本文關(guān)鍵詞： 基底細(xì)胞癌 病理分型 切緣 術(shù)中冷凍 復(fù)發(fā)　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討面部基底細(xì)胞癌發(fā)病機(jī)制、臨床表現(xiàn)、病理分型與組織學(xué)特點(diǎn),分析面部基底細(xì)胞癌手術(shù)切緣情況和預(yù)后的影響因素及不同創(chuàng)面修復(fù)方式的美學(xué)效果。方法:回顧性分析310例自2009年1月-2012年1月經(jīng)安徽省立醫(yī)院燒傷整形外科手術(shù)病理科確診的基底細(xì)胞癌,依據(jù)病理診斷及術(shù)后五年隨訪情況分為切緣陽性和陰性組,復(fù)發(fā)與無復(fù)發(fā)組。采用HE染色法和En Vision法分析各病理分型患者的組織學(xué)特點(diǎn),納入研究的影響因素為性別、年齡、病程、腫瘤部位、直徑、病理分型;結(jié)局指標(biāo)為首次術(shù)中冷凍切緣陽性率、術(shù)后隨訪5年復(fù)發(fā)率。利用卡方檢驗(yàn),logistic回歸模型分析各納入研究因素與術(shù)中冷凍切緣陽性的關(guān)系。運(yùn)用Kaplan-Meier生存分析描繪基底細(xì)胞癌生存曲線,COX風(fēng)險(xiǎn)比例回歸模型多因素分析各納入研究因素與術(shù)后隨訪5年復(fù)發(fā)的關(guān)系。結(jié)果:310例面部基底細(xì)胞癌患者首次術(shù)中冷凍切緣陽性47例。手術(shù)切緣3mm,4mm,5mm組分別為110例,100例,100例。結(jié)節(jié)型138例,淺表型67例,浸潤型77例,硬斑病樣型28例。顳部70例,眶周50例,鼻部100例,面頰56例,下頜34例。腫瘤直徑為2.0~27.0mm。病程4~48m。術(shù)后五年隨訪22例復(fù)發(fā)。310例BCC手術(shù)后創(chuàng)面112例直接縫合,168例皮瓣轉(zhuǎn)移修復(fù),30例皮片移植。Logistic多元回歸示病理分型、腫瘤直徑是首次術(shù)中冷凍切緣陽性率的主要危險(xiǎn)因素以浸潤型(OR=4.488,95%CI=1.975~10.355,P0.05),硬斑病樣型(OR=5.019,95%CI=2.025~16.629,P0.05),腫瘤直徑15mm以上(OR=2.013,95%CI=1.196~8.475,P0.05)切緣陽性風(fēng)險(xiǎn)高;COX多因素分析病理分型、腫瘤直徑是術(shù)后復(fù)發(fā)的主要危險(xiǎn)因素,以浸潤型(HR=3.437,95%CI=1.018~11.605,P0.05),硬斑病樣型(HR=5.912,95%CI=1.548~22.579,P0.05),腫瘤直徑15mm以上(HR=3.142,95%CI=1.221~12.330,P0.05)復(fù)發(fā)風(fēng)險(xiǎn)高。在不同切緣下,結(jié)節(jié)型、淺表型基底細(xì)胞癌切緣陽性率及復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義(P0.05),年齡、病程、性別、腫瘤位置與切緣陽性及復(fù)發(fā)的關(guān)系無統(tǒng)計(jì)學(xué)意義。結(jié)論:病理分型、腫瘤直徑是影響基底細(xì)胞癌手術(shù)切緣安全及復(fù)發(fā)的主要因素。直徑10mm以內(nèi)的面部結(jié)節(jié)型基底細(xì)胞癌,3mm手術(shù)切緣可達(dá)理想手術(shù)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R739.5

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本文編號(hào)：1502295