论文部分内容阅读
目的探讨妊娠哺乳期乳腺癌的诊断和治疗经验。方法1990年1月-2005年12月,15年共收治妊娠哺乳期乳腺癌14例。TNM分期Ⅱ期2例,Ⅲ期11例,Ⅳ期1例(肝转移)。采用细针穿刺涂片细胞学检查、术中冰冻活检或肿瘤切取活检明确诊断。合并早、中孕各1例,分别行人工流产及利凡诺腔内注射引产后行乳癌根治术。2例晚孕,1例至孕37周行剖宫产,产后一周行新辅助化疗2疗程,再行乳癌根治术,另一例病人行剖宫产后病人拒绝进一步治疗。哺乳期患者10例,立即停止哺乳,进行抗肿瘤综合治疗。结果14例患者全部采用细针穿刺涂片细胞学检查。9例获得确诊,余5例进一步经术中冰冻活检或肿瘤切取活检确诊。本组2例失访。Ⅳ期1例,5个月后死于广泛转移。Ⅲ期10例,3年生存率60％,5年生存率30％。死因皆为肿瘤广泛转移。Ⅱ期1例,至今无病存活8年。结论产前检查应重视乳房检查,妊娠哺乳期发现的肿块应采取积极措施(如穿刺活检)排除乳癌;对中、晚孕乳癌应与家属和病人共同决定胎儿取舍,尽快采用针对乳腺癌的多学科综合治疗。
Objective To investigate the diagnosis and treatment of breast cancer during pregnancy and lactation. Methods From January 1990 to December 2005, 14 cases of breast cancer during pregnancy and lactation were treated in 15 years. TNM stage Ⅱ in 2 cases, Ⅲ in 11 cases, Ⅳ in 1 case (liver metastasis). Fine needle aspiration smear cytology, intraoperative frozen biopsy or tumor biopsy confirmed the diagnosis. One case of early pregnancy and the second trimester of pregnancy were treated by radical abortion and rivanol after endovascular injection of abortion. 2 cases of late pregnancy, 1 case of 37 weeks pregnant cesarean section, one week postpartum neoadjuvant chemotherapy 2 courses, and then breast cancer radical surgery, the other cases of patients after cesarean section refused to further treatment. Lactation in 10 patients, immediately stop breastfeeding, anti-tumor comprehensive treatment. Results All 14 patients underwent fine needle aspiration biopsy. 9 cases were diagnosed, and the remaining 5 cases were further confirmed by intraoperative frozen biopsy or tumor biopsy. Two patients in this group were lost. One patient in stage Ⅳ died of extensive metastasis after 5 months. Stage Ⅲ 10 cases, 3-year survival rate of 60%, 5-year survival rate of 30%. The causes of death are extensive tumor metastasis. 1 case of stage Ⅱ, so far no disease to survive 8 years. Conclusions The prenatal examination should pay attention to the breast examination. The lumps detected during pregnancy and lactation should adopt positive measures (such as biopsy) to exclude breast cancer. The middle and late pregnancy breast cancer should be decided jointly with the family member and the patient, and the fetus should be adopted as soon as possible for breast cancer Comprehensive treatment of subjects.