本文選題：子宮內(nèi)膜癌　切入點(diǎn)：子宮外轉(zhuǎn)移　出處：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景和目的 子宮內(nèi)膜癌(endometrial cancer, EC)是婦科常見的惡性腫瘤，近年來在全球范圍內(nèi)，其發(fā)病率呈逐年上升趨勢(shì)，其發(fā)病率在歐美等發(fā)達(dá)國(guó)家已超過宮頸癌，躍居第一位[1]。在我國(guó)，，目前缺少確切的發(fā)病率，但在北京及上海，據(jù)統(tǒng)計(jì)其發(fā)病率已成為女性生殖道惡性腫瘤的首位[2]。其嚴(yán)重威脅了女性的健康及生活質(zhì)量。惡性腫瘤最主要的特性為轉(zhuǎn)移，轉(zhuǎn)移成為影響患者生存及預(yù)后的主要因素，子宮內(nèi)膜癌患者子宮外轉(zhuǎn)移包括淋巴結(jié)轉(zhuǎn)移、輸卵管轉(zhuǎn)移、卵巢轉(zhuǎn)移及腹膜轉(zhuǎn)移等。隨著現(xiàn)代醫(yī)學(xué)的發(fā)展，微創(chuàng)內(nèi)鏡在婦科方面的應(yīng)用越來越廣，使得較多的子宮內(nèi)膜癌患者能早期治療。2006年，F(xiàn)IGO公布了對(duì)1962-2001年間子宮內(nèi)膜癌患者生存率研究的結(jié)果，其生存率已由63%提高到80%［3］。為了進(jìn)一步提高患者的生存率，除了早期診斷及合理治療外，也應(yīng)該注意患者存在的風(fēng)險(xiǎn)因素，準(zhǔn)確的評(píng)估預(yù)后，制定一個(gè)個(gè)體化的輔助治療方案，最大程度的提高患者生存時(shí)間。 本文旨在通過回顧性分析子宮內(nèi)膜癌患者的臨床、病理及分子生物學(xué)指標(biāo)等情況，了解EC宮外轉(zhuǎn)移的高危因素，為子宮內(nèi)膜癌的診治提供一定的指導(dǎo)。 材料和方法 搜集2009年1月至2013年10月于鄭州大學(xué)第二附屬醫(yī)院治療的149例子宮內(nèi)膜癌患者，患者臨床資料完整，所有患者均行手術(shù)治療，術(shù)前未進(jìn)行過化療、放療及內(nèi)分泌治療等，無(wú)其他合并腫瘤，并按照國(guó)際婦產(chǎn)科聯(lián)盟2009年修訂的子宮內(nèi)膜癌手術(shù)-病理分期標(biāo)準(zhǔn)分期，其中I期患者行筋膜外子宮全切術(shù)+雙附件切除術(shù)，有高危因素（特殊病理類型、組織細(xì)胞分化差等）或可疑盆腔及腹主動(dòng)脈旁淋巴結(jié)腫大者行盆腔淋巴結(jié)及腹主動(dòng)脈旁淋巴結(jié)清掃術(shù)或取樣術(shù)，II期患者行廣泛或次廣泛子宮全切術(shù)+雙附件切除術(shù)+盆腔淋巴結(jié)及腹主動(dòng)脈旁淋巴結(jié)清掃術(shù)，III期患者行腫瘤細(xì)胞減滅術(shù)。 回顧性分析149例患者的年齡、絕經(jīng)情況、病理類型、組織學(xué)分級(jí)、肌層浸潤(rùn)深度及EC的高危因素（高血壓、糖尿病及肥胖）�；仡櫺苑治�149例患者中行免疫組化SP法檢測(cè)的104例患者的雌激素受體(estrogen receptor,ER)、103例患者的孕激素受體（progesterone receptor，PR）、104例患者的腫瘤蛋白53（tumorprotein53,P53)及行放射免疫法檢測(cè)的98例患者癌抗原125（cancer antigen125，CA125）的表達(dá)情況，分析子宮內(nèi)膜癌子宮外轉(zhuǎn)移的高危因素。 應(yīng)用SPSS17.0統(tǒng)計(jì)軟件包對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析，采用χ2檢驗(yàn)和Fisher確切概率法進(jìn)行計(jì)數(shù)資料分析，多因素采用Logistic回歸模型分析，以P0.05為有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1.子宮內(nèi)膜癌發(fā)病年齡分布于27-80歲，平均發(fā)病年齡為56.53±9.047歲，已絕經(jīng)者104例，占69.79%（104/149），未絕經(jīng)者45例，占30.21（45/149）。 2.149例患者中子宮外轉(zhuǎn)移者共13例，占8.72%(13/149),其中淋巴結(jié)轉(zhuǎn)移者7例，構(gòu)成比為53.84%(7/13)，最常見，其次為輸卵管轉(zhuǎn)移者3例，構(gòu)成比為23.07%(3/13)，其余3例為多部位子宮外轉(zhuǎn)移，包括1例出現(xiàn)了輸卵管、卵巢、腸系膜和腹水的轉(zhuǎn)移，1例卵巢及輸卵管均有轉(zhuǎn)移，1例有盆腔淋巴結(jié)及腹膜的轉(zhuǎn)移。 3.統(tǒng)計(jì)分析表明，特殊病理類型、組織學(xué)分級(jí)3級(jí)、肌層浸潤(rùn)深度≥1/2、ER陰性、PR陰性、CA125陽(yáng)性及伴高危因素（高血壓、糖尿病及肥胖）的子宮內(nèi)膜癌患者的子宮外轉(zhuǎn)移率高（P0.05），高-中分化組織、P53表達(dá)情況、絕經(jīng)情況及年齡對(duì)子宮內(nèi)膜癌子宮外轉(zhuǎn)移無(wú)明顯影響（P0.05），多因素Logistic回歸模型分析表明，特殊病理類型、組織學(xué)分級(jí)3級(jí)、肌層浸潤(rùn)深度≥1/2及子宮內(nèi)膜癌的高危因素（高血壓、糖尿病及肥胖）不是子宮內(nèi)膜癌子宮外轉(zhuǎn)移的獨(dú)立影響因素。 結(jié)論 1.子宮內(nèi)膜癌子宮外轉(zhuǎn)移最常見的是淋巴結(jié)轉(zhuǎn)移，其次為輸卵管轉(zhuǎn)移，有少部分患者表現(xiàn)為輸卵管、卵巢及腹膜等多部位轉(zhuǎn)移。 2.特殊病理類型、組織學(xué)分級(jí)3級(jí)、肌層浸潤(rùn)深度≥1/2、ER陰性、PR陰性、CA125陽(yáng)性及伴子宮內(nèi)膜癌的高危因素（高血壓、糖尿病及肥胖）是子宮內(nèi)膜癌子宮外轉(zhuǎn)移的高危影響因素。
[Abstract]:Background and purpose
Endometrial cancer (endometrial cancer EC) is a common gynecological malignant tumor in the world in recent years, its incidence increased year by year, the incidence rate in Europe and other developed countries have been more than cervical cancer, ranked first in the [1]. in our country, there is a lack of exact incidence, but in Beijing and Shanghai according to statistics, the incidence rate of [2]. has become the first malignant tumor of the female genital tract of the serious threat to the health and quality of life of women. The most important feature of malignant tumor metastasis, metastasis is the main factor affecting the survival and prognosis of patients, patients with uterine endometrial carcinoma metastasis including lymph node metastasis, tubal ovarian metastasis. Metastasis and peritoneal metastasis. With the development of modern medicine, minimally invasive endoscopic application is more and more widely in gynecology, that many patients with endometrial cancer can be early treatment for.2006 years, FIGO announced on the 1962-200 The 1 years survival rate of patients with endometrial cancer research results, the survival rate has increased from 63% to 80% in 3. In order to further improve the survival rate of patients, in addition to early diagnosis and reasonable treatment, should also pay attention to the risk factors of patients, accurate assessment of prognosis, treatment plan of one individual the survival time of the patients, increase the maximum degree.
The purpose of this study is to understand the risk factors of EC extrauterine metastasis by retrospective analysis of the clinical, pathological and molecular biological indicators, and provide guidance for the diagnosis and treatment of endometrial cancer.
Materials and methods
149 cases of endometrial cancer patients were collected from January 2009 to October 2013 in the Second Affiliated Hospital of Zhengzhou University of treatment, patients with complete clinical data, all patients underwent surgical treatment, preoperative without chemotherapy, radiotherapy and endocrine therapy, no other tumor, and in accordance with the operation of endometrial carcinoma in 2009 revision of the International Federation of gynecology and obstetrics staging the standard stage, stage I underwent extrafascial hysterectomy + double oophorectomy, high risk factors (special pathological type, cell differentiation etc.) or suspected pelvic and paraaortic lymph node enlargement for pelvic lymph nodes and para aortic lymph node dissection or biopsy in patients with II. During the period of either extensive hysterectomy + double appendix resection and pelvic lymph nodes and para aortic lymph node dissection, tumor cells were treated with III during cytoreductive surgery.
A retrospective analysis of 149 cases of patients with age, menopausal status, pathological type, histological grade, myometrial invasion and EC risk factors (hypertension, diabetes and obesity). A retrospective analysis of 149 cases of estrogen receptor 104 patients underwent SP immunohistochemical method to detect the patients (estrogen receptor, ER), progesterone receptor 103 patients (progesterone receptor, PR), 104 patients with tumor protein 53 (tumorprotein53, P53) in 98 patients with cancer antigen detection and radioimmunoassay for 125 (cancer antigen125 CA125) expression, the risk factors of endometrial cancer metastasis outside the uterus.
SPSS17.0 statistical software package was applied to analyze the data. Chi square test and Fisher exact probability method were used to analyze the count data. Multiple factors were analyzed by Logistic regression model. P0.05 was statistically significant. Logistic regression analysis showed that the data were statistically significant.
Result
1., the onset age of endometrial cancer is 27-80 years old, the average age of onset is 56.53 + 9.047 years, 104 cases of menopause, 69.79% (104/149), and 45 cases of non menopausal women, accounting for 30.21 (45/149).
In 2.149 patients of uterine metastasis were 13 cases, accounting for 8.72% (13/149), including 7 cases of lymph node metastasis, accounting for 53.84% (7/13), the most common, followed by 3 cases of tubal metastasis, accounting for 23.07% (3/13), and 3 cases of multiple sites of metastasis. Including 1 cases of oviduct, ovarian metastasis, mesentery and ascites, 1 cases of metastasis were ovary and fallopian tube, 1 cases of metastatic pelvic lymph node and peritoneal.
3. statistical analysis showed that the special pathological type, histological grade, 3 grade, myometrial invasion depth more than 1/2, ER negative, PR negative, CA125 positive and with risk factors (hypertension, diabetes and obesity) of the patients with carcinoma of endometrium outside the uterus high transfer rate (P0.05), high - in differentiated tissues, the expression of P53 the situation, menopausal status and age of uterine endometrial carcinoma metastasis has no significant effect (P0.05), multi factor Logistic regression analysis showed that, the special pathological type, histological grade, 3 grade, myometrial invasion depth more than 1/2 and endometrial cancer risk factors (hypertension, diabetes and obesity) were not independent factors of endometrial carcinoma of the uterine metastasis.
conclusion
1., the most common extrauterine metastasis of endometrial carcinoma is lymph node metastasis, followed by tubal metastasis. A few patients are metastatic to the multiple parts of the fallopian tube, ovary and peritoneum.
2. special pathological type, histological grade, 3 grade, myometrial invasion depth more than 1/2, ER negative, PR negative, positive and risk factors associated with endometrial cancer CA125 (hypertension, diabetes and obesity) are high risk factors of endometrial cancer metastasis outside the uterus.

【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.33

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王黎明,戴淑真;子宮內(nèi)膜癌術(shù)中肉眼觀察肌層浸潤(rùn)深度的臨床價(jià)值[J];山東醫(yī)藥;2002年31期

2 李新英;;子宮內(nèi)胰腺癌肌層浸潤(rùn)深度的判定[J];國(guó)外醫(yī)學(xué).婦產(chǎn)科學(xué)分冊(cè);1991年01期

3 許峭峰,符玉亭;子宮內(nèi)膜癌肌層浸潤(rùn)深度的陰道超聲診斷[J];現(xiàn)代臨床醫(yī)學(xué)生物工程學(xué)雜志;2001年02期

4 溫寶寧,詹雪梅,阮曉紅,鐘倩,羅中明;子宮內(nèi)膜癌肌層浸潤(rùn)深度的判斷[J];醫(yī)藥論壇雜志;2003年09期

5 陸云燕;劉蓉;邵佳;;術(shù)中肉眼觀察子宮內(nèi)膜癌肌層浸潤(rùn)深度的臨床價(jià)值[J];南通大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2007年06期

6 孫智晶;楊佳欣;沈鏗;郎景和;劉真真;姜玉新;;超聲造影技術(shù)對(duì)子宮內(nèi)膜癌肌層浸潤(rùn)深度診斷價(jià)值的探討[J];生殖醫(yī)學(xué)雜志;2008年03期

7 田梅;李芝芳;黃彩敏;;上、下級(jí)醫(yī)生術(shù)中肉眼觀察對(duì)判斷子宮內(nèi)膜癌肌層浸潤(rùn)深度的區(qū)別[J];中國(guó)計(jì)劃生育和婦產(chǎn)科;2010年04期

8 孫彤,徐小蓉,卞度宏,李曉華,張曲;經(jīng)陰道超聲判斷子宮內(nèi)膜癌肌層浸潤(rùn)深度[J];中華超聲影像學(xué)雜志;1998年05期

9 王鳳英,趙東利,楊雪峰,邵春寶;子宮內(nèi)膜癌病理類型與肌層浸潤(rùn)深度探討[J];中國(guó)腫瘤臨床與康復(fù);1999年04期

10 彭萍,沈鏗,郎景和,黃惠芳,吳鳴,崔全才,姜玉新,譚莉;子宮內(nèi)膜癌肌層浸潤(rùn)深度的評(píng)估[J];中華婦產(chǎn)科雜志;2002年11期

相關(guān)會(huì)議論文 前5條

1 常時(shí)新;陳瑤;周蕾;鮑紅;田芳;薛峰;周自明;陳笛;朱樂群;倪肖衛(wèi);陳亮;阮方;;3D THRIVE增強(qiáng)掃描結(jié)合曲面重建技術(shù)判斷子宮內(nèi)膜癌肌層浸潤(rùn)深度的價(jià)值[A];第十一次全國(guó)中西醫(yī)結(jié)合影像學(xué)術(shù)研討會(huì)暨全國(guó)中西醫(yī)結(jié)合影像學(xué)研究進(jìn)展學(xué)習(xí)班資料匯編[C];2010年

2 孫智晶;楊佳欣;沈鏗;郎景和;;超聲造影技術(shù)對(duì)子宮內(nèi)膜癌肌層浸潤(rùn)深度診斷價(jià)值的探討[A];中華醫(yī)學(xué)會(huì)第一屆全球華人婦產(chǎn)科學(xué)術(shù)大會(huì)暨第三次全國(guó)婦產(chǎn)科中青年醫(yī)師學(xué)術(shù)會(huì)議論文匯編[C];2007年

3 隋麗華;王晶;張?jiān)破G;張桂榮;;子宮內(nèi)膜癌手術(shù)中肉眼觀察的臨床價(jià)值[A];中國(guó)抗癌協(xié)會(huì)婦科腫瘤專業(yè)委員會(huì)第六次全國(guó)學(xué)術(shù)會(huì)議論文匯編[C];2001年

4 王秀芬;;子宮內(nèi)膜癌147例臨床分析[A];江蘇省抗癌協(xié)會(huì)婦科腫瘤專業(yè)委員會(huì)第四次腫瘤學(xué)術(shù)研討會(huì)暨無(wú)錫市婦產(chǎn)科年會(huì)論文匯編[C];2005年

5 林鳳;吳雪清;周凱;鄭飛云;;脂肪酸合成酶在子宮內(nèi)膜癌中的表達(dá)及其臨床意義[A];2008年浙江省婦產(chǎn)科學(xué)學(xué)術(shù)年會(huì)暨浙江省醫(yī)師協(xié)會(huì)婦產(chǎn)科醫(yī)師分會(huì)成立大會(huì)論文匯編[C];2008年

相關(guān)博士學(xué)位論文 前1條

1 王立俠;低場(chǎng)強(qiáng)和高場(chǎng)強(qiáng)磁共振成像在子宮內(nèi)膜癌的應(yīng)用[D];中國(guó)協(xié)和醫(yī)科大學(xué);2007年

相關(guān)碩士學(xué)位論文 前10條

1 金艷艷;200例子宮內(nèi)膜癌的臨床病例分析[D];寧夏醫(yī)科大學(xué);2013年

2 張z呏

本文編號(hào)：1697507