本文選題：卵巢惡性生殖細胞腫瘤 + 保留生育功能�。� 參考：《山東大學》2017年碩士論文

【摘要】：目的:卵巢惡性生殖細胞腫瘤(Malignant Ovarian Germ Cell Tumors,MOGCT)在青少年等年輕女性中有著較高的發(fā)病率,隨著近年來手術(shù)方式的提高改進和聯(lián)合化療的普及應用,MOGCT患者的生育及生存預后有了非常大的改善,本文經(jīng)過分析72例MOGCT患者的臨床特點,探討影響MOGCT患者預后的因素,同時,評估保留生育功能的手術(shù)治療對于該類患者獲得較好妊娠結(jié)局的價值。方法:首先收集整理2005年1月-2016年6月間就診于山東大學齊魯醫(yī)院的MOGCT患者的臨床病例資料,然后進行電話隨訪,進而回顧性分析這部分患者的治療和恢復情況。采用SPSS 22.0軟件行統(tǒng)計學方面的分析,使用Kaplan-Meier法計算各亞組累積發(fā)病率,并繪制各亞組的生存曲線,用log-rank法對比生存曲線之間的差別,使用χ2檢驗和Fisher確切概率法對妊娠率進行分析。P0.05差異具有統(tǒng)計學意義。結(jié)果:1、在72例患者中,發(fā)病年齡范圍為1歲1月-68歲,平均發(fā)病年齡為22.96±12.13歲,中位發(fā)病年齡為22歲�；颊呤状未蠖嘁愿姑浕蚋雇�(48.6%)、腹部包塊(27.8%)入院。術(shù)前接受血清CA-125檢查的患者54例,其中升高的患者有36例(包括16例未成熟性畸胎瘤、12例內(nèi)胚竇瘤);術(shù)前接受血清CA-199檢查的患者35例,其中升高的患者有11例(其中包括9例未成熟性畸胎瘤);術(shù)前接受血清AFP檢查的患者65例,其中升高的患者有40例(其中包括19例未成熟性畸胎瘤、18例內(nèi)胚竇瘤)。2、72例患者中,除外外院手術(shù)無法明確具體分期者3例,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分別有49、7、11、2例。其中Ⅰ期患者5年生存率達96.7%,而Ⅱ-Ⅳ期患者5年生存率為55.5%,差異具有顯著性(P0.001);內(nèi)胚竇瘤和非內(nèi)胚竇瘤兩組患者的五年生存率分別為60.2%、94.5%,差異具有統(tǒng)計學意義(P=0.006);對于同樣伴有高危因素的部分患者,分為手術(shù)以后行輔助性化療和未行輔助性化療的兩組,其5年生存率分別為88.6%、60.0%,具有顯著性差異(P=0.035);而對于有無合并腹水及是否行全面分期手術(shù)的不同患者之間進行5年生存率比較,無顯著性差異(P=0.226,P=0.562)。3、72例患者均接受手術(shù)治療,根據(jù)是否接受保留生育功能手術(shù),將全部患者分為兩組,分別包括62、10例。其中接受保守手術(shù)的患者包括全面分期術(shù)16例、不全面分期手術(shù)25例、卵巢腫瘤剝除術(shù)15例以及單側(cè)附件切除術(shù)6例。4、72例MOGCT患者中術(shù)后行輔助化療者59人,療程≤4次者23人,4療程≤6次者18人,大多采用PEB方案(76.3%)化療,部分兒童患者采用AVCP方案化療。5、隨訪(6-137個月)結(jié)束時,6例復發(fā),6例死亡,死亡時間為14-36個月。有生育計劃的18人中,14例妊娠17次,足月分娩10次,流產(chǎn)6次,1例目前處于妊娠期。FIGO分期Ⅰ期、Ⅱ-Ⅳ期患者妊娠率分別為85.7%、25.0%,差異有統(tǒng)計學意義(P=0.044);不同手術(shù)方式、有無術(shù)后輔助化療、病理類型之間妊娠率無顯著性差異(P=0.268、P=0.268、P=0.326)。結(jié)論:1、MOGCT多發(fā)生于年輕女性,最為常見的臨床癥狀有腹脹腹痛及盆腔包塊,多伴有AFP等腫瘤標志物的升高;2、FIGO分期Ⅰ期患者預后明顯好于Ⅱ-Ⅳ期患者;組織病理學類型為內(nèi)胚竇瘤的患者預后比較差;術(shù)后輔助化療對于改善患者的預后是有幫助的。3、對于年輕患者可保留生育功能手術(shù),早期患者妊娠結(jié)局好于晚期患者,手術(shù)方式、病理類型及術(shù)后是否行輔助化療對于妊娠結(jié)局無明顯影響。
[Abstract]:Objective: malignant ovarian germ cell tumors (Malignant Ovarian Germ Cell Tumors, MOGCT) with teenagers and other young women in high incidence in recent years, with improvement of surgical methods and combined chemotherapy for the popularization and application of growth and survival prognosis of patients with MOGCT have a very big improvement, this paper through the analysis of clinical characteristics of 72 MOGCT patients, to explore the factors that affect the prognosis of patients with MOGCT at the same time, assessment of fertility preserving surgery for better pregnancy outcome of the value of this kind of patients. Methods: first collected in January 2005 -2016 year in June admitted to Qilu Hospital of Shandong University MOGCT patients with clinical data, and telephone follow-up, then review analysis this part of the patient's treatment and recovery. By the analysis of SPSS 22 software for statistics, use the Kaplan-Meier method to calculate each subgroup tired Product of incidence and survival curves of each subgroup, with comparison between log-rank survival curve difference, using 2 test and Fisher exact test were used for analysis of.P0.05 had significant difference on pregnancy rate. Results: 1 in 72 patients, the onset age range was 1 -68 in January, the average the age of onset was 22.96 + 12.13 years old, the median age was 22 years. For the first time in most of the patients with abdominal distension or abdominal pain (48.6%), abdominal mass (27.8%). 54 cases received preoperative admission serum CA-125 examination of patients, including patients with elevated in 36 cases (including 16 cases of immature teratoma, 12 cases endodermal sinus tumor; 35 cases) underwent preoperative serum CA-199 examination of patients, including patients with elevated in 11 cases (including 9 cases of immature teratoma); 65 cases underwent preoperative serum AFP examination of patients, including patients with elevated in 40 cases (including 19 cases of immature teratoma, 18 cases. Embryo).2,72 sinus aneurysm patients, except outside the hospital surgery can not be clear and specific stage in 3 cases, of which I, II, III, IV were 49,7,11,2 cases. The patients with stage I 5 year survival rate was 96.7%, while patients with II-IV period 5 year survival rate was 55.5%, the difference was significant (P0.001); endodermal sinus tumor and non endodermal sinus tumor in two groups of patients with five year survival rates were 60.2%, 94.5%, the difference was statistically significant (P=0.006); also for some patients with high risk factors, divided into two groups after surgery for adjuvant chemotherapy and received adjuvant chemotherapy, 5 years the survival rates were 88.6%, 60%, with a significant difference (P=0.035); and to have no ascites and whether the 5 year survival rate comparison between different patients underwent comprehensive staging surgery, there was no significant difference (P=0.226, P=0.562).3,72 patients underwent surgical treatment, according to whether or not to accept the reservation of fertility 鍔熻兘鎵嬫湳,灝嗗叏閮ㄦ?zhèn)ｈ�呭垎涓轟袱緇，

本文編號：1772199