本文選題：超聲造影　切入點(diǎn)：乳腺癌　出處：《山西醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討超聲造影成像技術(shù)對乳腺癌前哨淋巴結(jié)檢出及其引導(dǎo)下導(dǎo)絲定位的應(yīng)用價(jià)值。方法:收集2016年3月~12月在山西醫(yī)科大學(xué)附屬腫瘤醫(yī)院就診的72例女性經(jīng)病理診斷為乳腺癌的患者。第一步,常規(guī)掃查患側(cè)乳房及同側(cè)腋窩區(qū)淋巴結(jié),對可疑淋巴結(jié)進(jìn)行大小、皮質(zhì)厚度測量及體表標(biāo)記;第二步,術(shù)前1小時左右經(jīng)乳暈緣皮下及原腫塊切緣周圍1cm的位置注射超聲造影劑進(jìn)行前哨淋巴結(jié)的顯影檢查,記錄其造影增強(qiáng)特征(增強(qiáng)特征分為三型:第一型,顯著均勻增強(qiáng);第二型,不均勻增強(qiáng),內(nèi)含低增強(qiáng)或無增強(qiáng)區(qū);第三型,微弱或不增強(qiáng)。)及其與常規(guī)掃查下的可疑淋巴結(jié)的對應(yīng)性;第三步,針對造影追蹤到的前哨淋巴結(jié)測量其皮質(zhì)厚度以及進(jìn)行超聲引導(dǎo)下導(dǎo)絲定位;第四步,前哨淋巴結(jié)導(dǎo)絲定位后即行經(jīng)乳暈緣皮下注射納米炭混懸液染色。術(shù)中切除黑染的淋巴結(jié)及導(dǎo)絲定位的淋巴結(jié)并分別送病理檢查。結(jié)果:1.依手術(shù)病理結(jié)果,72例乳腺癌患者一共摘除206枚前哨淋巴結(jié)。超聲造影導(dǎo)絲定位的前哨淋巴結(jié)數(shù)目比納米炭染色的少(83vs123)。超聲造影導(dǎo)絲定位前哨淋巴結(jié)發(fā)生轉(zhuǎn)移的陽性率為50.6%(42/83),比納米炭染色法的陽性率(32.5%,40/123)高(c2=6.763,P=0.009,0.05)。2.83枚導(dǎo)絲定位的前哨淋巴結(jié)中,轉(zhuǎn)移性淋巴結(jié)的皮質(zhì)不均勻增厚,多見于皮質(zhì)厚≥3.0mm(41/42)。3.前哨淋巴結(jié)造影增強(qiáng)的三型中,非轉(zhuǎn)移性前哨淋巴結(jié)最多見于第一型(35/39),轉(zhuǎn)移性前哨淋巴結(jié)常見于后兩型(37/42)。結(jié)論:1.超聲造影對乳腺癌腋窩前哨淋巴結(jié)有較高的敏感性。2.常規(guī)超聲聯(lián)合超聲造影檢查有望成為無創(chuàng)評價(jià)乳腺癌前哨淋巴結(jié)狀態(tài)的重要診療手段。3.淋巴結(jié)皮質(zhì)厚度對術(shù)前判斷乳腺癌淋巴結(jié)是否轉(zhuǎn)移具有重要價(jià)值。
[Abstract]:Objective: to evaluate the value of contrast-enhanced ultrasound in detecting sentinel lymph nodes of breast cancer and guiding the localization of guiding wire. Methods: from March 2016 to December, 72 women who were admitted to the affiliated Cancer Hospital of Shanxi Medical University were collected. Patients with pathologically diagnosed breast cancer. First step, Routine scanning of the breast and axillary lymph nodes on the ipsilateral side, the size of the suspected lymph nodes, the thickness of the cortex and body surface marking; the second step, Sentinel lymph nodes were examined with ultrasound contrast media 1 hour before operation by subcutaneous injection of mammary areola and 1 cm around the cutting margin of the original mass. The enhanced features of the sentinel lymph nodes were recorded (the enhancement features were divided into three types: type 1, significantly homogeneous enhancement; Type II, uneven enhancement, containing low or no enhancement areas; type III, weak or non-enhanced.) and its correspondence to suspicious lymph nodes under conventional scanning; step 3, For sentinel lymph nodes tracked by angiography, the cortical thickness was measured and guided by ultrasound to locate the guiding wire; 4th steps, The sentinel lymph nodes were treated with nano-carbon suspension staining by subcutaneous injection of nano-carbon suspension through the areola margin immediately after the orientation of the sentinel lymph nodes. The black stained lymph nodes and the guided filament-localized lymph nodes were removed during the operation and sent to pathological examination respectively. Results: 1. According to the results of surgery and pathology, 72 cases of mammary gland were removed. A total of 206 sentinel lymph nodes were removed in patients with adenocarcinoma. The number of sentinel lymph nodes located by the guide wire of contrast-enhanced ultrasound was 83vs123% less than that of carbon nanoparticles. The positive rate of metastasis of the sentinel lymph nodes was 50.642 / 83%, which was higher than that of carbon nanocrystalline staining. The positive rate of this method was 32.5% and 40 / 12 3) in the sentinel lymph nodes located by the guiding wire, the positive rate was 32.5%, and the number of sentinel lymph nodes (SLN) was high (C26.763) in 0.009 / 0.05 / 2.83 sentinel lymph nodes. Heterogeneous thickening of the cortex of metastatic lymph nodes was found in the three types of Sentinel lymph Node enhanced by Sentinel lymph Node contrast enhanced Sentinel lymph Node (Sentinel lymph Node). Non-metastatic sentinel lymph nodes were most commonly seen in type I 35 / 39, and metastatic sentinel lymph nodes were more common in the latter two types of lymph nodes than in the latter two types. Conclusion 1. Contrast-enhanced ultrasonography has a high sensitivity to axillary sentinel lymph nodes of breast cancer .2.Conventionally contrast-enhanced ultrasonography combined with contrast-enhanced ultrasonography is more sensitive to axillary sentinel lymph nodes in breast cancer. It is expected to be an important noninvasive method for the diagnosis and treatment of sentinel lymph node status in breast cancer .3.The thickness of lymph node cortex is of great value in determining the lymph node metastasis of breast cancer before operation.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9;R445.1

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