保留乳头乳晕的乳腺癌改良根治术的安全相关性因素分析

发布时间：2018-06-06 21:35

本文选题：乳腺癌 + 保留乳头乳晕的乳腺癌改良根治术　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]目前国内外乳腺癌的主要治疗手段以外科手术为主,保留乳头乳晕的乳腺癌改良根治术作为乳腺外科的一种术式,保留了患者的乳头乳晕复合体,提高了患者的术后美容效果,并为患者的术后重建创造更好的条件,但其安全性存在争议,本课题主要研究几个与其安全性相关的因素。[方法]收集云南省肿瘤医院乳腺外二科2016年10月—2016年12月期间首次入院且通过该院病理科确诊的137例乳腺癌患者的病例资料,包括姓名、年龄、住院证号、性别等一般资料,及患者的乳腺癌的病理类型及分子分型、初次就诊时B超显示的肿块大小、肿块距离乳头的距离及肿块距乳房表面皮肤的距离、术后腋窝淋巴结浸润的数量、术前的临床分期及术后的病理分期、术后免疫组化等临床资料。通过使用统计学方法分析保留乳头乳晕的乳腺癌改良根治术的相对安全性因素。所有数据采用Excel、SPSS 22.0软件包进行统计分析,方法主要包括x2检验,检验水准α=0.05。[结果]1.本课题NAC浸润发生年龄主要集中于40-59岁之间。40-49岁的乳腺癌患者NAC浸润构成比为11.6%, 50-59岁的乳腺癌患者NAC浸润的构成比为5.9%2.NAC浸润最多的乳腺癌类型为浸润性导管癌5例,NAC浸润构成比为7.8%;其次为浸润性癌2例,其NAC浸润构成比为3.7%;导管内癌1例,其NAC浸润构成比为8.7%。3.课题中NAC浸润在乳腺癌病理分子分型中,Lumina A型乳腺癌的NAC浸润构成比为16.7%;其次为HER-2过表达型,NAC浸润构成比为12.5%。4.B超下肿瘤边缘距乳头边缘最近距离在0.0-1.0cm区间的NAC浸润构成比为10.9%, 1.0-2.0cm区间的NAC浸润构成比为9.7%, B超下肿瘤边缘距乳头边缘最近距离大于2.0cm的NAC无浸润情况。5.B超下原发肿块直径大小为5.0-10.0cm的NAC浸润的构成比为35.3%,其次肿块直径大小为2.0-5.0cm的NAC浸润的构成比为2.1%。6.术后腋窝淋巴结阴性的NAC浸润构成比为3.4%,阳性淋巴结数量为1. 0-3. 0个的NAC浸润构成比为3. 5%。阳性淋巴结数量为4. 0-10. 0个的乳头乳晕复合体浸润构成比为17. 6%,阳性腋窝淋巴结数量大于等于10. 0个的乳头乳晕复合体浸润的构成比为20. 0%。[结论]1.年龄在40-59岁之间、浸润性导管癌及Lumina A型的乳腺癌患者NAC浸润风险大;2.B超下原发肿瘤直径大于5.0cm、TND在小于2.0cm的乳腺癌患者不适合行NSM手术;3.腋窝淋巴结数量大于3.0个的乳腺癌患者NSM的手术风险大。
[Abstract]:[objective] at present, the main treatment of breast cancer at home and abroad is surgery, and the modified radical mastectomy with nipple areola preservation is a kind of mammary surgery method, which preserves the nipple areola complex of the patients. It can improve the cosmetic effect of patients and create better conditions for postoperative reconstruction, but its safety is controversial. This paper mainly studies several factors related to their safety. [methods] data of 137 patients with breast cancer, including name, age, and number of admission certificate, were collected from October 2016 to December 2016 in Department of Extramammary gland of Yunnan Cancer Hospital. Sex and other general data, pathological types and molecular types of breast cancer, the size of the mass, the distance from the mass to the nipple, the distance from the mass to the skin on the breast surface, the number of axillary lymph nodes infiltrating after surgery, The clinical data such as preoperative clinical stage, postoperative pathological stage, postoperative immunohistochemistry and so on. The relative safety factors of modified radical mastectomy for breast cancer were analyzed by statistical method. All the data were analyzed by Excel SPSS22.0 software package. The methods mainly included x2 test, test level 伪 0.05. [result] 1. In this study, NAC invasion occurred mainly in breast cancer patients aged 40-59 years old and breast cancer patients aged 40-49 years. The NAC invasion composition ratio of breast cancer patients aged 50-59 years was 11.60.The proportion of NAC infiltration composition of breast cancer patients aged 50-59 years was 5.9%. 2. The type of breast cancer with the most NAC infiltration was invasive ductal carcinoma (5). NAC invasion ratio was 7.8%, followed by invasive carcinoma in 2 cases. The NAC invasion ratio was 3.7 and the NAC invasion ratio was 8.7. 3 in 1 case of intraductal carcinoma. The proportion of NAC-infiltrating composition of Lumina A breast cancer is 16.70.The next is HER-2 overexpression type NAC-infiltrating composition ratio is 12.5%. 4.B the nearest distance from the margin of tumor to the edge of papilla is in the 0.0-1.0cm region. When the nearest distance from the margin to the nipple margin of the tumor under B-ultrasound is greater than that of 2.0cm, the non-infiltrating condition of NAC with the diameter of the primary mass of 5.0-10.0cm is 35.3g, followed by the swelling under B-mode ultrasound, and the ratio of NAC-invasion is 10.9% and 9.7% respectively in the 1.0-2.0cm region, where the nearest distance from the margin of the tumor to the margin of the nipple is greater than that of the 2.0cm under B-ultrasound. The composition ratio of NAC infiltration with block diameter of 2.0-5.0cm is 2.1. 6. The NAC invasion ratio of axillary lymph node negative after operation was 3.4% and the number of positive lymph nodes was 1. 5%. 0-3. The ratio of 0 NAC infiltrating components was 3. Five. The number of positive lymph nodes was 4. 5%. 0-10. The invasion ratio of 0 nipple areola complex was 17.7%. The number of positive axillary lymph nodes was greater than 10. 5%. The constituent ratio of 0 nipple areola complex infiltration is 20. 5%. 0. [conclusion] 1. Patients aged 40-59 years with invasive ductal carcinoma and Lumina A breast cancer have a greater risk of infiltrating NAC-TND than 5.0 cm TND in patients with breast cancer less than 2.0cm. NSM patients with more than 3.0 axillary lymph nodes were at greater risk of surgery.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.9

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