書籍名 |
新女性医学大系 20 乳房とその疾患 |
出版社 |
中山書店
|
発行日 |
1999-07-31 |
著者 |
- 武谷雄二(総編集)
- 青野敏博(編集)
- 麻生武志(編集)
- 中野仁雄(編集)
- 野澤志朗(編集)
- 森宏之(担当編集)
|
ISBN |
4521541313 |
ページ数 |
411 |
版刷巻号 |
第1版第1刷 |
分野 |
|
シリーズ |
新女性医学大系
|
閲覧制限 |
未契約 |
本書では、乳房の発生、分化や加齢に伴う構造・機能の変化、妊娠・分娩・産褥と乳房との関係など、乳房疾患を理解するために必要な知識と、さまざまな良性疾患・悪性疾患をとりあげました。また、近年著しく進歩した画像診断法や分子生物学的手法も含め、病因・病態から各種検査法・治療法まで、臨床に即して、具体的に解説しました。女性の一生をトータルに扱うこれからの産婦人科医に、必要不可欠な一冊です。
目次
- 表紙
- 執筆者一覧
- 目次
- I 総論
- A. 乳房の進化
- 1. 原獣亜綱 (Prototheria) - 単孔類 (Monotremata) の乳器
- 2. 後獣下綱 (Metatheria) - 有袋類 (Marsupialia) の乳器
- 3. 正獣下綱 (Eutheria, 有胎盤類) の乳器
- a. 齧歯類 (Rodentia) の乳器
- b. 食肉類 (Carnivora) の乳器
- c. 偶蹄類 (Artiodactyla) の乳器
- d. 霊長類 (Primates) の乳器
- B. 乳房の発生と分化
- C. 加齢による乳房の構造と機能の変化
- 1. 成熟乳腺の構造
- a. 乳頭および乳輪
- b. 乳腺の実質
- c. 乳腺の間質
- 2. 乳房の発育と年齢的変化
- a. 新生児および乳幼児の乳房
- b. 思春期における乳房の変化
- c. 月経周期と乳腺の変化
- d. 閉経後の乳腺
- D. 妊娠, 分娩, 産褥による乳房の構造と機能の変化
- 1. 形態的変化
- 2. 乳腺発育の調節因子
- 3. 乳汁分泌発来の機序
- 4. 乳汁分泌の維持
- 5. 授乳後の乳腺の変化
- E. 乳腺疾患の病理
- 1. 上皮性腫瘍
- 2. 結合織性および上皮性混合腫瘍
- 3. 非上皮性腫瘍
- 4. 乳腺症
- 5. 腫瘍様病変
- F. 乳房疾患の理解に必要な内分泌学的基礎知識
- 1. 乳房におけるステロイドホルモン応答機構
- a. エストロゲンによる転写調節機構
- b. エストロゲンの合成代謝と乳房疾患
- c. ER結合性分子の分類
- d. ER依存性細胞増殖と乳房疾患
- e. その他のステロイドホルモンの応答機構
- 2. ペプチドホルモンと増殖因子の作用機構
- II 妊娠, 分娩, 産褥と乳房
- A. 母乳哺育
- 1. 母子相互作用
- 2. 栄養学的特徴
- 3. 免疫学的特徴
- 4. その他の母乳成分
- 5. 母乳汚染
- B. 乳房管理
- 1. 正しい授乳方法の指導
- 2. 乳汁分泌に関するトラブル
- 3. 乳頭・乳房トラブル
- 4. 母乳と薬
- 5. 卒乳
- C. 妊婦の乳房診察時の留意点
- 1. 診察時に必要な基礎知識
- a. 組織学的変化
- b. 視・触診所見
- c. マンモグラフィ像所見
- d. 超音波所見
- 2. 妊婦の乳房診察の実際
- a. 診察の時期と方法
- b. 視・触診で異常を発見, あるいは自覚的に異常を訴えた例における留意点
- D. 炎症性疾患の診断と治療
- 1. うっ滞性乳腺炎 (stagnation mastitis)
- 2. 急性化膿性乳腺炎 (acute purulent mastitis)
- 3. 乳腺膿瘍 (breast abscess)
- E. 乳腺腫瘤の診断と治療
- 1. 乳腺良性腫瘍
- a. 線維腺腫
- b. 葉状腫瘍
- c. 管内性乳頭腫
- d. 脂肪腫
- e. 嚢胞
- 2. 乳腺悪性腫瘍
- III 乳房疾患の診断法
- A. 診断に必要な病理学的知識
- 1. 組織型診断の意義
- 2. 乳房疾患の特徴
- 3. 乳癌の発生と増殖
- 4. 診断における基本姿勢
- 5. 生検の注意点
- 6. 診断チャート
- B. 問診, 視・触診
- 1. 問診のポイント
- 2. 視診のポイント
- 3. 触診のポイント
- a. 触診の方法
- b. 乳癌の触診所見
- c. 乳腺症・乳腺線維腺腫と乳癌の触診上の鑑別診断
- 4. 乳頭異常分泌の処置
- a. 乳頭分泌物の細胞診
- b. 乳管造影
- c. 乳管区域切除術
- C. 画像診断 - 超音波
- 1. 超音波診断装置
- 2. 検査の適応
- 3. 検査方法
- 4. 腫瘤性所見, 非腫瘤性所見
- 5. カラーDoppler
- 6. 診断基準
- 7. 超音波誘導下穿刺法
- D. 画像診断 - マンモグラフィ
- 1. マンモグラフィの役割
- 2. マンモグラフィの歩み
- 3. 良い画像を得るために
- a. 乳房専用の撮影装置の必要性
- b. 撮影技術の習得
- 4. 読影の実際
- a. 読影法
- b. 正常所見
- c. 異常所見
- d. 最終診断と判定
- e. 乳癌の広がり診断
- E. 画像診断 - CT
- 1. 装置の発展
- 2. 造影剤
- 3. 特徴
- 4. 適応
- 5. 検査方法の考え方 - 造影剤の使用について
- 6. 乳癌の特徴と注意点
- 7. 診断
- 8. 撮像条件
- 9. 造影条件
- 10. 症例
- F. 画像診断 - MRI
- 1. MR-mammographyの検査方法と注意点
- a. コイルと撮像体位・方向
- b. 撮像シークエンスと造影の仕方
- c. 背景信号抑制
- d. 画像表示と観察方法
- 2. 良悪性の診断
- 3. 腫瘍の広がりの診断
- G. 画像診断 - 乳管内視鏡
- 1. 装置
- 2. 手技
- 3. 適応
- 4. 内視鏡所見の特徴
- H. 細胞診
- 1. 細胞採取法の手技
- a. 乳頭分泌物の採取
- b. 乳頭部の擦過
- c. 穿刺吸引の技術
- 2. 検体処理法
- 3. 細胞診報告書の解釈
- 4. 乳腺疾患の組織像
- I. 組織診
- 1. 組織診の目的
- 2. 迅速組織診断の適応と問題点
- 3. 生検の種類
- 4. 生検の適応
- 5. 生検の方法
- J. 腫瘍マーカー
- 1. 腫瘍マーカーの定義
- 2. 腫瘍マーカーの使用法
- 3. 乳癌腫瘍マーカー各論
- a. CEA (carcinoembryonic antigen ; 癌胎児性抗原)
- b. CA15-3
- c. NCC-ST-439
- d. TPA (tissue polypeptide antigen)
- e. BCA225
- 4. その他の腫瘍マーカー
- a. CA72-4
- b. 酵素系腫瘍マーカー
- c. 骨代謝マーカー
- d. parathyroid hormone-related protein (PTHrP)
- e. ErbB-2タンパク質
- IV 乳房の良性疾患
- A. 乳汁漏出症
- 1. 原因
- 2. 症状と所見
- 3. 鑑別診断
- 4. 臨床的意義
- 5. 治療と予後
- B. 乳腺症
- 1. 概念, 定義
- 2. 疫学
- 3. 病理
- 4. 分類
- 5. 症状, 所見
- 6. 診断
- 7. 臨床的意義
- 8. 治療
- 9. 予後
- C. 線維腺腫, 葉状腫瘍, 乳頭腫
- 1. 線維腺腫
- a. 定義, 病因
- b. 病理と分類
- c. 所見
- d. 鑑別診断
- e. 臨床的意義
- f. 治療
- g. 予後
- 付) 巨大線維腺腫 (giant fibroadenoma)
- 2. 葉状腫瘍
- a. 定義
- b. 疫学
- c. 病理と分類
- d. 所見
- e. 鑑別診断
- f. 臨床的意義
- g. 治療
- h. 予後
- 3. 乳頭腫
- a. 定義
- b. 疫学
- c. 病理
- d. 所見
- e. 鑑別診断
- f. 臨床的意義
- g. 治療
- h. 予後
- 付-1) 乳頭部腺腫 (adenoma of the nipple)
- 付-2) 腺腫
- V 乳房の悪性疾患
- A. 疫学
- 1. 乳癌死亡の国際比較
- 2. 日本における乳癌の現況と動向
- 3. 日本における乳癌の将来予測
- 4. リスク因子
- a. 家族歴と遺伝要因
- b. 乳腺疾患の既往
- c. 社会階層, 職業
- d. 結婚, 出産, 授乳, 月経
- e. 初潮, 閉経年齢
- f. 外因性ホルモン
- g. 食物と栄養
- h. 肥満, 体重, 身長
- i. アルコール
- j. 喫煙
- k. 放射線
- B. 乳癌と遺伝子
- 1. 癌にかかわる遺伝子
- a. 癌遺伝子と癌抑制遺伝子
- b. 多段階発癌
- c. 乳癌にかかわる遺伝子
- 2. 家族性乳癌原因遺伝子
- a. 家族性乳癌
- b. BRCA1, BRCA2遺伝子
- c. BRCA1, BRCA2の機能
- d. BRCA1, BRCA2の遺伝子変異と病態
- 3. 家族性乳癌と遺伝子診断
- a. 遺伝子診断
- b. 家族性腫瘍における遺伝子診断
- c. 家族性乳癌の遺伝子診断
- d. 問題点と今後の展望
- C. 分類
- 1. 乳癌
- 2. 悪性の結合織性および上皮性混合腫瘍
- 3. 悪性非上皮性腫瘍
- D. 乳管癌の臨床的特徴
- 1. 概念, 疫学, 最近の傾向
- 2. 病理
- 3. 臨床症状と徴候
- 4. 診断
- 5. 臨床経過と予後, 転帰
- E. 小葉癌の臨床的特徴
- 1. 非浸潤性小葉癌 (lobular carcinoma in situ : LCIS)
- a. 臨床病理学的特徴
- b. 病理組織学的特徴
- c. 予後および治療
- 2. 浸潤性小葉癌 (invasive lobular carcinoma : ILC)
- a. 臨床病理学的特徴
- b. 診断
- c. 病理組織学的特徴
- d. 治療
- e. 自験例の成績
- F. Paget病の臨床的特徴
- 1. 定義, 概念
- 2. 歴史
- 3. 分類
- 4. 疫学
- 5. 病因, 病態生理
- 6. 病理
- 7. 症状
- 8. 診断, 鑑別診断
- 9. 治療
- 10. 経過, 予後
- G. 炎症性乳癌の臨床的特徴
- 1. 定義
- 2. 疫学
- 3. 病理
- 4. 症状
- 5. 診断上の留意点
- 6. 転移に関する特徴
- 7. 治療
- 8. 予後
- H. リンパ腫および造血器腫瘍の臨床的特徴
- 1. 乳腺原発悪性リンパ腫
- a. 疫学
- b. 病理
- c. 症状, 触診所見および鑑別診断
- d. 画像診断および病理学的検査による術前診断
- e. 診断基準
- f. 治療前病期決定
- g. 治療法の選択
- h. 予後
- 2.顆粒球性肉腫
- a. 疫学
- b. 臨床症状および経過
- c. 病理
- d. 治療および予後
- I. 手術療法
- 1. 乳癌手術法の変遷
- 2. 各術式の概要
- a. Halsted法 (定型的乳房切除術, 胸筋合併乳房切除術)
- b. modified radical mastectomy (非定型的乳房切除術, 胸筋温存乳房切除術)
- c. 乳房温存手術
- 3. 各術式の実際
- a. Halsted法 (定型的乳房切除術, 胸筋合併乳房切除術)
- b. Patey法 (大胸筋温存小胸筋切除乳房切除術)
- c. Auchincloss法 (大小胸筋温存乳房切除術)
- d. Kodama法 (大小胸筋温存大胸筋開排腋窩全郭清法)
- e. 乳房温存手術 (原発巣局所切除+腋窩郭清)
- J. 内分泌療法
- 1. 乳癌の内分泌療法とその特徴
- 2. 内分泌療法薬の種類
- a. 抗エストロゲン薬
- b. GnRHアゴニスト
- c. アロマターゼ阻害薬
- d. 黄体ホルモン薬
- 3. 補助療法における内分泌療法
- 4. 再発乳癌における内分泌療法
- 5. 複合内分泌療法, 化学内分泌療法
- K. 化学療法
- 1. 術前化学療法
- 2. 術後化学療法
- a. 予後因子としての腋窩リンパ節転移
- b. 術後化学療法による予後改善効果
- c. 術後補助薬物療法の選択
- 3. 転移性乳癌に対する化学療法
- a. 転移性乳癌患者の予後因子
- b. 治療方法選択におけるdecision making
- c. 転移性乳癌に対する治療方法
- L. 放射線療法
- 1. 早期乳癌に対する乳房温存療法
- 2. 局所進行乳癌に対する根治的放射線治療 (乳房温存療法)
- 3. 根治的手術後の放射線治療
- 4. 再発・転移に対する対症的放射線治療
- 5. 放射線治療に伴う有害事象
- VI その他
- A. 乳癌検診
- 1. 日本における乳癌検診の経緯
- 2. 乳房検査法の目的と方法
- 3. 乳癌検診の有効性評価
- 4. 日本におけるマンモグラフィ検診 - 感度, 費用 - 効果, リスク - 効果分析
- 5. マンモグラフィ導入による乳癌検診の指針 (ガイドライン)
- 6. 考察と今後の課題
- B. HRT・ピルからみた乳癌と子宮体癌
- 1. 乳癌の発生・進展に関するエストロゲンおよび関連因子
- 2. ホルモン受容体と乳癌・体癌
- 3. エストロゲン受容体(ER)変異株とその遺伝子発現および臨床的意義
- 4. ERβ変異株と乳癌
- 5. HRTと乳癌・子宮体癌
- 6. 経口避妊薬 (OC, ピル)と乳癌
- 7. 乳癌のホルモン療法
- C. 形成手術
- 1. 乳房, 乳頭, 乳輪の形態異常の分類
- 2. 乳癌術後乳房欠損
- a. ティッシュエキスパンダーと生食バッグによる再建
- b. 広背筋皮弁による再建
- c. 横軸型腹直筋皮弁による再建
- 3. 豊胸術後乳房変形
- 4. 陥没乳頭
- Glossary
- 索引
- 和文索引
- 欧文索引
- 奥付
参考文献
I 総論
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