本文選題：卵巢子宮內(nèi)膜異位癥　切入點(diǎn)：惡變　出處：《天津醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:分析卵巢子宮內(nèi)膜異位癥(EMs)惡變患者的一般資料、臨床表現(xiàn)、輔助檢查、治療方法及預(yù)后情況,總結(jié)卵巢EMs惡變的臨床特征,探索影響卵巢EMs惡變及預(yù)后的相關(guān)因素。旨在發(fā)現(xiàn)卵巢EMs惡變的前瞻性和預(yù)后判斷標(biāo)志,以便早診斷、早治療,延長患者生存時(shí)間,提高患者生活質(zhì)量。方法:以2010年-2015年天津中心婦產(chǎn)科醫(yī)院收治的564例卵巢EMs患者為研究對象,其中113例卵巢EMs惡變患者為研究組,451例卵巢EMs未惡變患者為對照組,回顧性分析兩組患者的所有臨床資料及術(shù)后隨訪情況,以多因素分析闡明EMs惡變的危險(xiǎn)因素及預(yù)后的相關(guān)因素。結(jié)果:1、研究組患者平均年齡較對照組大、首次性生活平均年齡較對照組大、平均結(jié)婚年齡較對照組大、平均病程較對照組長、平均BMI指數(shù)較對照組大、腦力勞動(dòng)者比例高于對照組、體力勞動(dòng)者比例低于對照組。研究組絕經(jīng)、痛經(jīng)的患者比例均高于對照組。研究組患者流產(chǎn)次數(shù)較對照組多、剖宮產(chǎn)比例較對照組高、順產(chǎn)比例較對照組低、生產(chǎn)次數(shù)較對照組少。兩組患者以上指標(biāo)均具有統(tǒng)計(jì)學(xué)差異(p0.05)。多因素非條件Logistic回歸分析表明結(jié)婚年齡、生產(chǎn)次數(shù)、病程、BMI指數(shù)是影響卵巢EMs惡變的4個(gè)主要因素。2、研究組及對照組患者臨床表現(xiàn)中腹部脹痛發(fā)生率最高,其他依次為腹部觸及包塊,性交痛,不孕,陰道不規(guī)律出血,無自覺癥狀。研究組患者腹部脹痛、腹部觸及包塊的發(fā)生率均高于對照組,且差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。根據(jù)癌癥臨床分期,將Ⅰ、Ⅱ期作為輕度組(87例),Ⅲ、Ⅳ期作為重度組(26例)。重度組患者腹部脹痛、性交痛、不孕的發(fā)生率較輕度組高,差異均具有統(tǒng)計(jì)學(xué)意義(p0.05)。3、研究組患者包塊以囊實(shí)混合性最多(40.7%),包塊直徑≥8cm者占34.5%,50.4%患者半年內(nèi)包塊迅速增大,所有標(biāo)本均檢出異位內(nèi)膜腺上皮不典型或核異型性改變。對照組患者包塊90%以上為囊性,包塊直徑≥8cm者占17.7%,14.4%患者半年內(nèi)包塊迅速增大,其中28例出現(xiàn)不典型或核異型性改變。4、研究組患者HE4、CA125、CA199水平均高于對照組,差異均有統(tǒng)計(jì)學(xué)意義(p0.05)。HE4、CA125、CA199在Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者血清中的表達(dá)水平均存在顯著差異(所有p0.05),隨著臨床分期的增加,HE4、CA199、CA125的水平升高。而HE4、CA125及CA199在不同組織病理分型的患者間無統(tǒng)計(jì)學(xué)差異(p0.05)。5、研究組術(shù)后平均隨訪37.6個(gè)月(6-72個(gè)月)。術(shù)后1年內(nèi)復(fù)發(fā)2例,3年內(nèi)復(fù)發(fā)11例,5年內(nèi)復(fù)發(fā)26例,死亡7例,其中5例死于術(shù)后復(fù)發(fā)。1年存活率99.4%,3年存活率96.8%,5年存活率92.8%。臨床分期、組織學(xué)分型、化療是影響惡變EMs患者術(shù)后預(yù)后的3個(gè)主要因素。結(jié)論:1、卵巢EMs患者以育齡婦女多見,惡變患者出現(xiàn)癥狀比例和癥狀復(fù)雜程度較未惡變患者高,且與臨床分期有關(guān),臨床分期越高,癥狀越明顯越復(fù)雜。2、結(jié)婚年齡晚、生產(chǎn)次數(shù)少、病程長、BMI指數(shù)大4個(gè)因素是卵巢EMs惡變的危險(xiǎn)因素。3、綜合臨床癥狀、病史、病理檢查、血清HE4、CA125、CA199和影像學(xué)檢查等能有效提高卵巢EMs惡變的診斷和鑒別診斷。4、臨床分期、組織學(xué)分型和化療是影響惡變EMs患者預(yù)后的相關(guān)因素。
[Abstract]:Objective: to analyze ovarian endometriosis (EMs) patients with malignant general data, clinical manifestation, auxiliary examination, treatment and prognosis of ovarian malignant EMs, summarize the clinical features, explore the influence factors of ovarian malignancy and prognosis of EMs. In order to find ovarian malignant EMs and prospective prognosis sign to early diagnosis early treatment, prolong the survival time of patients, improve the quality of life of patients. Methods: 564 cases of ovarian EMs patients admitted to Tianjin Central Obstetrics and Gynecology Hospital from 2010 -2015 years as the research object, including 113 cases of ovarian malignant EMs patients for the study group, 451 patients with non malignant ovarian EMs as control group, retrospective analysis of all clinical data and two groups. The patients were followed up, with the multivariate analysis of factors related risk factors and prognosis of malignant transformation in the elucidation of EMs. Results: 1, the average age of patients in the study group than in the control group, for the first time of birth The average age of living compared with the control group, the average age of marriage was larger than the control group, the average duration than in the control group, the average BMI index compared with the control group, the proportion of mental workers was higher than the control group, the proportion of manual workers is lower than the control group. The study group menopause, the proportion of patients with dysmenorrhea were higher than the control group. The patients in the study group compared to the number of abortion the control group, the rate of cesarean section was higher than that in control group, delivery ratio is lower than the control group, the number of production is less than the control group. Two groups of patients with the above indexes were statistically significant (P0.05). Non conditional Logistic regression analysis showed that the age of marriage, the number of production factors, disease duration, BMI index is 4 main factors influencing EMs.2 of ovarian malignant transformation, the study group and the control group of patients with clinical manifestations of abdominal pain was the highest, followed by the palpable abdominal mass, sexual pain, infertility, irregular vaginal bleeding, no symptoms. Study group patients with abdominal Department of pain, the incidence of palpable abdominal mass were higher than the control group, and the difference was statistically significant (P0.05). According to the clinical stage of cancer, will I, II as mild group (87 cases), III, IV as severe group (26 cases). Patients with severe abdominal pain, dyspareunia and infertility the incidence of mild group, the differences were statistically significant (.3, P0.05) of patients in the study group with mass cystic mass (40.7%), the largest diameter was larger than 8cm accounted for 34.5%, 50.4% patients within six months of mass increases rapidly, all specimens were detected in ectopic endometrial epithelial cells or atypical nuclear atypia the changes of the patients in the control group. More than 90% of cystic mass, mass diameter was larger than 8cm accounted for 17.7%, 14.4% patients within six months of mass increases rapidly, including 28 cases of atypical nuclear atypia or changes in.4, CA125 HE4, CA199 of patients in the study group, the level is higher than the control group, the differences were statistically significant (P0.05).HE 4,CA125,CA199鍦ㄢ厾,鈪，

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