乳腺癌保乳手术切缘及术后生存情况的临床研究

发布时间：2018-06-19 17:58

本文选题：早期乳腺癌 + 保乳手术　；参考：《浙江大学》2017年硕士论文

【摘要】：目的:保乳手术切缘阴性能降低乳腺癌局部复发的风险,而术中冰冻分析是术中评估切缘状况的重要方法。本研究通过统计浙江大学医学院附属邵逸夫医院乳腺癌保乳手术治疗的切缘情况和保乳手术后患者复发和转移的情况,研究保乳手术术中冰冻阴性切缘的准确性,及切缘对术后的复发和转移率的影响。方法:通过回顾性分析浙江大学医学院附属邵逸夫医院收治的自2000年1月到2016年3月期间经病理证实为乳腺癌,计划行保乳手术的660位患者总计664例保乳手术的临床病例资料,得出术中冰冻对阴性切缘判断的准确性,分析其对再次手术的影响。并在660例患者中选取随访超过3个月的患者639例进行生存结果分析,评估切缘阳性对患者术后复发和转移情况的影响。结果:保乳成功率为94.88%,首次切缘阳性率为14.76%,术中冰冻的假阴性率为3.87%。随访病例中位随访时间37个月,3年生存率为97.65%,复发率为0.94%,转移率为2.97%。淋巴结有转移的患者复发率高,与淋巴结阴性的患者复发率有显著差异(p0.05),而年龄、肿瘤大小、病理类型没有显著差异。术中切缘阳性和切缘阴性的复发和转移率无显著差异,而切缘假阴性患者的转移率高于术中和术后病理切缘一致者。结论:术中冰冻能在术中评估切缘情况,显著降低了首次手术术后切缘阳性的发生率,从而降低了保乳手术患者的二次手术率。淋巴结转移是术后复发的危险因素之一。切缘假阴性会使转移率升高,而对复发率未见明显影响。切缘出现阳性对复发率和转移率没有影响。
[Abstract]:Objective: the negative margin of breast conserving surgery can reduce the risk of local recurrence of breast cancer. In this study, the accuracy of frozen negative margin of breast cancer during breast conserving surgery was studied by statistics of the cutting margin of breast cancer surgery and the recurrence and metastasis of breast cancer patients after breast conserving surgery in run Shaw Hospital, affiliated to Zhejiang University Medical College, in order to study the accuracy of frozen negative margin during breast conserving surgery. The influence of cutting margin on recurrence and metastasis rate. Methods: from January 2000 to March 2016, 660 patients with breast cancer who were admitted to run Shaw Hospital affiliated to Zhejiang University Medical College were analyzed retrospectively. A total of 664 patients undergoing breast conserving surgery were enrolled in the study. The accuracy of intraoperative frozen judgment on negative margin was obtained and its influence on reoperation was analyzed. The survival results of 639 patients who were followed up for more than 3 months were analyzed to evaluate the influence of positive margin on postoperative recurrence and metastasis. Results: the success rate of breast preservation was 94.888.The positive rate of the first cutting edge was 14.76. the false negative rate of intraoperative freezing was 3.87. The median follow-up time was 37 months, the 3-year survival rate was 97.65, the recurrence rate was 0.94 and the metastasis rate was 2.97. The recurrence rate of patients with lymph node metastasis was higher than that of patients with negative lymph nodes (P 0.05), but there was no significant difference in age, tumor size and pathological type. There was no significant difference in the recurrence and metastasis rate between the positive and negative margin of incision, but the rate of metastasis in the false negative margin was higher than that in the same pathological margin after operation. Conclusion: intraoperative freezing can evaluate the incisal margin during operation, and decrease the positive rate of incision margin after the first operation, thus reducing the rate of secondary operation in patients undergoing breast conserving surgery. Lymph node metastasis is one of the risk factors for postoperative recurrence. False negative margin increased metastasis rate, but had no significant effect on recurrence rate. Positive margin had no effect on recurrence rate and metastasis rate.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

【参考文献】