本文選題：宮頸腫瘤 + 微偏腺癌��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：利用Meta分析方法，對(duì)國內(nèi)宮頸微偏腺癌患者臨床及病理資料進(jìn)行定量綜合分析，以探討宮頸微偏腺癌獨(dú)特的臨床及病理特征，為該疾病診斷及治療提供循證醫(yī)學(xué)證據(jù)。 方法：以宮頸微偏腺癌、宮頸惡性腺瘤及宮頸低離正性腺癌為檢索詞，檢索中國期刊網(wǎng)全文數(shù)據(jù)庫、萬方數(shù)據(jù)庫、中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫及維普中文科技期刊數(shù)據(jù)庫中1980-2014.1期間公開發(fā)表的關(guān)于宮頸微偏腺癌的臨床病例系列報(bào)道，并結(jié)合大連市婦產(chǎn)醫(yī)院診治的2例宮頸微偏腺癌；依照納入與排除標(biāo)準(zhǔn)進(jìn)行文獻(xiàn)篩選，定性評(píng)價(jià)最終納入文獻(xiàn)；提取文獻(xiàn)相關(guān)數(shù)據(jù)，并按各研究結(jié)局分別錄入StataSE.11及SPSS17.0統(tǒng)計(jì)學(xué)軟件中，處理數(shù)據(jù)以進(jìn)行Meta分析。結(jié)局指標(biāo)中年齡采用均數(shù)、中位數(shù)為總效應(yīng)量；二分類變量采用集合比值比（POR）為總效應(yīng)量進(jìn)行評(píng)估；區(qū)間估計(jì)均采用95%可信區(qū)間；生存分析應(yīng)用Kaplan-Meier法。 結(jié)果： 1.宮頸微偏腺癌臨床特點(diǎn)： (1)本研究最終共納入223例宮頸微偏腺癌患者臨床資料。 (2)發(fā)病年齡：20-86歲，平均年齡45.44歲，中位數(shù)年齡45歲。 (3)臨床癥狀：陰道大量排液約占報(bào)道病例65.92%（147/223，95%CI[59.70，72.14]）；陰道不規(guī)則流血或以接觸性出血為主約占報(bào)道病例56.95%（127/223，95%CI[50.45，63.44]）；下腹痛及下腹脹約占報(bào)道病例12.56%（28/223，95%CI[8.21，16.91]）。 (4)婦科檢查：最常見宮頸肥大、呈桶狀，，約占報(bào)道病例62.43%（118/189，95%CI[55.53，69.34]）；且大多數(shù)宮頸質(zhì)硬，占報(bào)道病例29.63%（56/189，95%CI[23.12，36.14]）；其次為宮頸糜爛占報(bào)道病例42.33%（80/189，95%CI[35.28，49.37]）；宮頸呈結(jié)節(jié)狀、表面凹凸不平約占報(bào)道病例24.39%（46/189，95%CI[18.22，30.46]）；部分患者宮頸光滑，未見異常，占報(bào)道病例13.76%（26/189，95%CI[8.85，18.67]）。 2.宮頸微偏腺癌影像學(xué)檢查：63例超聲檢查情況：宮頸回聲異常、宮腔積液24例；宮頸部增大19例；無明顯異常8例；宮頸占位性病變7例；宮頸多發(fā)囊性改變5例。 3.宮頸微偏腺癌細(xì)胞學(xué)檢查：宮頸細(xì)胞學(xué)篩查陽性率8.51%（8/94），大部分患者需經(jīng)多次（2-4次）細(xì)胞學(xué)篩查方可發(fā)現(xiàn)陽性。 4.宮頸微偏腺癌病理組織學(xué)檢查：通過宮頸活檢、宮頸錐切確診為宮頸微偏腺癌者約占報(bào)道病例61.11%（99/162，95%CI[53.60，68.62]）。免疫組化檢查結(jié)果：CEA陽性率93.58%（102/109，95%CI[88.98，98.18]）；P53陽性率75.00%（42/56，95%CI[63.66，86.34]）；Ki-67陽性率100%（41/41）；ER陽性率0%（0/34）；CA125陽性率10.34%（3/29，95%CI[0.00，21.43]）。 5.宮頸微偏腺癌治療方式：手術(shù)治療為主，術(shù)后輔助放、化療；早期確診、臨床分期及手術(shù)方法，對(duì)患者預(yù)后尤為重要。 結(jié)論：宮頸微偏腺癌臨床癥狀、體征不明顯，診斷較困難，且易漏診及誤診。細(xì)胞學(xué)篩查陽性率低，最終確診依據(jù)病理組織學(xué)檢查。重復(fù)且深層宮頸活檢或?qū)m頸錐形切病理，并聯(lián)合免疫組化可提高該病診斷準(zhǔn)確率。術(shù)前已明確診斷者，應(yīng)依據(jù)疾病臨床分期，指導(dǎo)選擇個(gè)體化治療方案。
[Abstract]:Objective : To analyze the clinical and pathological data of cervical micro - thyroid cancer patients by Meta - analysis , so as to investigate the unique clinical and pathological characteristics of cervical microdysplasia and provide evidence for evidence - based medicine for the diagnosis and treatment of the disease .

Methods : From 1980 to 2014 , the clinical case series of cervical microdysplasia was published in the database of Chinese Journal Net , Wanfang database , Chinese Biomedical Literature Database and Vpu Chinese Journal of Science and Technology .
Literature screening is conducted according to the inclusion and exclusion criteria , and the qualitative evaluation is finally included in the literature ;
Literature - related data was extracted , and the data was recorded in StataSE . 11 and SPSS 17.0 statistics software respectively according to the results of each study . The data was processed for Meta - analysis . The median age in the outcome measure was the mean number and the median is the total effective amount ;
The second classification variables are evaluated by the aggregate ratio ( PORs ) as the total effective amount ;
The interval estimate is 95 % confidence interval ;
Kaplan - Meier method was applied to survival analysis .

Results :

1 . Clinical characteristics of cervical micro - thyroid carcinoma :

( 1 ) The clinical data of 223 cases of cervical microdysplasia were enrolled in this study .

( 2 ) Age : 20 - 86 years , mean age 45.44 years , median age 45 years .

( 3 ) Clinical symptoms : about 65.92 % ( 147 / 223 , 95 % CI : 59.70 , 72.14 ) ;
vaginal irregular bleeding or contact bleeding accounted for 56.95 % of the reported cases ( 127 / 223 , 95 % CI : 50.45 , 63.44 ) ;
The lower abdominal pain and lower abdominal distension account for 12.56 % of the reported cases ( 28 / 223 , 95 % CI : 8.21 , 16.91 ) .

( 4 ) gynecological examination : the most common cervical hypertrophy , barrel - shaped , accounting for 62.43 % ( 118 / 189 , 95 % CI : 55.53 , 69.34 % ) ;
Most of the cases were hard , accounting for 29.63 % ( 56 / 189 , 95 % CI : 23.12 , 36.14 ) ;
Secondly , cervical erosion accounted for 42.33 % of the reported cases ( 80 / 189 , 95 % CI : 35.28 , 49.37 % ) ;
The cervix was nodular , and the surface was irregular about 24.39 % ( 46 / 189 , 95 % CI : 18.22 , 30.46 % ) .
In some cases , the cervix was smooth and abnormal , accounting for 13.76 % of the cases ( 26 / 189 , 95 % CI : 8.85 , 18.67 % ) .

2 . Imaging examination of cervical micro - thyroid carcinoma : 63 cases of ultrasonic examination : abnormal cervix echo and 24 cases of uterine cavity fluid ;
There were 19 cases of cervical enlargement .
No obvious abnormality was found in 8 cases .
7 cases of cervical occupying lesion ;
Multiple cystic changes of cervix were found in 5 cases .

3 . Cytological examination of cervical microadenoma : The positive rate of cervical cytology was 8.51 % ( 8 / 94 ) . Most of the patients were able to find positive after multiple ( 2 - 4 ) cytologic screening .

4 . The pathological and histological examination of cervical micro - thyroid carcinoma : The positive rate of CEA was 93.58 % ( 102 / 109 , 95 % CI : 88.98 , 98.18 % ) by cervical biopsy and cervical taper . The positive rate of CEA was 93.58 % ( 102 / 109 , 95 % CI : 88.98 , 98.18 % ) .
The positive rate of P53 was 75.00 % ( 42 / 56 , 95 % CI : 63.66 , 86.34 ) ;
The positive rate of Ki - 67 was 100 % ( 41 / 41 ) .
The positive rate of ER was 0 % ( 0 / 34 ) .
The positive rate of CA125 was 10.34 % ( 3 / 29 , 95 % CI : 0.00 , 21.43 % ) .

5 . Treatment of cervical micro - thyroid carcinoma : surgical treatment , postoperative adjuvant radiotherapy and chemotherapy ;
Early diagnosis , clinical staging and surgical methods are of particular importance to the prognosis of patients .

Conclusion : The clinical symptoms and signs of cervical micro - thyroid carcinoma are not obvious , the diagnosis is difficult , and the diagnosis is easy to missed and misdiagnosed . The positive rate of cytologic screening is low , and the diagnosis accuracy of the disease can be improved by immunohistochemistry . The diagnosis accuracy of the disease can be improved by immunohistochemistry . Before operation , the diagnosis accuracy of the disease can be improved . Before operation , the diagnosis accuracy of the disease can be improved . Before operation , the diagnosis accuracy of the disease can be improved .

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

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