本文選題：乳腺癌 + 前哨淋巴結(jié)活檢��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2017年碩士論文

【摘要】：背景隨著人們對(duì)乳腺癌的生物學(xué)特性的不斷研究和認(rèn)識(shí),乳腺癌手術(shù)范圍逐漸縮小。前哨淋巴結(jié)活檢(sentinel lymph node biopsy,SLNB)作為一種乳腺癌微創(chuàng)手術(shù)的方式,逐漸廣泛的應(yīng)用于臨床,SLNB在保持與腋窩淋巴結(jié)清掃(axillary lymph node dissection,ALND)相似的治療效果上,同時(shí)也減少了術(shù)后并發(fā)癥,改善了患者的生活質(zhì)量。目前SLNB的示蹤法有染料法、核素法及聯(lián)合法,不同的示蹤法直接影響著SLNB的成功率、準(zhǔn)確率及假陰性率,間接地影響著患者的預(yù)后。國(guó)內(nèi)外指南推薦應(yīng)用核素染料聯(lián)合法,由于操作復(fù)雜,設(shè)備昂貴,存在放射性危險(xiǎn)等原因,限制了其在國(guó)內(nèi)基層醫(yī)院的推廣。國(guó)內(nèi)染料法最常用的示蹤劑是亞甲藍(lán),近年來(lái)熒光劑吲哚菁綠開始作為一種新型示蹤劑應(yīng)用于乳腺癌SLNB中,利用吲哚菁綠在近紅外熒光系統(tǒng)下的特點(diǎn),吲哚菁綠與亞甲藍(lán)相比具有明顯的優(yōu)勢(shì),然而吲哚菁綠聯(lián)合亞甲藍(lán)的檢出效果需要進(jìn)一步的驗(yàn)證。目的通過吲哚菁綠聯(lián)合亞甲藍(lán)與單用亞甲藍(lán)在乳腺癌SLNB中的對(duì)比,探討這兩者聯(lián)合在乳腺癌SLNB中的臨床應(yīng)用價(jià)值。方法選擇2015年1月至2016年8月在新鄉(xiāng)市中心醫(yī)院頭頸乳腺外科行SLNB的乳腺癌患者120例,聯(lián)合組46例:吲哚菁綠熒光法聯(lián)合亞甲藍(lán)法行SLNB;亞甲藍(lán)組74例:單獨(dú)應(yīng)用亞甲藍(lán)法行SLNB,吲哚菁綠注射于乳暈區(qū)皮內(nèi),亞甲藍(lán)注射于乳暈區(qū)皮下,聯(lián)合組在近紅外熒光導(dǎo)航系統(tǒng)引導(dǎo)下及沿著藍(lán)染淋巴管尋找前哨淋巴結(jié),亞甲藍(lán)組沿著藍(lán)染淋巴管尋找前哨淋巴結(jié),取下的所有前哨淋巴結(jié)均行快速冰凍活檢及常規(guī)病理學(xué)檢查,所有患者SLNB后行ALND。結(jié)果聯(lián)合組SLNB的檢出率、準(zhǔn)確率、靈敏度、特異度、假陰性率、前哨淋巴結(jié)檢出平均數(shù)分別是97.8%(45/46)、95.6%(43/45)、94.1%(16/17),96.4%(27/28),5.9%(1/17)、(3.1±0.9)枚/例,亞甲藍(lán)組SLNB的檢出率、準(zhǔn)確率、靈敏度、特異度、假陰性率、前哨淋巴結(jié)檢出平均數(shù)分別為86.5%(64/74)、90.6%(58/64)、87.5%(21/24),92.5%(37/40),12.5%(3/24),(2.1±0.7)枚/例,聯(lián)合組的檢出率、準(zhǔn)確率、靈敏度、特異度及前哨淋巴結(jié)檢出平均數(shù)高于亞甲藍(lán),假陰性率低于亞甲藍(lán)組,兩組間的檢出率及前哨淋巴結(jié)檢出平均數(shù)的差異均有統(tǒng)計(jì)學(xué)意義(P0.05),但兩組間的準(zhǔn)確率、靈敏度、特異度及假陰性率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1、本研究中,在乳腺癌SLNB中應(yīng)用吲哚菁綠,在近紅外熒光導(dǎo)航系統(tǒng)的引導(dǎo)下能夠直觀地顯示淋巴管引流方向,準(zhǔn)確定位前哨淋巴結(jié)的位置,降低了SLNB的盲目性,減輕了對(duì)組織的損傷。2、本研究通過對(duì)吲哚菁綠聯(lián)合亞甲藍(lán)與單用亞甲藍(lán)的比較顯示,在乳腺癌SLNB中,兩者聯(lián)合可以提高SLNB的檢出率、前哨淋巴結(jié)檢出個(gè)數(shù),是一種很有前景的SLNB示蹤法。
[Abstract]:Background with the continuous research and understanding of the biological characteristics of breast cancer, the scope of breast cancer surgery is gradually reduced. Sentinel lymph node biopsys SLNBs, as a minimally invasive procedure for breast cancer, have gradually been widely used in clinical practice to maintain similar therapeutic effects as axillary lymph node dissection to axillary lymph node dissection (ALND), and to reduce postoperative complications. Improved the patient's quality of life. At present, the tracer methods of SLNB include dye method, nuclide method and combination method. Different tracer methods directly affect the success rate, accuracy and false negative rate of SLNB, and indirectly affect the prognosis of patients. The domestic and foreign guidelines recommend the application of radionuclide dye combination method, because of the complex operation, expensive equipment and the existence of radioactive hazards, it is limited in the promotion of basic hospitals in China. Methylene blue is the most commonly used tracer in domestic dye method. In recent years, indocyanine green has been used as a new tracer in breast cancer SLNB, using the characteristics of indocyanine green in near infrared fluorescence system. Indocyanine green has obvious advantages over methylene blue, but the detection effect of indocyanine green combined with methylene blue needs further verification. Objective to evaluate the clinical value of indocyanine green combined with methylene blue and methylene blue in SLNB of breast cancer. Methods from January 2015 to August 2016, 120 patients with breast cancer underwent SLNB in the Department of head and neck Breast surgery, Xinxiang Central Hospital. 46 cases in the combined group were treated with SLNB by indocyanine green fluorescence method combined with methylene blue method, 74 cases in the methylene blue group were treated with SLNB by methylene blue alone, indocyanine green was injected into the skin of the areola area, methylene blue was injected subcutaneously in the areola area, The sentinel lymph nodes were found in the combined group under the guidance of the near infrared fluorescence navigation system and along the blue-stained lymphatic vessels, while in the methylene blue group the sentinel lymph nodes were searched along the blue-stained lymphatic vessels. All sentinel lymph nodes removed were examined by rapid frozen biopsy and routine pathological examination. All patients underwent ALND after SLNB. Results the detection rate, accuracy, sensitivity, specificity, false negative rate and sentinel lymph node detection average of SLNB in the combined group were 97.885 / 46, 95.643 / 45 / 94.41 / 17 / 96.40% and 5.9% / case / case, respectively. The detection rate, accuracy, sensitivity, specificity, false negative rate of SLNB in methylene blue group were 3.1 鹵0.9 / case, and the detection rate, accuracy, sensitivity, specificity, false negative rate of SLNB in methylene blue group. The average number of sentinel lymph nodes detected was 86.5 / 74 / 90.60.58 / 64 / 87.5a / case, respectively. The false negative rate was lower than that of the methylene blue group, and the detection rate of the combined group was 2.1 鹵0.7. The detection rate, accuracy, sensitivity, specificity and the average detection of the sentinel lymph nodes in the combined group were higher than those in the methylene blue group, and the false negative rate was lower than that in the methylene blue group. There were significant differences in the detection rate and the average number of sentinel lymph nodes between the two groups (P 0.05), but there was no significant difference in accuracy, sensitivity, specificity and false negative rate between the two groups. Conclusion 1. In this study, the application of indocyanine green in breast cancer SLNB can show the direction of lymphatic drainage intuitively under the guidance of near infrared fluorescence navigation system, locate the position of sentinel lymph nodes accurately, and reduce the blindness of SLNB. This study showed that the combination of indocyanine green and methylene blue could improve the detection rate of SLNB and the number of sentinel lymph nodes in breast cancer SLNB. It is a promising SLNB tracer method.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【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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