本文關(guān)鍵詞：早期乳腺癌非前哨淋巴結(jié)陰性者避免腋窩清掃的臨床研究　出處：《安徽醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 乳腺癌 前哨淋巴結(jié)微轉(zhuǎn)移 亞甲藍(lán)染色 乳腺癌術(shù)后并發(fā)癥

【摘要】：目的分析比較早期乳腺癌前哨淋巴結(jié)(Sentinel Lymph Node,SLN)微轉(zhuǎn)移時(shí)非前哨淋巴結(jié)(Non sentinel lymph node,NSLN.)的轉(zhuǎn)移狀況,探討SLN發(fā)生微轉(zhuǎn)移時(shí)以前哨淋巴結(jié)活檢(Sentinel Lymph Node Biopsy,SLNB)替代腋窩淋巴結(jié)清掃(Axillary lymph node dissection,ALND)的安全性、可行性。方法對(duì)早期乳腺癌(T1-2N0M0)患者,術(shù)中用亞甲藍(lán)染色法尋找前哨淋巴結(jié),所有檢出的前哨淋巴結(jié)送快速冰凍病理并常規(guī)病理檢查。本研究分兩個(gè)階段進(jìn)行。第一階段:無(wú)論SLN陰性、微轉(zhuǎn)移還是宏轉(zhuǎn)移一律作全乳房切除或保留乳房+ALND;第二階段:SLN陰性者同意不作ALND做全乳房切除或保留乳房+SLNB,SLN微轉(zhuǎn)移及宏轉(zhuǎn)移者則作全乳房切除或保留乳房+ALND。術(shù)后常規(guī)輔助化療、放療、內(nèi)分泌治療、分子靶向治療。保乳手術(shù)常規(guī)殘乳放療,未作ALND者不常規(guī)照射腋窩。統(tǒng)計(jì)分析資料,探討SLN微轉(zhuǎn)移患者以SLNB代替ALND的安全性、可行性,比較SLNB與ALND的術(shù)后并發(fā)癥的發(fā)生情況。結(jié)果1、本組SLN 202的檢出率為93.1%,其中第一階段的檢出率為91.9%,第二階段的檢出率為94.2%;2、本組的假陰性率為3.23%;3、第一階段與第二階段之間患者的年齡、腫瘤分期、腫瘤所在位置、病理類型及組織學(xué)分級(jí)沒(méi)有明顯差異(P0.05);4、第一階段與第二階段檢出的SLN在個(gè)數(shù)及對(duì)應(yīng)的病例數(shù)上沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05)。5、第一階段與第二階段所檢出的SLN有微轉(zhuǎn)移或宏轉(zhuǎn)移在病例數(shù)和轉(zhuǎn)移數(shù)目上無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。6、在SLN陰性與SLN微轉(zhuǎn)移病例中,NSLN均未發(fā)生宏轉(zhuǎn)移,發(fā)生微轉(zhuǎn)移幾率沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05);7、SLN的轉(zhuǎn)移數(shù)/檢出數(shù)比值越小,NSLN發(fā)生轉(zhuǎn)移的風(fēng)險(xiǎn)越低,差異具有統(tǒng)計(jì)意義(P0.05);在檢出的SLN≥3個(gè),而僅有1枚SLN發(fā)生宏轉(zhuǎn)移時(shí)NSLN均未發(fā)生微轉(zhuǎn)移及宏轉(zhuǎn)移;8、SLNB組與腋窩清掃相關(guān)的并發(fā)癥(如上肢淋巴水腫、腋區(qū)疼痛、上肢麻木以及上肢運(yùn)動(dòng)受限等)明顯低于ALND組。結(jié)論1、前哨淋巴結(jié)微轉(zhuǎn)移狀況下非前哨淋巴結(jié)未發(fā)生宏轉(zhuǎn)移,而發(fā)生微轉(zhuǎn)移的幾率與前哨淋巴結(jié)陰性時(shí)非前哨淋巴結(jié)發(fā)生微轉(zhuǎn)移的幾率沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05),證明前哨淋巴結(jié)微轉(zhuǎn)時(shí)可以不作腋窩淋巴結(jié)的清掃,即:SLNB可以替代ALND;2、前哨淋巴結(jié)的轉(zhuǎn)移數(shù)/檢出數(shù)比值越小,非前哨淋巴結(jié)發(fā)生轉(zhuǎn)移風(fēng)險(xiǎn)越低,差異具有統(tǒng)計(jì)學(xué)意義(P0.05);當(dāng)前哨淋巴結(jié)≥3個(gè)而其中僅有1枚發(fā)生宏轉(zhuǎn)移時(shí),非前哨淋巴結(jié)均未發(fā)生轉(zhuǎn)移,也可能這種情況下可以不作腋窩淋巴結(jié)的清掃。由于本組樣本量小,尚不能作出肯定的結(jié)論。我們將會(huì)繼續(xù)這方面的臨床研究。另外,在作前哨淋巴結(jié)活檢時(shí)應(yīng)盡可能耐心、細(xì)致地多尋找藍(lán)管,多檢出前哨淋巴結(jié);3、在前哨淋巴結(jié)發(fā)生微轉(zhuǎn)移時(shí),以前哨淋巴結(jié)活檢替代腋窩淋巴結(jié)清掃可以進(jìn)一步降低手術(shù)并發(fā)癥。
[Abstract]:Objective to compare the sentinel Lymph Node of early breast cancer. The metastatic status of non sentinel lymph nodeus in non sentinel lymph nodes with SLN micrometastasis. To investigate the sentinel Lymph Node Biopsy (Sentinel Lymph Node Biopsy) in micrometastasis of SLN. The safety of axillary lymph node dissection for axillary lymph node dissection (SLNBs). Methods: the sentinel lymph nodes were searched by methylene blue staining in patients with early breast cancer (T1-2N0M0). All sentinel lymph nodes detected were rapidly frozen with routine pathological examination. This study was conducted in two stages. The first stage: SLN negative. Micrometastases or macro metastases were performed with total mastectomy or breast ALND preservation. Stage 2: SLN-negative patients agreed not to do ALND for total mastectomy or to preserve breast SLNB. SLN micrometastases and macrometastases were performed with total mastectomy or breast preservation. Routine adjuvant chemotherapy, radiotherapy, endocrine therapy, molecular targeted therapy, breast conserving surgery and conventional residual breast radiotherapy were performed. Patients without ALND were exposed to axilla unroutinely. Statistical analysis was made to explore the safety and feasibility of replacing ALND with SLNB in patients with micrometastasis of SLN. Results 1 the detection rate of SLN 202 in this group was 93. 1 and the detection rate in the first stage was 91.9%. The detection rate of the second stage was 94.2; 2, the false negative rate of this group is 3.23; 3There was no significant difference in age, tumor stage, location of tumor, pathological type and histological grade between the first stage and the second stage (P 0.05). 4, there was no statistical difference in the number of SLN detected in the first stage and the second stage and the corresponding number of cases (P 0.05). The SLN detected in the first stage and the second stage had micrometastasis or macro metastasis. There was no significant difference in the number of cases and the number of metastases (P0.05. 6). In SLN negative cases and SLN micrometastasis cases. There was no macro metastasis in NSLN, and there was no significant difference in the probability of micrometastasis (P 0.05). The smaller the ratio of transfer number to detection number of SLN is, the lower the risk of NSLN metastasis is. The difference is statistically significant (P 0.05). No micrometastasis or macro metastasis occurred in NSLN when only one SLN had macro metastasis and the detected SLN was more than 3. The complications associated with axillary dissection (such as upper limb lymphedema, axillary pain, upper limb numbness and upper limb motor limitation) were significantly lower in the ALND group than in the ALND group. Conclusion 1. There was no macro metastasis in non-sentinel lymph nodes under the condition of sentinel lymph node micrometastasis. However, there was no statistical difference in the probability of micrometastasis between sentinel lymph nodes and non-sentinel lymph nodes when the sentinel lymph nodes were negative. It was proved that the axillary lymph nodes could not be dissected when the sentinel lymph nodes turned slightly. That is,: SLNB can replace ALND; 2, the smaller the ratio of the number of sentinel lymph node metastasis to the number of detection, the lower the risk of metastasis of non-sentinel lymph node, the difference is statistically significant (P 0.05); When there were more than 3 sentinel lymph nodes and only one of them had macro metastasis, none of the non-sentinel lymph nodes had metastases. In this case, the axillary lymph nodes could not be dissected. We will continue our clinical research in this field. In addition, we should be as patient as possible in performing sentinel lymph node biopsy, look for more blue tubes and detect more sentinel lymph nodes. 3. In the case of sentinel lymph node micrometastasis, the replacement of axillary lymph node dissection with sentinel lymph node biopsy can further reduce the surgical complications.
【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】：2015
【分類號(hào)】：R737.9

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本文編號(hào)：1376755