發(fā)布時(shí)間：2018-04-03 21:37

  本文選題：晚期上皮性卵巢癌　切入點(diǎn)：腫瘤細(xì)胞減滅術(shù)　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景及意義卵巢癌(Ovarian Cancer,OC)是婦科常見(jiàn)的惡性腫瘤之一,惡性程度高,預(yù)后差,其死亡率在婦科腫瘤中居于首位。據(jù)統(tǒng)計(jì)分析,全球每年約有20萬(wàn)人被確診,死亡率高達(dá)60%。近年來(lái),女性卵巢癌的發(fā)病率逐年上升。由于卵巢位于盆腔深處,發(fā)病隱匿,并且缺乏普查和早期診斷等有效措施,超過(guò)70-80%的女性發(fā)現(xiàn)時(shí)已是晚期(FIGO分期),且復(fù)發(fā)率高達(dá)50%。晚期上皮性卵巢癌的標(biāo)準(zhǔn)治療為初治的細(xì)胞減滅術(shù)聯(lián)合鉑類(lèi)為基礎(chǔ)的綜合治療。晚期卵巢癌的療效主要與手術(shù)滿(mǎn)意度、化療方案、化療方式等因素相關(guān)。由于腹膜種植轉(zhuǎn)移、細(xì)胞減滅術(shù)后微觀/隱匿的殘余病灶,即使達(dá)到滿(mǎn)意的減滅術(shù)(殘余病灶直徑1cm),仍不能徹底清除腹膜表面腫瘤。臨床上,對(duì)于晚期上皮性卵巢癌患者,目前多采用手術(shù)聯(lián)合化療。手術(shù)有細(xì)胞減滅術(shù),包括初治的細(xì)胞減滅術(shù)和中間性細(xì)胞減滅術(shù)�；煼绞接腥砘�,其臨床應(yīng)用較為廣泛,除此之外,尚有腹腔化療、新輔助化療、新輔助腹腔化療/全身化療,以及近年來(lái)研究越來(lái)越熱的腹腔熱灌注化療,越來(lái)越引起臨床醫(yī)師的青睞。目的探討分析細(xì)胞減滅術(shù)聯(lián)合腹腔熱灌注治療在晚期上皮性卵巢癌中的臨床療效,為晚期上皮性卵巢癌患者的臨床治療提供相關(guān)依據(jù)。方法收集鄭州大學(xué)第一附屬醫(yī)院2014年1月至2016年7月收入的84例初治III期、IV期上皮性卵巢癌患者,按照不同治療方式將其分為兩組:腹腔熱灌注組:滿(mǎn)意腫瘤細(xì)胞減滅術(shù)+腹腔熱灌注共31例;對(duì)照組:僅行滿(mǎn)意腫瘤細(xì)胞減滅術(shù)53例;所有治療后均行PT方案化療。比較兩組CA125水平下降情況、腹水控制率、Karnofsky功能狀態(tài)、化療不良反應(yīng)、低蛋白血癥等治療前后變化情況。結(jié)果兩組患者不同治療階段CA125水平下降情況比較:術(shù)前與第一次化療后比較(P=0.025);第一次與第二次化療后比較(P=0.039);第二次與第三次化療后比較(P=0.035);第三次與第四次化療后比較(P=0.001),其中HIPEC(Hyperthermic Intraperitoneal chemotherapy)組CA125下降程度明顯;HIPEC組腹水控制效果好于對(duì)照組(P=0.017);HIPEC組較對(duì)照組生活質(zhì)量明顯改善(P=0.018);化療不良反應(yīng)、低蛋白血癥兩組治療前后變化無(wú)明顯差異(P0.05)。結(jié)論腹腔熱灌注治療可顯著降低晚期上皮性卵巢癌患者細(xì)胞減滅術(shù)后CA125水平,可有效控制腹水的產(chǎn)生,KPS評(píng)分顯著增加,可明顯改善患者生活質(zhì)量;且不增加化療副反應(yīng)及并發(fā)癥,如骨髓抑制、惡心、嘔吐以及低蛋白血癥的發(fā)生,值得在臨床上推廣應(yīng)用。
[Abstract]:Background and significance Ovarian Cancer OCis is one of the most common malignant tumors in gynecology, with a high degree of malignancy and poor prognosis.According to statistical analysis, about 200000 people worldwide are diagnosed every year, and the mortality rate is as high as 60 percent.In recent years, the incidence of ovarian cancer in women has increased year by year.Because the ovary is located deep in the pelvic cavity, the disease is hidden, and lack of effective measures such as general survey and early diagnosis, more than 70-80% of the women found it was a late stage of Figo staging, and the recurrence rate was as high as 50%.The standard treatment for advanced epithelial ovarian cancer is the combination of primary cell reduction and platinum-based therapy.The curative effect of advanced ovarian cancer is mainly related to surgical satisfaction, chemotherapy regimen, chemotherapy mode and other factors.As a result of peritoneal implantation metastasis, microcosmic / concealed residual lesions, even if satisfactory deactivation was achieved (1 cm in diameter of residual lesions), could not completely clear the peritoneal surface tumor.Clinically, most patients with advanced epithelial ovarian cancer are treated with surgery combined with chemotherapy.Surgical procedures include primary cytoreductive surgery and intermediate cell reduction surgery.The chemotherapy methods include systemic chemotherapy, which is widely used in clinic. In addition, there are intraperitoneal chemotherapy, neoadjuvant chemotherapy, neoadjuvant intraperitoneal chemotherapy / systemic chemotherapy, as well as intraperitoneal hyperthermic chemotherapy, which is becoming hotter and hotter in recent years.More and more clinicians are getting more and more attention.Objective to investigate the clinical efficacy of cytoreductive surgery combined with intraperitoneal hyperthermic perfusion in the treatment of advanced epithelial ovarian cancer and to provide relevant evidence for the clinical treatment of advanced epithelial ovarian cancer.Methods 84 patients with primary III stage IV epithelial ovarian cancer were collected from the first affiliated Hospital of Zhengzhou University from January 2014 to July 2016.According to different treatment methods, they were divided into two groups: the abdominal hyperthermic perfusion group (31 cases) with satisfactory tumor cell reduction and the control group (53 cases) with satisfactory tumor cell reduction. All patients were treated with PT regimen chemotherapy.The changes of CA125 level, ascites control rate and Karnofsky function state, adverse reaction of chemotherapy and hypoproteinemia were compared between the two groups before and after treatment.The degree of decrease of CA125 in HIPEC(Hyperthermic Intraperitoneal chemotherapy group was significantly lower than that in control group. The ascites control effect of HIPEC group was better than that of control group, and the quality of life of HIPEC group was significantly better than that of control group.There was no significant difference between the two groups before and after treatment (P 0.05).Conclusion Peritoneal hyperthermic perfusion therapy can significantly reduce the level of CA125 after cell reduction in patients with advanced epithelial ovarian cancer, effectively control the increase of ascites and improve the quality of life of patients.No side effects and complications, such as bone marrow suppression, nausea, vomiting and hypoproteinemia, were increased.
【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】：2017
【分類(lèi)號(hào)】：R737.31

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