本文關(guān)鍵詞： 意外發(fā)現(xiàn)的宮頸癌 宮旁廣泛切除術(shù) 放射治療 生活質(zhì)量　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景與目的宮頸癌是世界上女性常見的惡性腫瘤,發(fā)病率以及死亡率排在第四位。多數(shù)早期宮頸癌患者進(jìn)行根治性手術(shù)治療,5年生存率較高。然而,有時(shí)良性病變或?qū)m頸上皮內(nèi)瘤變僅行單純性子宮切除術(shù)后會(huì)發(fā)現(xiàn)宮頸癌,即意外發(fā)現(xiàn)的宮頸癌。意外發(fā)現(xiàn)的宮頸癌臨床上并不常見,主要?dú)w因于術(shù)前檢查不充分或者術(shù)中快速冰凍病理不能確診。目前對于意外發(fā)現(xiàn)的宮頸癌尚無完善的最佳治療方法,單純性子宮切除是不夠的,復(fù)發(fā)率大約60%。根據(jù)2107年NCCN宮頸癌臨床指南,如果切緣陰性并且影像學(xué)檢查陰性且無高危因素及中危因素的患者,有兩種補(bǔ)救治療方案:宮旁廣泛切除術(shù)或者放射治療。然而,目前關(guān)于治療的最佳方案的文獻(xiàn)較少,國內(nèi)尚無文獻(xiàn)對兩種方案療效進(jìn)行比較。經(jīng)過這兩種方案的治療,意外發(fā)現(xiàn)的宮頸癌生存率較高。然而治療存在的并發(fā)癥,可不同程度的影響著患者的生活質(zhì)量。隨著現(xiàn)代生活水平的提高,人們由關(guān)注生存率,開始逐漸轉(zhuǎn)移到關(guān)注患者的生活質(zhì)量上來。生活質(zhì)量是一個(gè)復(fù)雜的多維結(jié)構(gòu),通常使用生活治療工具進(jìn)行評估,即生活質(zhì)量評定表。本研究應(yīng)用宮頸癌患者生活質(zhì)量的評估表為FACT-Cx,由共性模塊及宮頸癌特異性模塊構(gòu)成。本研究旨在分析腹腔鏡下宮旁廣泛切除術(shù)和放射治療兩種補(bǔ)救措施治療意外發(fā)現(xiàn)的宮頸癌的臨床效果,以及分別評估兩種治療組患者的生活質(zhì)量,為臨床醫(yī)師診療提供診治思路。研究對象及方法回顧性分析鄭州大學(xué)第一附屬醫(yī)院2011年1月至2015年3月收治的資料完整的32例意外發(fā)現(xiàn)的宮頸癌患者臨床資料,17例患者接受腹腔鏡下宮旁廣泛切除術(shù)+陰道上段切除術(shù)+盆腔淋巴結(jié)清掃術(shù)(以下簡稱宮旁廣泛切除術(shù),手術(shù)組),15例患者行放射治療及化療同步療法(放射治療組),記錄手術(shù)組手術(shù)時(shí)間、術(shù)中出血量、術(shù)中及術(shù)后并發(fā)癥等,放射治療組觀察放療早期及晚期并發(fā)癥。統(tǒng)計(jì)兩組年齡、體重指數(shù)、住院費(fèi)用、住院天數(shù)。在全程治療結(jié)束一年復(fù)查時(shí)進(jìn)行對患者采用調(diào)查問卷形式評估生活質(zhì)量。生活質(zhì)量評估采取FACT-G共性模塊及宮頸特異模塊(CCS)對兩組進(jìn)行生活質(zhì)量問卷調(diào)查并進(jìn)行評分。對患者定期隨訪,隨訪時(shí)間截止到2017年3月。采用SPSS 17.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)處理。定量資料以((x|-)±s)表示,服從正態(tài)分布的定量資料間比較采用兩獨(dú)立樣本t檢驗(yàn),定性資料采用Fisher確切概率法檢驗(yàn)。以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.隨訪期間,手術(shù)組無復(fù)發(fā),放射治療組有1例復(fù)發(fā),兩組無復(fù)發(fā)率分別為100%及93.3%(P=0.47),差異無統(tǒng)計(jì)學(xué)意義。隨訪期間兩組均無患者死亡。2.手術(shù)組及放射治療組住院費(fèi)用分別為21472.6±4179.1元及46102.1±3495.1元(P0.05),住院天數(shù)分別為14.3±4.1天及32.6±5.4天(P0.05)。差異均具有統(tǒng)計(jì)學(xué)意義。3.手術(shù)組生活質(zhì)量評分FACT-Cx總分(P=0.006)、軀體情況得分(P=0.02)及宮頸癌特異模塊(CCS)得分(P=0.001)均高于放射治療組,差異具有統(tǒng)計(jì)學(xué)意義。社會(huì)情況、情緒情況及功能情況得分兩組差異無統(tǒng)計(jì)學(xué)意義(P值分別為0.31、0.218及0.077)。4.手術(shù)組術(shù)后并發(fā)癥3例(17.6%),放射治療組早期并發(fā)癥6例(40%),晚期并發(fā)癥3例(20%),兩組并發(fā)癥發(fā)病率差異具有統(tǒng)計(jì)學(xué)意義(P=0.03)結(jié)論1.腹腔鏡下宮旁廣泛切除術(shù)及放射治療均是意外發(fā)現(xiàn)的宮頸癌有效的補(bǔ)救治療措施。2.在本研究中心,腹腔鏡下宮旁廣泛切除術(shù)是可行的,具有并發(fā)癥少、便于術(shù)后恢復(fù)等優(yōu)點(diǎn),能夠減輕患者經(jīng)濟(jì)負(fù)擔(dān)及精神壓力,增加患者治療依從性,且能保留年輕患者卵巢功能、提高生活質(zhì)量,尤其是對年輕患者值得臨床推廣。
[Abstract]:Background and objective: cervical cancer is a common malignant tumor in women in the world, the incidence and mortality ranked fourth. The majority of patients with early stage cervical cancer underwent radical surgery, 5 years survival rate is high. However, sometimes benign lesions or cervical intraepithelial neoplasia underwent simple hysterectomy will find cervical cancer. The unexpected discovery of cervical cancer. Cervical cancer is uncommon clinical discovered by accident, mainly due to inadequate preoperative examination or intraoperative frozen pathology could not be confirmed. The best treatment at present for cervical cancer found that there is no perfect method, simple hysterectomy is not enough, the recurrence rate is about 60%. according to clinical guidelines in 2107 NCCN cervical cancer, if the margin is negative and negative imaging and no risk factors and risk factors of the patients, there are two kinds of remedial treatment: Uterine resection or radiotherapy Treatment. However, the current literature on the treatment of the best scheme is less, there is no domestic literature to compare the effect of two kinds of schemes. After treatment of the two methods, found that cervical cancer survival rates are high. However, for the existence of complications, can influence the quality of life of patients. With the development of modern living standards to improve, people from the attention of the survival rate, begun to pay attention to the quality of life of patients. The quality of life is a complex multidimensional structure, usually are evaluated using life treatment tools, namely life quality evaluation table. The research on assessment of quality of life in patients with cervical cancer using the table for FACT-Cx, composed of general module and cervical cancer specific module. This study aims to analyze the clinical effect of laparoscopic parametrial resection and radiotherapy two remedial measures treat accident found in cervical cancer, and respectively. To evaluate the quality of life of two patients in the treatment group, to provide for clinical diagnosis. Diagnosis and treatment of cervical cancer patients were retrospectively analyzed in 32 cases of accidents in the First Affiliated Hospital of Zhengzhou University from January 2011 to March 2015 were complete data found in the object of study and methods, 17 patients underwent laparoscopic parametrial resection + vagina resection and pelvic lymph node dissection (hereinafter referred to as the parametrial resection, surgery group), 15 cases were treated by radiotherapy and chemotherapy therapy (synchronous radiotherapy group), operation group recorded the operation time, intraoperative blood loss, intraoperative and postoperative complications, radiotherapy for early and late complications of radiotherapy. Two statistical observation group age, body mass index, hospitalization expenses, hospitalization days. To evaluate the life quality of patients by questionnaire in the whole treatment over a year. The quality of life assessment review Take the FACT-G general module and cervical specific module (CCS) quality of life questionnaire survey of two groups of patients and score. Regular follow-up, follow-up time by the end of March 2017. The data were processed by SPSS 17 statistical software. The quantitative data ((x|-) + s) said to obey the normal distribution of quantitative data comparison using two independent samples t test, qualitative data using Fisher exact test. P0.05 the difference was statistically significant. The 1. group had no recurrence during follow-up, surgery, radiotherapy group had 1 cases of recurrence, two groups had no recurrence rate is respectively 100% and 93.3% (P=0.47), there was no significant difference in the follow-up period. The two groups had no death in patients with.2. surgery group and radiotherapy group hospitalization costs were 21472.6 + 46102.1 + 4179.1 yuan and 3495.1 yuan (P0.05), hospitalization days were 14.3 + 4.1 and 32.6 + 5.4 days (P0.05). The difference was statistically Learn the meaning of life quality group.3. Surgery score FACT-Cx score (P=0.006), body condition score (P=0.02) and cervical cancer specific module (CCS) score (P=0.001) were higher than the radiotherapy group, the difference was statistically significant. The social situation, no statistically significant difference between the two groups and the emotional function score (P = 0.31,0.218 0.077) and 3 cases of.4. surgery group, postoperative complications (17.6%), radiotherapy group of early complications in 6 cases (40%), 3 cases of late complications (20%), the incidence of complications of the two groups had significant difference (P=0.03) of 1. laparoscopic parametrial resection and radiotherapy were found in cervical cancer treatment effective remedial measures of.2. in the research center, laparoscopic parametrial resection is feasible, with less complications, postoperative recovery and other advantages, can reduce the patients economic burden and mental stress, increase patients Compliance, and can retain the ovarian function of young patients, improve the quality of life, especially for young patients worthy of clinical promotion.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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