發(fā)布時間：2018-06-02 03:37

  本文選題：宮頸癌 + 根治術(shù)��； 參考：《廣西醫(yī)科大學》2017年碩士論文

【摘要】：目的:探討宮頸癌經(jīng)根治性手術(shù)治療后復發(fā)或未控的臨床及病理因素,為宮頸癌的治療提供參考。方法:回顧性分析2010年4月至2014年4月廣西醫(yī)科大學附屬腫瘤醫(yī)院婦瘤科收治的550例IA2期-IIB期宮頸癌患者的病例資料,收集全部患者的臨床病理資料及隨訪資料,采用SPSS22.0統(tǒng)計學軟件包進行統(tǒng)計學分析,共納入13個臨床及病理因素,首先進行單因素分析,將單因素分析中有意義的因素納入Logistic回歸模型進行多因素分析。結(jié)果:(1)經(jīng)根治性手術(shù)治療后的550例宮頸癌患者中,復發(fā)或未控的患者有103例,占18.7%。(2)單因素分析結(jié)果顯示:臨床分期、腫瘤大小、組織分化程度、腫瘤浸潤深度、宮旁浸潤、脈管癌栓、淋巴結(jié)轉(zhuǎn)移、切緣、新輔助化療及術(shù)后輔助治療共10個臨床病理因素是宮頸癌根治術(shù)后復發(fā)或未控的影響因素。(3)多因素分析結(jié)果顯示:臨床分期、腫瘤大小、淋巴結(jié)轉(zhuǎn)移、脈管癌栓、切緣、新輔助化療及術(shù)后輔助放化療共7個臨床病理因素是宮頸癌根治術(shù)后復發(fā)的獨立因素(p0.05)。其中臨床分期晚、腫瘤直徑≥4cm、淋巴結(jié)轉(zhuǎn)移、脈管癌栓、切緣陽性的OR值均大于1,是宮頸癌根治術(shù)后復發(fā)或未控的危險因素;新輔助化療及術(shù)后放化療的OR值均小于1,是宮頸癌根治術(shù)后復發(fā)或未控的保護因素。結(jié)論:臨床分期晚、腫瘤直徑≥4cm、淋巴結(jié)轉(zhuǎn)移、脈管癌栓、切緣陽性是宮頸癌術(shù)后復發(fā)或未控的危險因素,新輔助化療及術(shù)后放化療有利于減少術(shù)后復發(fā)。目的:回顧性研究宮頸癌根治術(shù)后復發(fā)或未控的再治療方式及療效,為宮頸癌術(shù)后復發(fā)或未控的治療提供參考。方法:回顧性分析2010年4月至2014年4月廣西醫(yī)科大學附屬腫瘤醫(yī)院婦瘤科收治的97例IB1期-IIB期宮頸癌根治術(shù)后復發(fā)或未控患者,分析患者術(shù)后復發(fā)或未控的時間、首發(fā)癥狀、復發(fā)或未控部位、復發(fā)或未控后的治療方式及療效等。結(jié)果:(1)97例宮頸癌復發(fā)或未控患者中,45例患者確診復發(fā)或未控時未有不適癥狀或體征,占46%;另52例患者常見的癥狀有陰道流液、腰骶部及大腿部疼痛、下肢腫脹等。(2)宮頸癌根治術(shù)后復發(fā)或未控的時間為1-40個月,中位時間13個月,平均時間12.0±7.5個月;1年內(nèi)復發(fā)或未控占49.5%、2年內(nèi)復發(fā)和未控占94.8%;常見的復發(fā)或轉(zhuǎn)移部位有盆腔、陰道殘端、骨、肺、肝等。(3)宮頸癌根治術(shù)后復發(fā)或未控患者的生存時間為2-60個月,中位生存時間為10個月,平均生存時間為13.3±10.4個月。(4)宮頸癌根治術(shù)后復發(fā)或未控患者的1年生存率為44.1%,2年生存率為16.7%,3年生存率為7.3%。(5)治療后生存時間比較:各治療組的平均生存時間整體比較具有統(tǒng)計學差異,兩兩比較提示:手術(shù)+放化療組優(yōu)于放療組、化療組;放化療組優(yōu)于化療組。中位生存時間比較:手術(shù)+放化療組手術(shù)組放化療組放療組化療組。(6)治療后近期療效比較:各治療組的有效率整體比較具有統(tǒng)計學差異,兩兩比較提示:手術(shù)組、放療組、放化療組及手術(shù)+放化療組的有效率均優(yōu)于化療組。(7)治療后生存率比較:各治療組的生存率整體比較具有統(tǒng)計學差異;兩兩比較提示:手術(shù)+放化療組生存率優(yōu)于放療組、化療組、放化療組;手術(shù)組生存率優(yōu)于化療組;放化療組優(yōu)于化療組。(8)陰道殘端復發(fā)或未控后各治療方式療效比較提示:患者經(jīng)手術(shù)+放化療治療后的平均生存時間、中位生存時間及1、2、3年生存率均為各治療組中最優(yōu)。(9)盆腔復發(fā)或未控后各治療方式療效比較提示:手術(shù)組、放療組、化療組及放化療組在近期療效及1、2、3年生存率方面的比較均無統(tǒng)計學差異。結(jié)論:(1)宮頸癌根治術(shù)后復發(fā)多在2年內(nèi),起病隱匿,術(shù)后應(yīng)加強隨訪。(2)宮頸癌根治術(shù)后復發(fā)或未控患者預后差。(3)手術(shù)+放化療是宮頸癌根治術(shù)后復發(fā)或未控患者的最佳治療方法。
[Abstract]:Objective: To explore the clinical and pathological factors of recurrent or uncontrolled cervical cancer after radical operation, and to provide a reference for the treatment of cervical cancer. Methods: a retrospective analysis of 550 cases of IA2 -IIB cervical cancer patients admitted to the Department of cancer hospital, affiliated to Guangxi Medical University, from April 2010 to April 2014, was reviewed. The bed pathological data and follow-up data were statistically analyzed with SPSS22.0 statistics software package. 13 clinical and pathological factors were included. First, single factor analysis was carried out. The significant factors in the single factor analysis were included in the Logistic regression model for multifactor analysis. Results: (1) 550 cases of cervical cancer patients after radical operation treatment. 103 cases of recurrent or uncontrolled patients, accounting for 18.7%. (2) single factor analysis, showed that 10 clinicopathological factors, including clinical staging, tumor size, degree of tissue differentiation, invasion depth of the tumor, intrastalal infiltration, vascular tumor thrombus, lymph node metastasis, cutting edge, neoadjuvant chemotherapy and postoperative adjuvant therapy were the recurrence or uncontrolled shadow of cervical cancer after radical resection. (3) the results of multiple factors analysis showed that clinical stages, tumor size, lymph node metastasis, vascular tumor thrombus, cutting edge, neoadjuvant chemotherapy and postoperative adjuvant chemotherapy were independent factors of recurrence after radical resection of cervical cancer (P0.05). The clinical stages were late, tumor diameter was more than 4cm, lymph node metastasis, vascular tumor thrombus, tangential Yang The OR value of sex is more than 1, which is a risk factor for recurrent or uncontrolled cervical cancer. The OR value of neoadjuvant chemotherapy and postoperative radiotherapy and chemotherapy is less than 1. It is a protective factor for recurrent or uncontrolled cervical cancer after radical operation. Conclusion: the clinical stage is late, the diameter of the tumor is more than 4cm, lymph node metastasis, pulse tube cancer thrombus, and the positive margin of cutting edge is the recurrence or failure of cervical cancer after operation. Control risk factors, neoadjuvant chemotherapy and postoperative radiotherapy and chemotherapy are beneficial to reduce postoperative recurrence. Objective: retrospective study of recurrent or uncontrolled retreatment after radical resection of cervical cancer, and to provide a reference for recurrent or uncontrolled treatment of cervical cancer. Methods: a retrospective analysis of the Affiliated Tumor of Guangxi Medical University from April 2010 to April 2014. 97 cases of recurrent or uncontrolled patients after IB1 -IIB radical resection of cervical cancer were treated in the Department of Hospital Department of gynaecoma. The recurrence or uncontrolled site, recurrent or uncontrolled treatment and curative effect were analyzed. Results: (1) in 97 cases of recurrent or uncontrolled cervical cancer, 45 patients had no recurrence or control. Symptoms or signs of discomfort accounted for 46%, the other 52 cases were common symptoms of vaginal fluid, lumbosacral and thigh pain, lower limb swelling, etc. (2) the recurrence or uncontrolled time of cervical cancer after radical resection was 1-40 months, median time was 13 months, the average time was 12 + 7.5 months, 1 years had relapsed or uncontrolled 49.5%, 2 years recurred and 94.8% uncontrolled in 2 years. The recurrent or metastatic sites were pelvic cavity, vaginal stump, bone, lung, liver, etc. (3) the survival time of the recurrent or uncontrolled patients after radical cervical cancer was 2-60 months, the median survival time was 10 months, the average survival time was 13.3 + 10.4 months. (4) the 1 year survival rate of recurrent or uncontrolled patients after cervical cancer was 44.1%, and the 2 year survival rate was 16.7%, 3. The survival time of the annual survival rate was 7.3%. (5) after treatment: the overall comparison of the average survival time of the treatment groups was statistically different. The 22 comparison suggested that the operation + radiotherapy and chemotherapy group was superior to the radiotherapy group and chemotherapy group; the radiotherapy and chemotherapy group was superior to the chemotherapy group. The median survival time was compared: the operation group in the operation group of hand + radiotherapy and chemotherapy group was treated with radiotherapy group chemotherapy group (6). Comparison of the short-term effect after treatment: the overall efficiency of the treatment groups had statistical differences. 22 the comparison showed that the effective rate of the operation group, the radiotherapy group, the radiotherapy and chemotherapy group and the operation + radiotherapy and chemotherapy group were superior to those in the chemotherapy group. (7) the survival rate after treatment was compared: the overall comparison of the survival rate of the treatment groups was statistically different; 22 the comparison suggests hand: hand The survival rate of the operation plus radiotherapy group was superior to the radiotherapy group, the chemotherapy group and the radiotherapy and chemotherapy group, the survival rate of the operation group was better than the chemotherapy group, and the radiotherapy and chemotherapy group was superior to the chemotherapy group. (8) the comparison of the curative effect of the recurrent or uncontrolled vaginal stump after the recrudescence or uncontrolled treatment of the vaginal stump showed that the average survival time, the median survival time and the 1,2,3 year survival rate of the patients after the operation plus radiotherapy and chemotherapy were all treated by each treatment. The treatment group was the best. (9) the comparison of the curative effect of the recurrent or uncontrolled treatment of pelvic cavity showed that there was no statistical difference between the operation group, the radiotherapy group, the chemotherapy group and the radiotherapy and chemotherapy group in the short term curative effect and the 1,2,3 year survival rate. Conclusion: (1) the recurrence of the cervical cancer after radical resection is 2 years, the onset of the disease is hidden, and the follow-up should be strengthened. (2) radical cervical cancer radical cure Postoperative recurrence or uncontrolled patients have poor prognosis. (3) surgery plus radiotherapy and chemotherapy is the best treatment for recurrent or uncontrolled cervical cancer patients.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R737.33

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