乳腺癌术后患者附件区肿块的诊断和治疗

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.

Diagnosis and treatment of the adnexal mass occurred in breast cancer patients

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 eases of metastatic ovarian cancer,2 ease survived 27,28 months, 3 cases were disease-free survival. Conelusion Adnexal masses in breast cancer patients mostly were histologically benign cysts, if combined with elevated tumor marker, multiplecysts 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.