术前使用反射式共聚焦显微镜界定乳房外Paget病边界对肿瘤精准切除的研究

发布时间：2018-04-25 05:15

本文选题：乳房外paget病 + 边界　；参考：《北京协和医学院》2017年硕士论文

【摘要】：目的:探讨反射式共聚焦显微镜辅助界定乳房外paget病肿瘤边界在手术治疗中的作用。方法:对入院前已行病理组织检查确诊为EMPD的13位患者实施RCM诊断及皮损边界判定。检查前对皮损表面严重糜烂、渗出、结痂的患者,采取硼酸洗液湿敷、乳酸依沙吖啶糊剂外用、醋酸泼尼松片口服对症处理,减少渗出,减小分泌物对成像准确性的影响。检查前对皮损及皮损周围毛发备皮处理。患者平卧,屈髋屈膝位。规定RCM镜头的两侧分别为内侧、外侧缘。根据RCM下肿瘤组织具有异型性以及paget细胞体积大、胞浆暗、细胞核亮的特点,沿肿瘤肉眼边缘进行四点定位,记录RCM下肿瘤边界。在RCM边界基础上,参考传统手术方法,对EMPD患者进行切除,切缘行四点检测。RCM边界定位点取材行病理学检查。搜集既往6年我院初诊为EMPD并行扩大切除术者的四点监测结果。对比分析13例EMPD患者的扩大切除与对照组常规扩大切除组织病理的吻合率,并进行统计学分析。分析不同解剖部位对RCM准确性影响。结果:试验组的13例EMPD患者中,3例患者四点检测病理至少1点存在肿瘤残余,病理检测阳性率23.1%;10例患者四点监测病理全部阴性,病理检测阴性率76.9%。对照组50例患者中23例患者四点监病理至少1点存在肿瘤残余,病理检测阳性率46%;27例患者四点监测病理全部阴性,病理检查阴性率54%。阴囊处RCM准确性最低。结论:在本次临床观察中,试验组与对照组有统计学差异。与传统扩大切除相比,术前对EMPD皮损进行边界定位可以提高EMPD精准切除率。
[Abstract]:Objective: to study the role of reflex confocal microscope in the determination of tumor boundary of extramammary paget disease. Methods: 13 patients with EMPD diagnosed by histopathology before admission were diagnosed with RCM and the boundary of skin lesion was determined. Before examination, the patients with severe erosion, exudation and scab of skin lesions were treated with boric acid lotion, topical use of ethacridine lactic acid paste, oral treatment of prednisone acetate tablets to reduce exudation and the effect of secretion on imaging accuracy. Prepare skin for skin lesions and around skin lesions before examination. The patient was supine with flexion of hip and knee. The two sides of the RCM lens are defined as the medial and lateral edges, respectively. According to the heterogeneity of tumor tissue under RCM, the large size of paget cells, dark cytoplasm and bright nucleus, four points were located along the naked edge of the tumor, and the tumor boundary was recorded under RCM. On the basis of the RCM boundary, the patients with EMPD were resected with reference to the traditional surgical methods. To collect the four-point monitoring results of the patients who were first diagnosed as EMPD and extended excision in our hospital in the past 6 years. The histopathological anastomosis rate of 13 patients with EMPD was compared with that of the control group. The effect of different anatomical sites on the accuracy of RCM was analyzed. Results: of the 13 patients with EMPD in the trial group, 3 patients had at least one tumor remnant at four points. The positive rate of pathological examination was 23.1and 10 patients were all negative. The negative rate of pathological examination was 76.9. In the control group of 50 patients, 23 patients had at least one tumor remnant in four points of pathology. The positive rate of pathological examination was 46 and 27 patients were all negative in four points, and the negative rate of pathological examination was 54. The accuracy of RCM in scrotum was the lowest. Conclusion: in this clinical observation, there is statistical difference between the experimental group and the control group. Compared with traditional extended resection, preoperative localization of EMPD lesions can improve the rate of accurate EMPD excision.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.5

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