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  本文關(guān)鍵詞： 乳腺癌 前哨淋巴結(jié)活檢 吲哚菁綠 亞甲藍　出處：《中國人民解放軍醫(yī)學院》2015年碩士論文　論文類型：學位論文

【摘要】：背景：當前乳腺癌前哨淋巴結(jié)活檢(SLNB)的方法主要有染料法、核素法及二者的聯(lián)合,現(xiàn)行的方法各有其優(yōu)缺點。國外指南推薦同時運用染料法和核素法以降低假陰性率,提高成功率。受多方面的制約,國內(nèi)指南目前僅支持亞甲藍法作為乳腺癌SLNB的首選。光學分子成像技術(shù)是目前生物醫(yī)學研究領(lǐng)域的熱點之一該技術(shù)使用熒光示蹤劑特異性結(jié)合體內(nèi)的生物大分子,通過專門的體外影像檢測設(shè)備觀察,使前哨淋巴結(jié)(SLN)產(chǎn)生穿透組織層的光學顯影以實現(xiàn)實時手術(shù)導航的目的。該方法常使用吲哚菁綠(ICG)作為熒光示蹤劑。研究認為,使用光學分子影像技術(shù)介導的ICG法實施乳腺癌SLNB較傳統(tǒng)方法更具優(yōu)勢,但這種方法的廣泛應用仍需更進一步的臨床實驗驗證。目的：研究ICG聯(lián)合光分子手術(shù)導航系統(tǒng)(SNS)在乳腺癌SLNB中的臨床應用價值。方法：共入組初診為乳腺癌并具備SLNB適應證的74例患者,在SNS的引導下,分別使用ICG和亞甲藍、及單用ICG開展乳腺SLNB的研究。快速冰凍病理證實SLN轉(zhuǎn)移者,接受腋窩淋巴結(jié)清掃(ALND); SLN陰性者免于ALND。對不同方法的平均檢出個數(shù)、成功率、假陰性率、準確率、靈敏度等結(jié)果進行統(tǒng)計學分析。結(jié)果：在自身對照設(shè)計的39例臨床實驗中,ICG法成功率92.3%,共檢出SLN 124個,平均3.18個,靈敏度100%,假陰性率為0%;亞甲藍法成功率89.7%,共檢出SLN71個,平均1.8個,靈敏度93.7%,假陰性率為6.3%; ICG法平均檢出個數(shù)優(yōu)于亞甲藍法(p0.05)。成功率、假陰性率等主要觀察指標非劣效于亞甲藍法(一致性檢驗p0.05,差異性檢驗p0.05)。在單用ICG法的35例臨床實驗中,ICG法成功率94.3%,共檢出SLN111個,平均3.17個,靈敏度100%,假陰性率0%。結(jié)論:ICG法實施乳腺癌SLNB成功率高,假陰性率低,手術(shù)操作直觀可靠,準確性好,對術(shù)者手術(shù)經(jīng)驗依賴較少,易被手術(shù)醫(yī)生掌握,可縮短學習曲線;臨床效果不差于傳統(tǒng)亞甲藍法,值得深入研究和推廣,有望普遍應用于乳腺癌SLNB。SNS在試用過程中,效果穩(wěn)定,成像清晰,安全可靠,有效避免了傳統(tǒng)手術(shù)操作的盲目性,預示了光分子影像技術(shù)在乳腺微創(chuàng)外科領(lǐng)域的良好應用前景。
[Abstract]:Background: at present, the methods of sentinel lymph node biopsy (SLNB) for breast cancer mainly include dye method, nuclide method and their combination. The current methods have their own advantages and disadvantages. Foreign guidelines recommend the use of dye method and nuclide method to reduce false negative rate. Increase success rates. Subject to multiple constraints, The domestic guidelines only support methylene blue method as the first choice for breast cancer SLNB. Optical molecular imaging is one of the hot topics in biomedical research. This technique uses fluorescent tracer to specifically bind biomolecules in vivo. In order to realize the aim of real-time operation navigation, the SLN (sentinel lymph node) was observed by a special imaging equipment in vitro. In this method, indocyanine green (ICG) was often used as a fluorescent tracer, and it was found that ICG was used as a fluorescent tracer. The ICG method mediated by optical molecular imaging technique has more advantages than the traditional method in the implementation of breast cancer SLNB. But the extensive application of this method still needs further clinical experiment verification. Objective: to study the clinical application value of ICG combined with photomolecular surgery navigation system in SLNB of breast cancer. 74 patients with SLNB indications, Under the guidance of SNS, the study of breast SLNB was carried out with ICG and methylene blue, and ICG alone. The patients with SLN metastasis received axillary lymph node dissection and those with SLN negative were exempted from ALND. The average number of detections and the success rate of different methods were obtained. Results: in 39 cases of self-control design, the success rate of SLN was 92.3%, and the SLN was 124, with an average of 3.18. Sensitivity 100, false negative rate 0; methylene blue method 89.7%, detection rate 1.8, sensitivity 93.7m, false negative rate 6.3%; ICG method average detection number better than methylene blue method p 0.05%. The main observation indexes such as false negative rate were not inferior to methylene blue (consistency test p 0.05, difference test P 0.05). In 35 clinical trials using ICG alone, the success rate of ICG method was 94.3%, and a total of 3.17 SLN111 were detected. The sensitivity is 100 and the false negative rate is 0.Conclusion the successful rate of SLNB in breast cancer is high, the false negative rate is low, the operation is intuitionistic and reliable, the accuracy is good, the operation experience is less, the operation is easy to be mastered by the surgeon, and the learning curve can be shortened. The clinical effect is not worse than that of the traditional methylene blue method, which is worthy of further study and popularization. It is expected to be widely used in the trial process of breast cancer SLNB.SNS. The effect is stable, the imaging is clear, the imaging is safe and reliable, and the blindness of the traditional surgical operation is effectively avoided. The prospect of the application of photomolecular imaging in breast minimally invasive surgery is predicted.
【學位授予單位】：中國人民解放軍醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R737.9

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6 蔣s，

本文編號：1546124