本文選題：子宮內(nèi)膜漿液性腺癌 + 臨床表現(xiàn)　； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:研究討論子宮內(nèi)膜漿液性腺癌的臨床特點(diǎn)、診斷方法及治療方案。方法:回顧性分析2011年6月至2016年6月大連市婦產(chǎn)醫(yī)院收治的51例臨床資料完整的UPSC(Uterine papillary serous carcinoma,子宮內(nèi)膜漿液性腺癌)的臨床表現(xiàn)、輔助檢查結(jié)果、治療方法、手術(shù)情況、術(shù)中及術(shù)后病理檢查結(jié)果、術(shù)后恢復(fù)情況、后續(xù)治療方法。結(jié)果:1.51例UPSC患者的平均發(fā)病年齡為61±6.43歲,平均絕經(jīng)年齡51.60±2.88歲,4例患者未絕經(jīng)(占7.84%);其余47例患者均已絕經(jīng)(占92.16%),UPSC在絕經(jīng)后的女性中發(fā)病率較高。2.50例患者有陽(yáng)性癥狀,以陰道流血癥狀居多(占68.00%),陰道異常排液(血性分泌物或淘米水樣分泌物)6例(占12.00%),3例為發(fā)現(xiàn)盆腔包塊(占6.00%),下腹痛癥狀的有5例(占10.00%),2例表現(xiàn)為腹脹(占4.00%)。1例患者無(wú)明顯不適。UPSC主要的臨床表現(xiàn)是陰道異常的流血,無(wú)特異性的臨床表現(xiàn),如遇到絕經(jīng)后女性出現(xiàn)異常陰道流血注意進(jìn)一步檢查進(jìn)行鑒別。3.本課題中術(shù)前無(wú)合并癥的患者有13例,有既往史的患者共有38例(占74.51%),其中既往合并高血壓病史的患者最多,共有18例(占總患者人數(shù)的35.29%),15例合并糖尿病史(占29.41%),乳腺癌術(shù)后的有2例(占3.92%),子宮內(nèi)膜息肉7例(占13.73%),宮頸息肉4例(占7.84%),子宮肌瘤26例(占50.98%),3例患者有家族史(占5.88%),分別是母親肝癌去世,妹妹宮頸癌病史,母親乳腺癌病史。BMI≥28 kg/m2有16例,占31.37%(16/51),至今該病的發(fā)病因素尚不明確。4.輔助檢查缺乏特異性,影像學(xué)檢查檢查均對(duì)該疾病的診斷有提示作用,但均無(wú)確診意義;51例患者中CA125值升高者(≥35.00U/ml)共有21例,占41.18%,CA125≥35.00U/ml的患者中手術(shù)病理分期為晚期占76.19%(16/21)。CA12535.00U/ml的患者中手術(shù)病理分期為晚期者占23.33%(7/30),兩者相比較χ2=10.08,P0.01,差異有顯著的統(tǒng)計(jì)學(xué)意義,CA125對(duì)于UPSC的診斷有提示價(jià)值。研究的病例中23例為宮腔鏡下分段診刮術(shù),總陽(yáng)性病理診斷率為37.26%(19/51),而其余28例患者行分段診刮術(shù),總陽(yáng)性病理診斷率為11.77%(6/51)。比較而言,宮腔鏡輔助直視下行診刮術(shù)的病理結(jié)果準(zhǔn)確率高于傳統(tǒng)診刮術(shù),在術(shù)前的診斷檢查中有意義。5.51例患者均行手術(shù)治療,其中有16例術(shù)后行紫杉醇和卡鉑聯(lián)合治療,對(duì)與該病目前的主要治療方法仍以手術(shù)治療為主,對(duì)于放化療的效果尚無(wú)明確評(píng)價(jià)。結(jié)論:1.子宮內(nèi)膜漿液性腺癌大多數(shù)發(fā)生于絕經(jīng)后婦女,其臨床癥狀缺乏特異性,以絕經(jīng)后陰道流血最為常見(jiàn)。2.子宮內(nèi)膜漿液性腺癌的診斷以病理學(xué)檢查為金標(biāo)準(zhǔn),宮腔鏡下行分段診刮術(shù)的準(zhǔn)確率較經(jīng)典分段診刮術(shù)明顯升高。3.子宮內(nèi)膜漿液性腺癌輔助檢查中CA125對(duì)于判斷該病的分期有提示意義。4.子宮內(nèi)膜漿液性腺癌治療目前仍以手術(shù)治療為主,手術(shù)方式應(yīng)進(jìn)行標(biāo)準(zhǔn)的外科分期手術(shù),即腫瘤細(xì)胞減滅術(shù)(類(lèi)似于卵巢漿液性乳頭癌的腫瘤細(xì)胞減滅術(shù))。
[Abstract]:Objective: to study the clinical features, diagnosis and treatment of endometrial serous adenocarcinoma. Methods: from June 2011 to June 2016, 51 cases of UPSC(Uterine papillary serous carcinoma, endometrial serous adenocarcinoma treated in Dalian Obstetrics and Gynecology Hospital were retrospectively analyzed. Intraoperative and postoperative pathological findings, postoperative recovery, follow-up treatment. Results the mean age of onset of UPSC was 61 鹵6.43 years old, the mean menopausal age was 51.60 鹵2.88 years old and the average menopausal age was 51.60 鹵2.88 years old. The most common symptoms were vaginal bleeding (68.00%), abnormal vaginal discharge (6 cases) (blood secretion or water secretion from rice panning rice) in 6 cases (12.00%), pelvic mass (6.00%), abdominal pain in 5 cases (10.00%) and abdominal distension (4.00%) in 2 cases (4.00%). The main clinical manifestation of UPSC is abnormal vaginal bleeding. No specific clinical manifestations, such as postmenopausal women with abnormal vaginal bleeding attention to further examination to identify. 3. In this study, there were 13 patients without preoperative complications and 38 patients with previous history (74.51%). There were 18 cases (35.29% of the total patients) with diabetes history (29.41%), 2 cases (3.92%) with breast cancer, 7 cases (13.73%) with endometrial polyps, 4 cases (7.84%) with cervical polyps, 26 cases (50.98%) with myoma of uterus. Shi (5.88%) died of her mother's liver cancer. The history of cervical cancer in sister and breast cancer in mother (鈮，

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