乳腺癌术后引流液细胞学检查的临床价值

Examination of exfoliative cytology of draining liquid in patients with breast tumor

目的:探讨乳腺癌手术创面脱落癌细胞的相关因素及防范对策。方法:对174例乳腺癌术后的腋下和肿瘤附近创面引流液作脱落细胞涂片检查,将结果与相关因素作对比分析。结果:本组脱落癌细胞阳性者42例,占24%。T1和T2(χ2=6.960,P=0.008)、T2和T3、T4(χ2=26.372,P=0.000)、Ⅰ期和Ⅱ、Ⅲ、Ⅳ期(χ2=33.187,P=0.000)及Ⅱ期和Ⅲ、Ⅳ期(χ2=18.200,P=0.000)差异均有统计学意义。Ⅲ期和Ⅳ期(χ2=0.520,P=0.471)、根治和改良根治(χ2=3.563,P=0.059),差异无统计学意义。有淋巴结转移和无淋巴结转移(χ2=18.748,P=0.000)、非浸润和浸润(χ2=8.121,P=0.004)、腋下引流和胸创面(χ2=8.116,P=0.004)差异均有统计学意义。结论:脱落癌细胞阳性率与肿瘤大小、病期早晚、组织学类型和有无淋巴结转移有关,提高手术操作质量可降低脱落癌细胞阳性率。

OBJECTIVE：To study the relative action about exfoliative cytology of operative wound and to explore the prevention methods. METHODS. Examination of drained liquid of the axilla and the wound around tumor was done in 174 patients with breast tumor. The correlation between exfoliated cells and patients＇characteristics, such as tumor size, clinical classification of tumor and lymphmetastasis of axilla was analyzed. RESULTS： In 174 patients, exfoliated tumor cells were found in 42 patients （24 % ）. There was a significant difference （χ^2 = 6. 960, P = 0.008） between T1 and T2. There was a significant difference （χ^2= 26. 372,P= 0. 000） between T2 and T3, T4. There was a significant difference （χ^2= 33. 187, P = 0.000） between Ⅰ and Ⅱ, Ⅲ, Ⅳstage, There was a significant difference （χ^2= 18. 200,P=0. 000） between Ⅱ and Ⅲ, Ⅳ stage. There was no significant difference （χ^2= 0. 520, P = 0.471） between Ⅲ and Ⅳstage. There was a significant difference （ χ^2= 18. 748,P=0. 000） between lymphmetastasis and no lymphmetastasis, There was a significant difference （χ^2= 8. 121, P= 0. 004） between cellular infiltration and no infiltration. There was not significant difference （χ^2= 3. 563 ,P=0. 059） between the operations of Patey and Halsted. There was a significant difference （χ^2=8. 116, P=0. 004） between wound of axilla and operation. CONCLUSIONS： Exfoliated tumor cells are related to size, stage, type and lymphmetastasis of tumor and operation. It are necessary to advance operation for lowering exfoliative tumor cells.