乳腺癌前哨淋巴结活检影响因素的临床研究写手代写初始材料

皖南医学院硕士学位论文乳腺癌前哨淋巴结活检影响因素的临床研究皖南医学院硕士学位论文摘要目的：随着人们生活节奏的不断加快，癌症的发病率日益增加。女性乳腺是由皮肤、纤维组织、乳腺腺体和脂肪组成的，乳腺癌是发生在乳腺腺上皮组织的恶性肿瘤。乳腺癌中99%发生在女性，男性仅占1%。所以，乳腺癌这种十分常见的恶性肿瘤已经严重危害了现代女性的健康。据统计，全球每年大约有近120万妇女不幸患乳腺癌，其中42.1%的妇女死于此病。（中国）癌症研究基金调查结果显示：乳腺癌主要发生在经济发达城市，诸如，上海、北京、广州等地。乳腺癌预后主要受腋窝淋巴结状态的影响，所以腋窝淋巴结清扫(英文：AxillaryLymphNodesDissection，ALND)是治疗乳腺癌的关键。同时，腋窝淋巴结状态在乳腺癌的临床分期、预后判断、术后辅助治疗和术后复发等方面都有着非常重要的临床价值和意义。随着医疗技术的日益发展，乳腺癌的早期确诊率已有明显的提高，腋窝淋巴结状态的阴性率也随之增加。然而，腋窝淋巴结清扫对乳腺癌患者术后生存质量的影响不大，容易出现水肿、肢体障碍、腋窝积液、伤口感染以及皮瓣坏死等并发症。前哨淋巴结是乳腺癌原发引流区内淋巴转移所经过的第一个淋巴结，可以短时间内控制淋巴道内肿瘤细胞的扩散。从理论上讲，如果前哨淋巴结没有出现肿瘤转移的情况，那么，处在该区域的其他淋巴结也不会发生转移的情况。因此，在20世纪90年代中后期，乳腺癌前哨淋巴结活检在乳腺癌治疗方面取得快速发展。乳腺癌前哨淋巴结活检可以有效地预测腋窝淋巴结内癌细胞的转移情况，保留未转移的腋窝淋巴结，提高患者自身的免疫能力。目前，有关乳腺癌前哨淋巴结活检的影响因素的研究很多，但各家的研究结果不统一，存在诸多争议。本文主要研究乳腺癌前哨淋巴结活检的影响因素，以及各个因素之间的影响机制。方法：本文选择178例乳腺癌患者，采用1％亚甲蓝染色法进行前哨淋巴结活检。178例患者均无腋窝手术、辅助化疗（或放疗）史，临床分期M0期(Tis-3No-2Mo)，其中8例为Tis，58例为T1，84例为T2，22例为T3，6例为Tx；前哨淋巴结活检前，42例患者出现（可触）腋窝淋巴结肿大，136例患者出现（未触）淋巴结肿大。上述患者经病理分析为乳腺癌，在乳腺癌肿瘤位置皮下（或乳晕）注射2ml（1％）亚甲蓝，待10分钟后，（解剖）沿染色淋巴管腋窝皖南医学院硕士学位论文找到前哨淋巴结，并送入病理室进行病检。依据检验结果，采用相应的治疗措施。其中，前哨淋巴结的检出结果采用百分比形式，并进行x2检验，P0.05为显著差异，具有统计学意义。结果：在178例患者中，156例患者检出前哨淋巴结，整体成功检出率为87．6％。术前136例患者出现（未触）淋巴结肿大的检出率（94．12％），显著高于42例患者出现（可触）腋窝淋巴结肿大(66．70％)，两者之间存在差异，并具有统计学意义(P0.05)；研究发现后128例患者的检出率（93．75％），高于前50例的检出率（72.0%），两者之间存在差异，并具有统计学意义(P0.05)；178例患者在年龄、肿块大小、（活检前）病灶切除部位，（示踪剂）注射部位，（病理）类型，C-erbB-2状态，ER状态等方面不具有显著差异，无统计学意义。结论：1．腋窝淋巴结肿大情况对前哨淋巴结活检的成功率产生影响；活检（前哨淋巴结）技术学习情况对前哨淋巴结活检的成功率产生影响。2．（1％）亚甲蓝的染料法可以准确定位肿瘤病灶的前哨淋巴结。3．前哨淋巴结活检不但可以帮助乳腺癌的早期治疗，还可以有效提高乳腺癌患者术后的生存质量。关键词：乳腺癌；亚甲蓝；前哨淋巴结；活检影响因素皖南医学院硕士学位论文AbstractObjective:Aspeople'sliferhythmspeedingupunceasingly,theincidenceofcancerisincreasing.Femalebreastiscomposedofskin,composedoffibroustissue,mammaryglandandfat,thebreastcanceroccurinmammaryglandmalignanttumorofepithelialtissue.99%ofbreastcancerinwomen,only1%ofmen.Therefore,asakindofcommonmalignanttumor,breastcancerseriouslyendangeringthehealthofwomen.Atpresent,theworldeachyear,1.2millionwomenwithbreastcancer,42.1%ofthewomendiedofthedisease.Cancerresearchfund(China)theresultsshowthatbreastcanceroccursmainlyineconomicallydevelopedcities,suchas,Shanghai,Beijing,Guangzhouandotherplaces.PrognosisofbreastcancerismainlyinfluencedbyAxillaryLymphnodestatus,sotheAxillaryLymphnodecleaning(English:AxillaryLymphNodesDissection,ALND)isthekeytothetreatmentofbreastcancer.Atthesametime,theaxillarylymphnodestatusisinbreastcancerclinicalstagesandprognosisjudgment,postoperativeadjuvanttherapyandpostoperativerecurrence,etc.,whichhasveryimportantclinicalsignificance.Withthecontinuousdevelopmentofmedicaltechnology,therateofearlydiagnosisofbreastcancerincreasedsignificantly,thestateoftheaxillarylymphnodenegativeratealsowillincrease.Axillarylymphnodecleaningthepostoperativesurvivalrateinpatientswithbreastcancer,however,theimpactisnotbig,pronetoedema,physicalbarriers,axillaryeffusion,woundinfectionandskinflapnecrosisandothercomplications.Sentinellymphnodeisbreastcancerprimarydrainageareaafterthefirstlymphnodelymphnodemetastases,caninashortperiodoftimetocontrolthespreadoflymphatictumorcellswithintheTao.Intheory,thesentinellymphnodedoesnotappeartumormetastasis,primarytumorotherlymphnodewillnotbetransferredwithintheregion.Therefore,inthe1990s,sentinellymphnodebiopsyinbreastcancertreatmentofbreastcancerhasmaderapiddevelopment.Breastcancersentinellymphnodebiopsycaneffectivelypredicttheaxillarylymphnodes,the皖南医学院硕士学位论文transferofcellswithinthesituation,keeptransferofaxillarylymphnodes,improvethepatient'sownimmuneability.Atpresent,thestudiesoftheinfluencefactorsofthesentinellymphnodebiopsyofbreastcancer,buttheresultshavenotunified,therearemanycontroversial.Thispapermainlystudiestheinfluencefactorsofthesentinellymphnodebiopsyofbreastcancer,andtheinfluencemechanismbetweenthevariousfactors.Methods:Thisarticlechoose178casesofbreastcancerpatients,1%ethylenebluestainingmethodisadoptedtoimprovethesentinellymphnodebiopsy.178patientshadnohistoryofaxillarysurgeryandadjuvantchemotherapyorradiotherapy,clinicalstageM0(Ties-3-2mo),ofwhich8casesforTies,58casesofT1,84casesofT2,22casesofT3,6casesofTX;Sentinellymphnodebiopsybefore,42patients(touch)axillarylymphnodeenlargement,136casesofpatientswithlymphnodeenlargement(withouttouch).Bypathologicalanalysisofbreastcancer,thepatientsinbreasttumorlocationsubcutaneousinjection(orareola)2mlethyleneblue(1%),with10minutes,(anatomy)alongthedyeinglymphaticmaxillafoundsentinellymphnode,andintothepathologicalroomfordiseasedetection.thecorrespondingtreatmentmeasuresOnthebasisoftestresults.Amongthem,thedetectionofsentinelnodesresultsintheformofpercentage,andx2test,P0.05forthesignificantdifference,statisticallysignificant.Results:Inthe178patients,156patientsweredetectedwithsentinellymphnode,theoverallsuccessratewas87.6%.136casesofpreoperativepatients(withouttouch)rateoflymphnodeenlargement(94.12%),significantlyhigherthanin42patients(touch)axillarylymphnodeenlargement(66.70%),thedifferencesbetweenthetwo,withstatisticalsignificance(P0.05);Afterthestudyfoundthatthedetectionrateof128patients(93.75%),higherthanthepr