CAJ | 학술논문

目的探讨乳房肿物体表定位膜(简称乳房尺膜)标记法在乳腺癌新辅助化疗中乳腺肿瘤病灶定位的应用价值.方法对120例乳腺癌患者新辅助化疗前同时采用乳房尺膜对乳腺肿瘤病灶的位置和边界进行标记.对于非隆起性乳腺肿瘤病灶,将尺膜直接贴在乳房上,正向标记;对于边界不清楚的肿瘤病灶在超声引导下确定边界.对于隆起性乳腺肿瘤病灶,尺膜贴在肿瘤病灶以外的正常乳房皮肤上,反向标记.应用TEC方案2个疗程后再次标记,结合超声、钼靶及核磁共振结果综合判断临床疗效,决定手术或改为TP方案继续化疗.术前复位第一次标记结果,按标记的乳腺肿瘤病灶的位置和边界手术.结果完全缓解26例,部分缓解76例,稳定10例,进展8例.其中,完全缓解的24例按尺膜标记的肿瘤病灶位置和边界行保乳手术,部分缓解的18例按尺膜标记的肿瘤病灶位置及残余肿瘤病灶边界外1.5～2.0 cm行保乳手术;其余78例,按尺膜标记的肿瘤病灶边界,行简化根治术,其中局部晚期皮缘不充足的13例,采用腹部全厚游离皮瓣覆盖创面.结论乳腺癌新辅助化疗的肿瘤病灶定位应用乳房尺膜法准确且无创,有效节省了肿瘤病灶周围正常的乳腺组织及皮肤,患者依从性好,明显优于传统的坐标法、体表纹身法以及金属标志物法.乳房尺膜标记法操作简单,尺膜价格低廉,便于普及和推广.
목적 탐토유방종물체표정위막(간칭유방척막)표기법재유선암신보조화료중유선종류병조정위적응용개치.방법 대120례유선암환자신보조화료전동시채용유방척막대유선종류병조적위치화변계진행표기.대우비륭기성유선종류병조,장척막직접첩재유방상,정향표기;대우변계불청초적종류병조재초성인도하학정변계.대우륭기성유선종류병조,척막첩재종류병조이외적정상유방피부상,반향표기.응용TEC방안2개료정후재차표기,결합초성、목파급핵자공진결과종합판단림상료효,결정수술혹개위TP방안계속화료.술전복위제일차표기결과,안표기적유선종류병조적위치화변계수술.결과 완전완해26례,부분완해76례,은정10례,진전8례.기중,완전완해적24례안척막표기적종류병조위치화변계행보유수술,부분완해적18례안척막표기적종류병조위치급잔여종류병조변계외1.5～2.0 cm행보유수술;기여78례,안척막표기적종류병조변계,행간화근치술,기중국부만기피연불충족적13례,채용복부전후유리피판복개창면.결론 유선암신보조화료적종류병조정위응용유방척막법준학차무창,유효절성료종류병조주위정상적유선조직급피부,환자의종성호,명현우우전통적좌표법、체표문신법이급금속표지물법.유방척막표기법조작간단,척막개격저렴,편우보급화추엄.
Objective To investigate the application value of breast scale membrane marking method to locate breast tumor lesion in neoadjuvant chemotherapy.Methods Before neoadjuvant chemotherapy for 120 cases of breast cancer,adopt scale membrane marking method was used to mark the position and boundaries of breast tumor lesion in the mean time.For non-protuberant breast tumor lesion,scale membrane was adhered directly to the breast and positive mark was made.For tumor lesion with vague boundaries,its boundaries was defined under the direction of ultrasound.For protuberant breast tumor lesion,scale membrane was only adhered to normal mammary skin beyond the tumor lesion and reverse mark was made.After two courses of treatment of TEC scheme,mark was made again and combined with ultrasound,molybdenum target and MRI results to comprehensive judgment of clinical curative efficacy so as to decide whether operation or change to TP scheme for continuous chemotherapy.Before operation,the first marking results were reset and then operation was conducted according to the position and boundaries of the marked tumor lesion.Results There were 26 cases of complete remission,76 cases of partial remission,10 cases of stabile disease and 8 cases of progressive desease.According to mark by scale membrane,breast conserving operations were conducted in 24 cases of complete remission and in 18 cases of partial remission according to position+ boundaries of the tumor lesion and tumor lesion position+ 1.5-2.0 cm beyond the original boundaries of tumor lesion marked by scale membrane,respectively.The simplified radical mastectomy was conducted in other 78 cases according to boundaries of the tumor lesion marked by scale membrane,in which 13 cases had insufficient locally advanced skin edges and adopted abdominal full-thickness free skin flap to cover the wound.Conclusion Tumor lesion location in neoadjuvant chemotherapy for breast cancer and scale membrane positioning method have the advantage of precision and non-invasion,which effectively save normal breat tissues and skin around tumor lesion with high patient compliance and tremendously outmatches traditional coordinate method,body surface tattoo method and mental marker method.Scale membrane marking method is easy to be operated with low cost,which is convenient for popularization and generalization.