發(fā)布時(shí)間：2018-03-26 05:01

  本文選題：保乳手術(shù)　切入點(diǎn)：切緣狀態(tài)　出處：《廣西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:保乳治療已成為早期乳腺癌的標(biāo)準(zhǔn)治療方式之一。保證手術(shù)切緣陰性可顯著降低局部復(fù)發(fā),當(dāng)切緣陽(yáng)性時(shí)往往需要再次手術(shù)達(dá)到充分切緣,再次手術(shù)延長(zhǎng)了手術(shù)時(shí)間、增加住院費(fèi)用及病人痛苦。本研究目的是評(píng)估病人、腫瘤及診療因素與首次切除切緣陽(yáng)性率的關(guān)聯(lián),為乳腺癌保乳手術(shù)決策提供幫助。材料和方法:本研究共納入312例于2012年8月至2016年8月于廣西醫(yī)科大學(xué)第一附屬醫(yī)院行保乳手術(shù)的早期乳腺癌病人,采用SPSS19.0軟件行卡方檢驗(yàn)及二元邏輯回歸分析如下因素與切緣陽(yáng)性的關(guān)聯(lián):患者年齡、絕經(jīng)狀態(tài)、乳腺密度、有無(wú)術(shù)前MRI檢查、微小鈣化、蟹足腫樣外觀、活檢方式、活檢與保乳手術(shù)時(shí)間間隔、腫瘤的ER、PR、Ki-67、HER-2、P16、P53表達(dá)情況,有無(wú)DCIS成分、脈管淋巴浸潤(rùn)(LVI)、組織學(xué)分級(jí)、腫瘤大小、淋巴結(jié)狀態(tài)、腫瘤方位、切緣取材方式及手術(shù)方式。結(jié)果:本研究納入的312個(gè)病例中共有55例切緣陽(yáng)性,陽(yáng)性率17.6%。在單因素分析中,如下因素與切緣陽(yáng)性率相關(guān)聯(lián):Ki-67(P=0.021)、LVI(P=0.048)、有無(wú)導(dǎo)管內(nèi)癌成分(P=0.012)及手術(shù)方式(P=0.004)。在多因素分析中:高ki-67表達(dá)(OR=0.398,95%CI(0.204-0.777))及保乳整形手術(shù)(OR=0.650,95%CI(0.452-0.933))是切緣陽(yáng)性的保護(hù)因素。結(jié)論:腫瘤相關(guān)因素與診療方式與切緣陽(yáng)性率有關(guān),腫瘤組織的ki-67低表達(dá)、LVI、含DCIS成分會(huì)增加保乳手術(shù)首次切緣陽(yáng)性率,而實(shí)施保乳整形手術(shù)可以降低首次切緣陽(yáng)性率。
[Abstract]:Objective: breast conserving therapy has become one of the standard treatment methods for early breast cancer. To ensure the negative margin of operation can significantly reduce the local recurrence, when the incision margin is positive, it is often necessary to reoperate to the full margin, and the reoperation prolongs the operation time. The purpose of this study was to evaluate the association between the patient, tumor, diagnosis and treatment factors and the positive rate of the first excision margin. Materials and methods: 312 breast cancer patients who underwent breast conserving surgery in the first affiliated Hospital of Guangxi Medical University from August 2012 to August 2016 were enrolled in this study. SPSS19.0 software was used to perform chi-square test and binary logistic regression analysis. The following factors were associated with positive margin: age, menopausal status, breast density, MRI examination before operation, microcalcification, appearance of crab foot swelling, and biopsy method. The time interval between biopsy and breast conserving surgery, the expression of P16 p53, DCIS, histological grade, tumor size, lymph node status, tumor location, tumor size, lymph node status, tumor location, and the presence of DCIS. Results: 55 of 312 cases in this study were positive for cutting edge, the positive rate was 17.6%. The following factors were associated with the positive rate of incision margin: 1 Ki-67 PnP 0.021 LVII Pu 0.048 (with or without intraductal carcinoma P0. 012) and surgical procedure P0. 004. In the multivariate analysis: high expression of ki-67 was 0.3988 ~ 95CII 0.204-0.777) and OR0.650 / 95CI0.452-0.933) were protective factors. Conclusion: tumor related factors are: tumor related factors. It is related to the diagnosis and treatment mode and the positive rate of cutting edge. The low expression of ki-67 in tumor tissues may increase the positive rate of the first cut edge of breast conserving surgery, but the positive rate of the first cut edge can be reduced by breast conserving plastic surgery.
【學(xué)位授予單位】：廣西醫(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)】：R737.9

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本文編號(hào)：1666442