. The tumor diameter was 1.975 / 10.355C / P 0.05, and the diameter of the tumor was 2.02525 ~ 16.629C / P0.05. the diameter of the tumor was more than 15mm (OR 2.01395CI 1.1968.475p 0.05) the tumor diameter was the main risk factor of postoperative recurrence, and the tumor diameter was the main risk factor of postoperative recurrence. The risk of recurrence was high in infiltrating type HR3.437 / 95 CIQ 1.0181811.605 (P0.05), in hard spot type (HR5.91295CII 1.54822.579P0.05) and in diameter of 15mm (1.22112.330P0.05). There was no significant difference in the positive rate and recurrence rate between nodular and superficial basal cell carcinoma (P 0.05), age, course of disease, sex, sex, age, course of disease, sex, sex, age, disease course, sex, sex, age, course of disease, sex, age, course of disease, sex, age, disease course, sex, age, disease course, sex, age, disease course, sex, age, course of disease, sex, age, course of disease, sex, age, course of disease, sex, age, disease course, sex, There was no statistical significance between tumor location and positive margin and recurrence. Conclusion: pathological classification, The tumor diameter is the main factor that affects the safety and recurrence of the resection margin of basal cell carcinoma (BCC), and the 3mm surgical margin of BCC with diameter less than 10 mm can achieve the ideal surgical effect.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.5

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