本文選題：卵巢癌　切入點(diǎn)：腫瘤細(xì)胞減滅術(shù)　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:隨著醫(yī)學(xué)技術(shù)的飛速發(fā)展,婦科惡性腫瘤的治療從傳統(tǒng)的開放式手術(shù)逐漸發(fā)展到微創(chuàng)手術(shù),而對(duì)于卵巢癌患者的具體手術(shù)方式一直是婦科臨床醫(yī)師討論的焦點(diǎn),尤其是對(duì)于“多器官轉(zhuǎn)移、盆腹腔致密粘連”的晚期卵巢癌患者,單單借助腹腔鏡技術(shù)是遠(yuǎn)遠(yuǎn)不能獨(dú)立實(shí)現(xiàn)滿意的腫瘤細(xì)胞減滅術(shù)的。本研究探討一種“雜交”的手術(shù)方式——手助腹腔鏡手術(shù)(hand-assisted laparoscopic surgery,HALS)在卵巢癌腫瘤細(xì)胞減滅術(shù)中的應(yīng)用;并將其與常規(guī)開腹手術(shù)(open surgery,OS)在卵巢癌腫瘤細(xì)胞減滅術(shù)中的應(yīng)用進(jìn)行初步的臨床對(duì)比研究,為卵巢癌的臨床治療提供新思路。方法:1病例收集:收集自2014年11月至2016年11月在我院因卵巢癌行腫瘤細(xì)胞減滅術(shù)的58例患者,其中手助腹腔鏡組(HALS組:18例)及開腹組(OS組:40例)。術(shù)前無化療史,術(shù)后石蠟結(jié)果屬于卵巢上皮性惡性腫瘤。所有病例均按照國際婦產(chǎn)科聯(lián)盟(International Federation of Gynecology and Obstetrics,FIGO 2014)手術(shù)分期標(biāo)準(zhǔn)進(jìn)行分期,并給予規(guī)范的TP方案化療。2比較兩組患者一般資料:HALS組與OS組患者的年齡[(58.33±8.19)歲VS(55.95±7.29)歲,P0.05],兩組患者合并癥分別包括高血壓、糖尿病、肥胖、低蛋白血癥、盆腹腔手術(shù)史等,一般情況比較差異無統(tǒng)計(jì)學(xué)意義,具有可比性。3術(shù)前準(zhǔn)備、麻醉和體位、手術(shù)。4觀察指標(biāo):手術(shù)切口長度、手術(shù)時(shí)間、術(shù)中出血量、術(shù)后殘留腫瘤大小、術(shù)后腸道恢復(fù)時(shí)間、術(shù)后住院時(shí)間、術(shù)后第一次化療的時(shí)間之間的差異,兩組患者術(shù)后病理結(jié)果及腫瘤分期的分布,及兩組患者術(shù)后生存情況之間的差異。5統(tǒng)計(jì)學(xué)處理:采用SPSS 21.0統(tǒng)計(jì)軟件進(jìn)行分析,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用χ2檢驗(yàn)。采用Kaplan-Meier方法描繪生存曲線。α=0.05為檢驗(yàn)標(biāo)準(zhǔn),P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1 HALS組與OS組組間手術(shù)及術(shù)后指標(biāo)相比:手術(shù)切口長度[(7.22±0.42)cm vs(22.73±1.54)cm,P0.05]、術(shù)中出血量[(569.44±249.79)mL vs(881.50±539.73)mL,P0.05]、術(shù)后腸道功能恢復(fù)時(shí)間[(2.89±0.90)d vs(3.95±0.88)d,P0.05]、術(shù)后第一次化療時(shí)間[(11.07±3.26)d vs(13.54±3.06)d,P0.05],HALS組均少于OS組,差異有統(tǒng)計(jì)學(xué)意義。手術(shù)時(shí)間[(263.61±70.86)min vs(275.00±29.96)min,P0.05]、術(shù)后住院天數(shù)[(18.17±5.35)d vs(18.20±3.93)d,P0.05],HALS組與OS組差異無統(tǒng)計(jì)學(xué)意義。術(shù)后殘留腫瘤直徑1cm的患者HALS組占總數(shù)88.89%,而OS組占總數(shù)62.5%,說明HALS組比OS組有較好的腫瘤減滅效果。2兩組患者術(shù)后病理結(jié)果按組織學(xué)類型分為漿液性腫瘤、粘液性腫瘤、子宮內(nèi)膜樣腫瘤、透明細(xì)胞腫瘤、其他類型腫瘤,HALS組占總數(shù)比例依次為66.66%、11.11%、5.56%、0、16.67%;OS組占總數(shù)比例依次為60%、17.5%、7.5%、10%、5%。按病理分期分為I期、II期、III期、IV期,HALS組各期別依次占總數(shù)比例為0、0、77.78%、22.22%;OS組各期別依次占總數(shù)比例為15%、5%、62.5%、17.5%。3自2014年11月隨訪患者至2016年11月,HALS組與OS組患者的術(shù)后短期生存率差異無統(tǒng)計(jì)學(xué)意義。結(jié)論:1與開腹卵巢癌腫瘤細(xì)胞減滅術(shù)相比,手助腹腔鏡手術(shù)沒有降低治療效果,并且具有安全可行、創(chuàng)傷小、恢復(fù)快、腫瘤細(xì)胞減滅程度滿意的優(yōu)勢(shì),值得在臨床中推廣應(yīng)用。2早期卵巢癌可在腹腔鏡下行腫瘤細(xì)胞減滅術(shù),大部分晚期卵巢癌可借助手助腹腔鏡技術(shù)完成滿意的腫瘤細(xì)胞減滅術(shù),小部分可先進(jìn)行新輔助化療再行腫瘤細(xì)胞減滅術(shù),術(shù)后結(jié)合敏感化療藥物的應(yīng)用,改善患者的預(yù)后。
[Abstract]:Objective: with the rapid development of medical technology, the treatment of gynecological malignant tumors gradually developed from traditional open surgery to minimally invasive surgery, and for a specific operation in patients with ovarian cancer has been the focus of gynecological clinicians discussed, especially for multiple organ metastasis, peritoneal adhesion in advanced ovarian cancer patients, with only "the laparoscopic technique is far from independence to achieve satisfactory cytoreduction surgery. This study explores a" hybrid "of hand assisted laparoscopic surgery (hand-assisted laparoscopic surgery, HALS) and the clinical application of reduction in ovarian cancer cells; and with the conventional laparotomy (open surgery OS) destroy the clinical application of clinical preliminary comparative study on reduction in ovarian cancer cells, to provide new ideas for clinical treatment of ovarian cancer. Methods: 1 cases collected: collected from 2014 From November to November 2016 for 58 cases of ovarian cancer tumor cells by cytoreductive surgery patients in our hospital, including hand assisted laparoscopic group (HALS group, 18 cases) and laparotomy group (group OS, 40 cases). Preoperative chemotherapy history, postoperative paraffin results belong to malignant ovarian epithelial tumor. All cases were according to the International Federation of gynecology and Obstetrics (International Federation of Gynecology and Obstetrics, FIGO 2014) surgical staging, and received TP chemotherapy.2 standard data were compared between the two groups: HALS group and OS group were age (58.33 + 8.19) [VS (55.95 + 7.29) P0.05], two years old. Patients with comorbidities including hypertension, diabetes, obesity, hypoproteinemia, abdominal surgery history, generally no significant difference, comparable.3 preoperative preparation, anesthesia and surgical posture,.4 observation index: the incision length, operative time, intraoperative bleeding 閲，

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