本文選題：早期乳腺癌 + 保乳手術(shù)　； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:保乳手術(shù)切緣陰性能降低乳腺癌局部復(fù)發(fā)的風(fēng)險,而術(shù)中冰凍分析是術(shù)中評估切緣狀況的重要方法。本研究通過統(tǒng)計浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院乳腺癌保乳手術(shù)治療的切緣情況和保乳手術(shù)后患者復(fù)發(fā)和轉(zhuǎn)移的情況,研究保乳手術(shù)術(shù)中冰凍陰性切緣的準確性,及切緣對術(shù)后的復(fù)發(fā)和轉(zhuǎn)移率的影響。方法:通過回顧性分析浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院收治的自2000年1月到2016年3月期間經(jīng)病理證實為乳腺癌,計劃行保乳手術(shù)的660位患者總計664例保乳手術(shù)的臨床病例資料,得出術(shù)中冰凍對陰性切緣判斷的準確性,分析其對再次手術(shù)的影響。并在660例患者中選取隨訪超過3個月的患者639例進行生存結(jié)果分析,評估切緣陽性對患者術(shù)后復(fù)發(fā)和轉(zhuǎn)移情況的影響。結(jié)果:保乳成功率為94.88%,首次切緣陽性率為14.76%,術(shù)中冰凍的假陰性率為3.87%。隨訪病例中位隨訪時間37個月,3年生存率為97.65%,復(fù)發(fā)率為0.94%,轉(zhuǎn)移率為2.97%。淋巴結(jié)有轉(zhuǎn)移的患者復(fù)發(fā)率高,與淋巴結(jié)陰性的患者復(fù)發(fā)率有顯著差異(p0.05),而年齡、腫瘤大小、病理類型沒有顯著差異。術(shù)中切緣陽性和切緣陰性的復(fù)發(fā)和轉(zhuǎn)移率無顯著差異,而切緣假陰性患者的轉(zhuǎn)移率高于術(shù)中和術(shù)后病理切緣一致者。結(jié)論:術(shù)中冰凍能在術(shù)中評估切緣情況,顯著降低了首次手術(shù)術(shù)后切緣陽性的發(fā)生率,從而降低了保乳手術(shù)患者的二次手術(shù)率。淋巴結(jié)轉(zhuǎn)移是術(shù)后復(fù)發(fā)的危險因素之一。切緣假陰性會使轉(zhuǎn)移率升高,而對復(fù)發(fā)率未見明顯影響。切緣出現(xiàn)陽性對復(fù)發(fā)率和轉(zhuǎn)移率沒有影響。
[Abstract]:Objective: the negative margin of breast conserving surgery can reduce the risk of local recurrence of breast cancer. In this study, the accuracy of frozen negative margin of breast cancer during breast conserving surgery was studied by statistics of the cutting margin of breast cancer surgery and the recurrence and metastasis of breast cancer patients after breast conserving surgery in run Shaw Hospital, affiliated to Zhejiang University Medical College, in order to study the accuracy of frozen negative margin during breast conserving surgery. The influence of cutting margin on recurrence and metastasis rate. Methods: from January 2000 to March 2016, 660 patients with breast cancer who were admitted to run Shaw Hospital affiliated to Zhejiang University Medical College were analyzed retrospectively. A total of 664 patients undergoing breast conserving surgery were enrolled in the study. The accuracy of intraoperative frozen judgment on negative margin was obtained and its influence on reoperation was analyzed. The survival results of 639 patients who were followed up for more than 3 months were analyzed to evaluate the influence of positive margin on postoperative recurrence and metastasis. Results: the success rate of breast preservation was 94.888.The positive rate of the first cutting edge was 14.76. the false negative rate of intraoperative freezing was 3.87. The median follow-up time was 37 months, the 3-year survival rate was 97.65, the recurrence rate was 0.94 and the metastasis rate was 2.97. The recurrence rate of patients with lymph node metastasis was higher than that of patients with negative lymph nodes (P 0.05), but there was no significant difference in age, tumor size and pathological type. There was no significant difference in the recurrence and metastasis rate between the positive and negative margin of incision, but the rate of metastasis in the false negative margin was higher than that in the same pathological margin after operation. Conclusion: intraoperative freezing can evaluate the incisal margin during operation, and decrease the positive rate of incision margin after the first operation, thus reducing the rate of secondary operation in patients undergoing breast conserving surgery. Lymph node metastasis is one of the risk factors for postoperative recurrence. False negative margin increased metastasis rate, but had no significant effect on recurrence rate. Positive margin had no effect on recurrence rate and metastasis rate.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

【參考文獻】

相關(guān)期刊論文 前10條

1 吳克瑾;陸云姝;UWe.K?hler;;《2015年St.Gallen早期乳腺癌國際專家共識》手術(shù)治療部分解讀[J];中國實用外科雜志;2015年07期

2 程敏怡;王坤;;乳腺癌保乳術(shù)后采用殘腔環(huán)切降低切緣陽性率和二次手術(shù)率[J];循證醫(yī)學(xué);2015年03期

3 趙劍;羅天航;丁三;;保乳手術(shù)患者術(shù)后局部復(fù)發(fā)情況調(diào)查及影響因素研究[J];中國臨床醫(yī)生雜志;2015年01期

4 曹純;馬代遠;譚榜憲;;66例年輕女性乳腺癌臨床及病理特點分析[J];中國民族民間醫(yī)藥;2014年16期

5 周琨;;乳腺癌保乳手術(shù)后局部復(fù)發(fā)因素的分析[J];中國臨床醫(yī)學(xué);2014年04期

6 吳克瑾;;美國《Ⅰ、Ⅱ期浸潤性乳腺癌保乳手術(shù)的切緣指南》要點解讀[J];中國實用外科雜志;2014年04期

7 許娟;朱彩霞;陳中揚;連臻強;楊劍敏;韓曉蓉;李文萍;張安秦;王頎;;乳腺癌保留乳房治療局部復(fù)發(fā)風(fēng)險因素回顧性分析[J];中華腫瘤防治雜志;2013年07期

8 賈海霞;賈衛(wèi)娟;蘇逢錫;;腔周邊緣法在乳腺癌保乳手術(shù)中的應(yīng)用[J];廣東醫(yī)學(xué);2013年02期

9 楊陽;張健;李愛東;;早期乳腺癌的診斷及治療進展[J];現(xiàn)代生物醫(yī)學(xué)進展;2012年31期

10 黃哲宙;陳萬青;吳春曉;鄭榮壽;陳建國;楊念念;王寧;張思維;鄭瑩;;中國女性乳腺癌的發(fā)病和死亡現(xiàn)況——全國32個腫瘤登記點2003—2007年資料分析報告[J];腫瘤;2012年06期

，

本文編號：2040774