本文選題：乳腺癌 + 保留乳頭乳暈的乳腺癌改良根治術(shù)　； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]目前國內(nèi)外乳腺癌的主要治療手段以外科手術(shù)為主,保留乳頭乳暈的乳腺癌改良根治術(shù)作為乳腺外科的一種術(shù)式,保留了患者的乳頭乳暈復(fù)合體,提高了患者的術(shù)后美容效果,并為患者的術(shù)后重建創(chuàng)造更好的條件,但其安全性存在爭議,本課題主要研究幾個(gè)與其安全性相關(guān)的因素。[方法]收集云南省腫瘤醫(yī)院乳腺外二科2016年10月—2016年12月期間首次入院且通過該院病理科確診的137例乳腺癌患者的病例資料,包括姓名、年齡、住院證號、性別等一般資料,及患者的乳腺癌的病理類型及分子分型、初次就診時(shí)B超顯示的腫塊大小、腫塊距離乳頭的距離及腫塊距乳房表面皮膚的距離、術(shù)后腋窩淋巴結(jié)浸潤的數(shù)量、術(shù)前的臨床分期及術(shù)后的病理分期、術(shù)后免疫組化等臨床資料。通過使用統(tǒng)計(jì)學(xué)方法分析保留乳頭乳暈的乳腺癌改良根治術(shù)的相對安全性因素。所有數(shù)據(jù)采用Excel、SPSS 22.0軟件包進(jìn)行統(tǒng)計(jì)分析,方法主要包括x2檢驗(yàn),檢驗(yàn)水準(zhǔn)α=0.05。[結(jié)果]1.本課題NAC浸潤發(fā)生年齡主要集中于40-59歲之間。40-49歲的乳腺癌患者NAC浸潤構(gòu)成比為11.6%, 50-59歲的乳腺癌患者NAC浸潤的構(gòu)成比為5.9%2.NAC浸潤最多的乳腺癌類型為浸潤性導(dǎo)管癌5例,NAC浸潤構(gòu)成比為7.8%;其次為浸潤性癌2例,其NAC浸潤構(gòu)成比為3.7%;導(dǎo)管內(nèi)癌1例,其NAC浸潤構(gòu)成比為8.7%。3.課題中NAC浸潤在乳腺癌病理分子分型中,Lumina A型乳腺癌的NAC浸潤構(gòu)成比為16.7%;其次為HER-2過表達(dá)型,NAC浸潤構(gòu)成比為12.5%。4.B超下腫瘤邊緣距乳頭邊緣最近距離在0.0-1.0cm區(qū)間的NAC浸潤構(gòu)成比為10.9%, 1.0-2.0cm區(qū)間的NAC浸潤構(gòu)成比為9.7%, B超下腫瘤邊緣距乳頭邊緣最近距離大于2.0cm的NAC無浸潤情況。5.B超下原發(fā)腫塊直徑大小為5.0-10.0cm的NAC浸潤的構(gòu)成比為35.3%,其次腫塊直徑大小為2.0-5.0cm的NAC浸潤的構(gòu)成比為2.1%。6.術(shù)后腋窩淋巴結(jié)陰性的NAC浸潤構(gòu)成比為3.4%,陽性淋巴結(jié)數(shù)量為1. 0-3. 0個(gè)的NAC浸潤構(gòu)成比為3. 5%。陽性淋巴結(jié)數(shù)量為4. 0-10. 0個(gè)的乳頭乳暈復(fù)合體浸潤構(gòu)成比為17. 6%,陽性腋窩淋巴結(jié)數(shù)量大于等于10. 0個(gè)的乳頭乳暈復(fù)合體浸潤的構(gòu)成比為20. 0%。[結(jié)論]1.年齡在40-59歲之間、浸潤性導(dǎo)管癌及Lumina A型的乳腺癌患者NAC浸潤風(fēng)險(xiǎn)大;2.B超下原發(fā)腫瘤直徑大于5.0cm、TND在小于2.0cm的乳腺癌患者不適合行NSM手術(shù);3.腋窩淋巴結(jié)數(shù)量大于3.0個(gè)的乳腺癌患者NSM的手術(shù)風(fēng)險(xiǎn)大。
[Abstract]:[objective] at present, the main treatment of breast cancer at home and abroad is surgery, and the modified radical mastectomy with nipple areola preservation is a kind of mammary surgery method, which preserves the nipple areola complex of the patients. It can improve the cosmetic effect of patients and create better conditions for postoperative reconstruction, but its safety is controversial. This paper mainly studies several factors related to their safety. [methods] data of 137 patients with breast cancer, including name, age, and number of admission certificate, were collected from October 2016 to December 2016 in Department of Extramammary gland of Yunnan Cancer Hospital. Sex and other general data, pathological types and molecular types of breast cancer, the size of the mass, the distance from the mass to the nipple, the distance from the mass to the skin on the breast surface, the number of axillary lymph nodes infiltrating after surgery, The clinical data such as preoperative clinical stage, postoperative pathological stage, postoperative immunohistochemistry and so on. The relative safety factors of modified radical mastectomy for breast cancer were analyzed by statistical method. All the data were analyzed by Excel SPSS22.0 software package. The methods mainly included x2 test, test level 偽 0.05. [result] 1. In this study, NAC invasion occurred mainly in breast cancer patients aged 40-59 years old and breast cancer patients aged 40-49 years. The NAC invasion composition ratio of breast cancer patients aged 50-59 years was 11.60.The proportion of NAC infiltration composition of breast cancer patients aged 50-59 years was 5.9%. 2. The type of breast cancer with the most NAC infiltration was invasive ductal carcinoma (5). NAC invasion ratio was 7.8%, followed by invasive carcinoma in 2 cases. The NAC invasion ratio was 3.7 and the NAC invasion ratio was 8.7. 3 in 1 case of intraductal carcinoma. The proportion of NAC-infiltrating composition of Lumina A breast cancer is 16.70.The next is HER-2 overexpression type NAC-infiltrating composition ratio is 12.5%. 4.B the nearest distance from the margin of tumor to the edge of papilla is in the 0.0-1.0cm region. When the nearest distance from the margin to the nipple margin of the tumor under B-ultrasound is greater than that of 2.0cm, the non-infiltrating condition of NAC with the diameter of the primary mass of 5.0-10.0cm is 35.3g, followed by the swelling under B-mode ultrasound, and the ratio of NAC-invasion is 10.9% and 9.7% respectively in the 1.0-2.0cm region, where the nearest distance from the margin of the tumor to the margin of the nipple is greater than that of the 2.0cm under B-ultrasound. The composition ratio of NAC infiltration with block diameter of 2.0-5.0cm is 2.1. 6. The NAC invasion ratio of axillary lymph node negative after operation was 3.4% and the number of positive lymph nodes was 1. 5%. 0-3. The ratio of 0 NAC infiltrating components was 3. Five. The number of positive lymph nodes was 4. 5%. 0-10. The invasion ratio of 0 nipple areola complex was 17.7%. The number of positive axillary lymph nodes was greater than 10. 5%. The constituent ratio of 0 nipple areola complex infiltration is 20. 5%. 0. [conclusion] 1. Patients aged 40-59 years with invasive ductal carcinoma and Lumina A breast cancer have a greater risk of infiltrating NAC-TND than 5.0 cm TND in patients with breast cancer less than 2.0cm. NSM patients with more than 3.0 axillary lymph nodes were at greater risk of surgery.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.9

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