乳腺癌保乳手术范围的临床和病理研究

乳腺癌保乳手术范围的临床和病理讨论【摘要】 目的 探讨适合中国女性保乳手术的切除范围，提出法律规范化治疗标准。方法 对 68 例乳腺癌全乳腺切除标本采纳常规病理、免疫组化及分子生物学方法，检测癌和癌旁不同范围组织增殖细胞核抗原、P53、C-erbB-2 等表达情况。结果 随距原发癌越远，癌旁发生高危病变、PCNA、C-erbB-2 及 P53 阳性的比例逐渐降低。EIC、C-erbB-2 或 P53 阳性者，癌旁危险因素阳性的范围广；而癌旁危险因素阳性范围与年龄、肿瘤大小、腋淋巴结受累情况、ER/PR 状况、PCNA 表达无关。结论 Ⅰ、Ⅱ期乳腺癌保乳术后复发危险因素绝大多数在瘤缘外 2cm 以内存在，因此推举以癌旁 2cm 作为保乳手术的安全切除范围，远离乳头端可缩小手术范围至癌旁 1cm 处；原发癌 C-erbB-2 扩增和 P53 突变时，行保乳手术应适当扩大切除范围；EIC 时，应扩大手术范围。 【关键词】 乳腺癌；保乳手术；P53；增殖细胞核抗原；C-erbB-2 Clinical and pathological study about the excision volume of breast-conserving operation for breast cancer 【Abstract】 Objective To research the excision volume that adapt to Chinese women in breast-conserving therapy and to provide a standard rule of therapy in 68 specimens of mammary exsected due to breast cancer were tested by method of immunohistochemistry,pathology and molecularbiology to detect the expression of PCNA,P53,C-erbB-2 in tumor and around With the distance to tumor increased,the expression of PCNA,P53,C-erbB-2 range of risk factors around tumor was relative to EIC,P53,C-erbB-2,but not relative to age,tumor size,the expression of PCNA,the status of ER/PR and the status of Most risk factors appear in 2cm to tumor in stage Ⅰ and Ⅱ breast cancer patients,so we recommend 2cm to tumor as the safe exsection range of exsection should be expandedwhen there were P53 mutation,the expression of C-erB-2 expanded and EIC. 【Key words】 breast cancer;breast-conserving operation;P53;PCNA;C-erbB-2 保乳手术的目的是切除足够的癌旁组...