CAJ | 학술논문

目的分析乳腺癌术后患者发现附件区肿块的诊断、治疗原则。方法收集西安交通大学第二附属医院2003至2011年乳腺癌术后附件区肿块诊治患者44例，全组患者术前行血清CEA、CA12-5及CA15-3检测，同时行盆腔超声检查。确诊后行手术治疗，术后按病理结果行综合治疗或随访。结果（1）附件区肿块诊断时中位年龄46岁（32～63岁），确诊乳腺癌至出现附件肿块的中位间隔时间为37个月（6～251个月）；（2）附件区肿块为恶性肿瘤患者中，术前血清CEA、CA12-5及CA15-3均明显高于良性肿瘤患者（P＜0.01），其术前超声提示非薄壁囊肿明显多于良性肿瘤患者（P＜0.01）；（3）附件区肿块术后病理为良性肿瘤35例、原发性卵巢恶性肿瘤4例及转移性卵巢恶性肿瘤5例；（4）4例原发性卵巢癌患者，1例术后54个月时死亡，3例无病生存；5例转移性癌患者，2例分别于术后27、28个月时死亡，3例无病生存。结论乳腺癌术后患者的附件区肿块大多数为良性卵巢囊肿，超声提示非薄壁囊肿、血清肿瘤标记物升高者提示恶性危险性增高需行手术治疗，术后病理为恶性者需行综合治疗。
목적분석유선암술후환자발현부건구종괴적진단、치료원칙。방법수집서안교통대학제이부속의원2003지2011년유선암술후부건구종괴진치환자44례，전조환자술전행혈청CEA、CA12-5급CA15-3검측，동시행분강초성검사。학진후행수술치료，술후안병리결과행종합치료혹수방。결과（1）부건구종괴진단시중위년령46세（32～63세），학진유선암지출현부건종괴적중위간격시간위37개월（6～251개월）；（2）부건구종괴위악성종류환자중，술전혈청CEA、CA12-5급CA15-3균명현고우량성종류환자（P＜0.01），기술전초성제시비박벽낭종명현다우량성종류환자（P＜0.01）；（3）부건구종괴술후병리위량성종류35례、원발성란소악성종류4례급전이성란소악성종류5례；（4）4례원발성란소암환자，1례술후54개월시사망，3례무병생존；5례전이성암환자，2례분별우술후27、28개월시사망，3례무병생존。결론유선암술후환자적부건구종괴대다수위량성란소낭종，초성제시비박벽낭종、혈청종류표기물승고자제시악성위험성증고수행수술치료，술후병리위악성자수행종합치료。
Objective To analyse the diagnosis and treatment principle of the adnexal mass occurred in breast cancer patients .Methods 44 cases of adnexal mass occurred in breast cancer patients in the second affiliated hospital of Xi′an Jiaotong University during 2003-2011 were collected .The serum CEA ,CA12-5 and CA15-3 of the whole patients were detected , so did the pelvic ultrasound .They underwent surgery after diagnosis and received comprehensive treatment or follow-up after operation according to the pathology .Results (1) The median diagnostic age of the adnexal mass patients was 46 years(32-63) and the median interval time from the diagnosis of breast cancer to appearing adnexial mass was 37 months.(2) The serum CEA,CA12-5 and CA15-3 in maligant adnexal mass patients were higher then that in benign tumor patients ( P<0.01 ) and the no-thin-wallde cysts were more shown by preoperative ultrasound (P<0.01).(3)The adnexal mass histological pathology included 35 cases of benign tumors ,4 cases of primary ovarian cancer and 5 cases of metastatic ovarian cancer .( 4 ) In the 4 cases of primary ovarian cancer ,1 case survived 54 months after operation ,3 cases were disease-free survival .In the 5 cases of metastatic ovarian cancer ,2 case survived 27,28 months,3 cases were disease-free survival.Conclusion Adnexal masses in breast cancer patients mostly were histologically benign cysts , if combined with elevated tumor marker , multiple cysts or mixed mass might predicate a possibility of malignancy and the breast patients with the adnexal malignant tumor should receive comprehensive treatment according to the histological pathology .