發(fā)布時(shí)間：2018-05-25 15:45

  本文選題：皮下積液 + 乳腺癌術(shù)后��； 參考：《新鄉(xiāng)醫(yī)學(xué)院》2014年碩士論文

【摘要】：背景乳腺癌是女性最常見的惡性腫瘤之一,盡管我國在世界范圍內(nèi)的總體發(fā)病率偏低,但近年來有不斷上升的趨勢,對(duì)女性身體健康構(gòu)成了嚴(yán)重威脅。隨著社會(huì)經(jīng)濟(jì)發(fā)展和科學(xué)技術(shù)革新,乳腺癌的治療手段日趨成熟和完善,而其中手術(shù)治療是其中最為有效和顯著的。但由于病患體質(zhì)因素以及合并病癥等影響,乳腺癌術(shù)后容易引起皮下積液的發(fā)生,嚴(yán)重影響病患術(shù)后恢復(fù)和進(jìn)行綜合治療的有效時(shí)機(jī),增加了術(shù)后復(fù)發(fā)轉(zhuǎn)移的危險(xiǎn)。 目的探討乳腺癌術(shù)后皮下積液產(chǎn)生的影響因素,探索減少皮下積液發(fā)生的有效途徑,降低乳腺癌術(shù)后皮下積液的發(fā)生率。 方法收集新鄉(xiāng)醫(yī)學(xué)院第一附屬醫(yī)院普外科2012年4月到2013年4月間乳腺癌連續(xù)性病例220例,病患均在本院行乳腺癌改良根治術(shù)或乳腺癌根治術(shù)治療。采集病患相關(guān)臨床資料,獲取年齡、身高、體重、合并既往病史(高血壓、糖尿病、冠心病、低蛋白血癥等)、手術(shù)方式等基本信息；對(duì)病患進(jìn)行術(shù)后臨床觀察,根據(jù)是否發(fā)生皮下積液,將220例病患分為比較組與對(duì)照組,比較組為術(shù)后發(fā)生皮下積液的病患,對(duì)照組為術(shù)后未發(fā)生皮下積液的病患。應(yīng)用描述性統(tǒng)計(jì)分析描述病患基本特征；采用卡方檢驗(yàn)(計(jì)數(shù)資料)或t檢驗(yàn)(計(jì)量資料)進(jìn)行雙變量分析,比較兩組病患相關(guān)基本特征；采用logistic回歸分析篩選影響乳腺癌術(shù)后皮下積液產(chǎn)生的相關(guān)因素。 結(jié)果通過統(tǒng)計(jì)分析對(duì)比,比較組與對(duì)照組患者年齡(p=0.002)、BMI(身體質(zhì)量指數(shù),下同；p=0.001)、合并高血壓(p=0.023)、合并糖尿病(p=0.017)、合并低蛋白血癥(p=0.004)具有統(tǒng)計(jì)學(xué)意義。而兩組手術(shù)方式以及合并冠心病病史并沒有產(chǎn)生顯著性差異(p0.05)�？梢哉J(rèn)為比較組患者年齡較大,BMI較高,高血壓、糖尿病、低蛋白血癥合并病史較多。通過運(yùn)用logistic逐步回歸模型,篩選出皮下積液產(chǎn)生的主要危險(xiǎn)因素,可以認(rèn)為皮下積液的產(chǎn)生,與患者年齡(OR,1.10;95%CI,1.55-2.06)、BMI(OR,1.30;95%CI,1.05-2.33)、高血壓(OR,1.15；95%CI,2.11-3.35)、糖尿病(OR,1.05；95%CI,1.17-4.22)、低蛋白血癥(OR,1.23；95%CI,1.11-3.56)相關(guān)。與對(duì)照組患者相比,高齡、較高BMI、高血壓、糖尿病和低蛋白血癥合并病史均能導(dǎo)致乳腺癌術(shù)后皮下積液產(chǎn)生。 結(jié)論乳腺癌術(shù)后皮下積液的發(fā)生與病患年齡、BMI、合并低蛋白血癥、合并高血壓、合并糖尿病等因素有關(guān),而手術(shù)方式以及合并冠心病對(duì)皮下積液發(fā)生影響不大；通過圍手術(shù)期減小身體質(zhì)量指數(shù)、緩解合并病癥等有助于減少術(shù)后皮下積液的發(fā)生。
[Abstract]:Background Breast cancer is one of the most common malignant tumors in women. Although the overall incidence of breast cancer in China is low in the world, there is a rising trend in recent years, which poses a serious threat to the health of women. With the development of social economy and the innovation of science and technology, the treatment of breast cancer is becoming more and more mature and perfect, among which surgical treatment is the most effective and significant. However, due to the influence of patients' physical condition and complicated diseases, the occurrence of subcutaneous effusion is easy to occur after operation of breast cancer, which seriously affects the effective time of postoperative recovery and comprehensive treatment, and increases the risk of postoperative recurrence and metastasis. Objective to explore the influencing factors of subcutaneous effusion after breast cancer operation, and to explore the effective way to reduce the incidence of subcutaneous effusion after breast cancer operation. Methods 220 consecutive cases of breast cancer were collected from April 2012 to April 2013 in the General surgery Department of the first affiliated Hospital of Xinxiang Medical College. All the patients were treated with modified radical mastectomy or radical mastectomy. To collect the clinical data of patients, obtain the basic information of age, height, weight, history (hypertension, diabetes, coronary heart disease, hypoproteinemia, etc.) According to the occurrence of subcutaneous effusion 220 patients were divided into two groups: the comparison group and the control group. The comparison group was the patient with postoperative subcutaneous effusion and the control group was the patient with no postoperative subcutaneous effusion. Descriptive statistical analysis was used to describe the basic characteristics of patients, and bivariate analysis was performed by chi-square test (counting data) or t-test (measurement data) to compare the basic characteristics of the two groups of patients. Logistic regression analysis was used to screen the factors related to subcutaneous effusion after breast cancer operation. Results by statistical analysis and comparison, the age of patients in the comparison group and the control group was significantly higher than that in the control group (body mass index (BMI), hypertension, diabetes mellitus, hypoproteinemia, and hypoproteinemia, respectively, P 0.001, P 0. 023, P 0. 017, P 0. 004). However, there was no significant difference between the two groups in the surgical methods and the history of coronary heart disease (P 0.05). It can be concluded that the patients in the comparison group have higher BMI, hypertension, diabetes and hypoproteinemia. By using the logistic stepwise regression model, the main risk factors for subcutaneous effusion were screened out. It can be concluded that the subcutaneous effusion is related to the patient's age, OR1.10 ~ 95CI1. 55-2. 06 BMIOR1. 3095CIQ 1.05-2.33, hypertension OR1. 1595CI2.11-3.35CI2.11-3.35, diabetes OR1.0595CI1. 17-4.22, hypoproteinemia OR1. 2395CI1. 11-3.56). Advanced age, high BMIs, hypertension, diabetes and hypoproteinemia combined with history all resulted in subcutaneous effusion after breast cancer surgery. Conclusion the occurrence of subcutaneous effusion after breast cancer operation is related to the age of patients with BMI, hypoproteinemia, hypertension and diabetes mellitus, but the operative method and coronary heart disease have little effect on the occurrence of subcutaneous effusion. The reduction of body mass index (BMI) during perioperative period and the relief of complications may help to reduce the incidence of postoperative subcutaneous effusion.
【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】：2014
【分類號(hào)】：R737.9

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