本文選題：子宮內(nèi)膜癌 + 淋巴結(jié)切除數(shù)目　； 參考：《鄭州大學(xué)》2014年碩士論文

【摘要】：背景與目的 子宮內(nèi)膜癌（endometrial carcinoma，EC）是女性生殖道三大惡性腫瘤之一，發(fā)病率呈逐年上升趨勢，嚴(yán)重威脅了女性的健康。子宮內(nèi)膜癌的治療方法主要以手術(shù)為主，根據(jù)術(shù)后病理決定是否行放療、化療、激素治療以及生物治療等輔助治療。國際婦產(chǎn)科聯(lián)盟(International Federation of Gynecology and Obstetrics，F(xiàn)IGO)對手術(shù)治療的患者進(jìn)行手術(shù)-病理分期，強(qiáng)調(diào)了切除腹主動脈旁淋巴結(jié)的重要意義。然而，進(jìn)行系統(tǒng)性的分期手術(shù)的價值是治療手段還是預(yù)后判斷、系統(tǒng)性的盆腔淋巴結(jié)切除（pelvic lymphadenectomy, PLD)和腹主動脈旁淋巴結(jié)切除（para-aortic lymphadenectomy, PALD）的必要性和切除范圍一直存在著較大的爭議。淋巴結(jié)是外周免疫器官，是T細(xì)胞和B細(xì)胞定居的場所，也是免疫應(yīng)答發(fā)生的場所，參與淋巴細(xì)胞再循環(huán)，若切除過多淋巴結(jié)，必然破壞了機(jī)體免疫系統(tǒng)的完整性。陰性淋巴結(jié)過多的切除對預(yù)后是否產(chǎn)生影響也值得思考。本文探討了腹主動脈旁淋巴結(jié)切除對子宮內(nèi)膜癌患者預(yù)后的影響，以及切除盆腔淋巴結(jié)及腹主動脈旁淋巴結(jié)的總數(shù)目和陰性淋巴結(jié)數(shù)目對子宮內(nèi)膜癌患者預(yù)后的影響。 資料與方法 1、資料來源：分析2004年01月-2013年06月期間在鄭州大學(xué)第二附屬醫(yī)院行系統(tǒng)性盆腔淋巴結(jié)切除，同時行或不行腹主動脈旁淋巴結(jié)切除的206例子宮內(nèi)膜癌患者的臨床資料。應(yīng)用查看門診復(fù)診病歷和電話隨訪結(jié)合的方式獲得隨訪結(jié)果，如果兩種方式都不能獲得結(jié)果，按失訪病例處理，失訪病例舍棄。 2、預(yù)后指標(biāo)：通過比較患者的復(fù)發(fā)率、3年生存率、5年生存率來評價患者的預(yù)后。 3、統(tǒng)計(jì)方法：本文的臨床資料數(shù)據(jù)采用SPSS17．0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析，年齡和隨訪時間均描述為平均值±標(biāo)準(zhǔn)差。采用χ2檢驗(yàn)分別分析腹主動脈旁淋巴結(jié)切除、淋巴結(jié)總數(shù)、淋巴結(jié)陰性數(shù)對子宮內(nèi)膜癌預(yù)后的影響以及腹主動脈旁淋巴結(jié)切除對患者術(shù)后及術(shù)后并發(fā)癥發(fā)生率的影響。應(yīng)用Logisitic回歸分析腹主動脈旁淋巴結(jié)切除、術(shù)后輔助治療、切除淋巴結(jié)陰性數(shù)目對患者預(yù)后的影響。應(yīng)用壽命表法進(jìn)行生存率的分析。檢驗(yàn)水準(zhǔn)設(shè)定為α=0.05，均采用雙側(cè)分布，P＜0.05有統(tǒng)計(jì)學(xué)差異。 結(jié)果 1、對Ⅰ期、Ⅱ期患者，切除腹主動脈旁淋巴結(jié)與否子宮內(nèi)膜癌患者術(shù)后復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義（P=0.475＞0.05，P=0.052＞0.05），Ⅲ期患者PALD+PLD組與PLD組的子宮內(nèi)膜癌患者術(shù)后復(fù)發(fā)率差異有統(tǒng)計(jì)學(xué)意義（P=0.016＜0.05），對總體而言，是否切除腹主動脈旁淋巴結(jié)子宮內(nèi)膜癌患者術(shù)后復(fù)發(fā)率差異有統(tǒng)計(jì)學(xué)意義（P=0.034＜0.05）。因?yàn)棰羝诳偫龜?shù)只有2例，均進(jìn)行腹主動脈旁淋巴結(jié)切除，故不進(jìn)行統(tǒng)計(jì)學(xué)分析。 2、對于Ⅰ期、Ⅱ期患者，淋巴結(jié)總數(shù)≥20個與淋巴結(jié)總數(shù)＜20個術(shù)后復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義（P=0.298＞0.05，P=0.640＞0.05），Ⅲ期患者淋巴結(jié)總數(shù)≥20個與淋巴結(jié)總數(shù)＜20個術(shù)后復(fù)發(fā)率差異有統(tǒng)計(jì)學(xué)意義（P=0.008＜0.05），對總體而言，切除淋巴結(jié)總數(shù)≥20個與淋巴結(jié)總數(shù)＜20個術(shù)后復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義（P=0.263＞0.05）。因?yàn)棰羝诳偫龜?shù)只有2例，且淋巴結(jié)總數(shù)均≥20個，故不進(jìn)行統(tǒng)計(jì)學(xué)分析。 3、對于Ⅰ期、Ⅱ期患者，陰性淋巴結(jié)數(shù)≥20個與陰性淋巴結(jié)數(shù)＜20個術(shù)后復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義（P=0.298＞0.05，P=0.640＞0.05），Ⅲ期患者陰性淋巴結(jié)數(shù)≥20個與陰性淋巴結(jié)數(shù)＜20個術(shù)后復(fù)發(fā)率差異有統(tǒng)計(jì)學(xué)意義（P=0.047＜0.05），對總體而言，切除陰性淋巴結(jié)數(shù)≥20個與陰性淋巴結(jié)數(shù)＜20個術(shù)后復(fù)發(fā)率差異無統(tǒng)計(jì)學(xué)意義（P=0.190＞0.05）。因?yàn)棰羝诳偫龜?shù)只有2例，且陰性淋巴結(jié)數(shù)目均≥20個，故不進(jìn)行統(tǒng)計(jì)學(xué)分析。 4、切除陰性淋巴結(jié)數(shù)目與淋巴結(jié)總數(shù)呈正相關(guān)，相關(guān)系數(shù)r=0.971，P=0.000＜0.05。 5、腹主動脈旁淋巴結(jié)切除、術(shù)后輔助治療、陰性淋巴結(jié)數(shù)目≥20個是子宮內(nèi)膜癌術(shù)后復(fù)發(fā)率的影響因素（P＜0.05），可以降低患者復(fù)發(fā)率（OR＜1）。 6、本研究207例患者中共有20例出現(xiàn)術(shù)中術(shù)后并發(fā)癥，占總數(shù)的9.76%，其中行腹主動脈旁淋巴結(jié)切除組中有16例出現(xiàn)并發(fā)癥，占17.39%，不切除腹主動脈旁淋巴結(jié)組中有4例患者出現(xiàn)并發(fā)癥，占3.54%。腹主動脈旁淋巴結(jié)切除組與不切除腹主動脈旁淋巴結(jié)組術(shù)中術(shù)后并發(fā)癥發(fā)生率差異有統(tǒng)計(jì)學(xué)意義（P=0.001＜0.05）。 7、PALD+PLD組Ⅰ期、Ⅱ期患者3年生存率均為100%，5年生存率分別為100%、96%，Ⅲ期患者3年生存率為93%，5年生存率為72%；PLD組Ⅰ期、Ⅱ期患者3年生存率均為100%，5年生存率分別為98%、80%，Ⅲ期患者3年生存率為77%，5年生存率為68%。陰性淋巴結(jié)≥20個組Ⅰ期、Ⅱ期患者3年生存率均為100%，5年生存率均為100%，Ⅲ期患者3年生存率為92%，5年生存率為75%；陰性淋巴結(jié)＜20個組Ⅰ期、Ⅱ期患者3年生存率均為100%，5年生存率分別為97%、82%，Ⅲ期患者3年生存率為76%，5年生存率為67%。因?yàn)棰羝诨颊咧挥?例，均進(jìn)行腹主動脈旁淋巴結(jié)切除，且切除陰性淋巴結(jié)數(shù)均≥20個，，不進(jìn)行生存率的分析。 結(jié)論 1、理想的腹主動脈旁淋巴結(jié)的切除可以降低Ⅲ期子宮內(nèi)膜癌患者的復(fù)發(fā)率，但對于Ⅰ期、Ⅱ期患者的預(yù)后改善作用不明顯。 2、淋巴結(jié)切除總數(shù)≥20個可以降低Ⅲ期子宮內(nèi)膜癌患者術(shù)后復(fù)發(fā)率，切除陰性淋巴結(jié)數(shù)≥20個并不影響患者生存期。
[Abstract]:Background and purpose
Endometrial carcinoma (EC) is one of the three major malignant tumors in female genital tract. The incidence of endometriosis is increasing year by year, which seriously threatens the health of women. The main treatment methods for endometrial cancer are surgery based on radiotherapy, chemical therapy, hormone therapy and biological therapy. The International Federation of Gynecology and Obstetrics, FIGO) performed surgical pathological staging to patients with surgical treatment, emphasizing the importance of excision of the paraaortic lymph nodes. However, the value of systematic staging is the treatment and prognosis, and systematic pelvic lymph node excision (pelvi). C lymphadenectomy, PLD) and para aortic lymph node excision (para-aortic lymphadenectomy, PALD) have a great controversy. The lymph nodes are peripheral immune organs, are the sites for the settlement of T cells and B cells, and are the sites of the immune response, participating in the lymphocytic recirculation, if excessively many lymph nodes are removed. The effects of excision of the negative lymph nodes on the prognosis of the patients with endometrial carcinoma, and the total number of lymph nodes and the total number of lymph nodes in the para aorta and the number of negative lymph nodes were discussed. The effect on the prognosis of endometrial cancer patients.
Information and methods
1. Data sources: analysis of the clinical data of 206 patients with endometrial cancer who underwent systemic pelvic lymph node resection in the Second Affiliated Hospital of Zhengzhou University, 01 months -2013, 2004, during 06 months of 06 months. Fruit can not be obtained in two ways. According to the lost cases, the case is abandoned.
2, prognostic indicators: the prognosis was evaluated by comparing the recurrence rate, the 3 year survival rate and the 5 year survival rate.
3, statistical methods: the clinical data of this article were statistically analyzed with SPSS17.0 software. Age and follow-up time were described as mean standard deviation. The effect of lymph node resection, total number of lymph nodes, negative number of lymph nodes on the prognosis of endometrial carcinoma and the lymph node of abdominal aorta were analyzed by Chi 2 test. The effect of resection on the incidence of postoperative and postoperative complications. Logisitic regression analysis was used to analyze the effect of lymph node dissection of the abdominal aorta, the postoperative adjuvant treatment, the effect of the negative number of lymph nodes on the prognosis of the patients. The life table method was used to analyze the survival rate. The test level was set as alpha =0.05, both were bilateral distribution, P < 0.05 had statistics. Learning differences.
Result
1, there was no statistically significant difference in the recurrence rate of patients with stage I, stage II, para aortic lymph nodes or endometrial carcinoma (P=0.475 > 0.05, P=0.052 > 0.05). The recurrence rate of endometrial cancer patients in group PALD+PLD and PLD group was statistically significant (P=0.016 < 0.05). The postoperative recurrence rate of the patients with para arterial lymphadenocarcinoma was statistically significant (P=0.034 < 0.05). Because the total number of cases in stage IV was only 2 cases, the lymph node dissection of the abdominal aorta was performed, so no statistical analysis was performed.
2, for stage I and stage II patients, there was no statistical significance (P=0.298 > 0.05, P=0.640 > 0.05) for the total number of lymph nodes more than 20 and the total number of lymph nodes (P=0.298 > 0.05, P=0.640 > 0.05). There was a statistical significance (P=0.008 < 0.05) for the recurrence rate of the total number of lymph nodes more than 20 and the total number of lymph nodes in stage III patients (P=0.008 < 0.05). There was no statistically significant difference in the recurrence rate between the number of more than 20 lymph nodes and the total number of lymph nodes (P=0.263 > 0.05). The total number of cases in stage IV was only 2, and the total number of lymph nodes were more than 20, so no statistical analysis was performed.
3, for stage I, stage II patients, there was no statistically significant difference between 20 negative lymph node number and negative lymph node number and negative lymph node number (P=0.298 > 0.05, P=0.640 > 0.05). There were statistical significance (P=0.047 < 0.05) for the recurrence rate of the negative lymph node number more than 20 and negative lymph nodes in stage III patients (P=0.047 < 0.05). There was no statistically significant difference between the number of negative lymph nodes or negative lymph nodes and the number of negative lymph nodes (P=0.190 > 0.05) (P=0.190 > 0.05), because the number of total cases in stage IV was only 2, and the number of negative lymph nodes was more than 20, so no statistical analysis was performed.
4, the number of negative lymph nodes was positively correlated with the total number of lymph nodes, and the correlation coefficient r=0.971, P=0.000 < 0.05.
5, para aortic lymph node resection, postoperative adjuvant treatment and negative lymph node number more than 20 were the factors affecting the recurrence rate after endometrial carcinoma (P < 0.05), which could reduce the recurrence rate of patients (OR < 1).
6, in this study, there were 20 cases of postoperative complications in 207 patients, accounting for 9.76% of the total, of which 16 cases in the para aortic lymph node resection group had complications, accounting for 17.39%, and 4 patients in the non resected para aortic lymph node group had complications, which accounted for 3.54%. abdominal aorta resection group and non abdominal aorta removal. The incidence of intraoperative and postoperative complications in lymph node group was statistically significant (P=0.001 < 0.05).
7, group I, stage I, stage II, 3 year survival rate was 100%, 5 year survival rate was 100%, 96%, 96%, 3 year survival rate was 93%, 5 year survival rate was 72%; PLD group I, stage II patients were 100%, 5 year survival rate was 100%, 100% period survival rate was 68%. negative lymph node group. The 3 year survival rate was 100%, the 5 year survival rate was 100%, the 3 year survival rate was 92%, the 5 year survival rate was 75%, the negative lymph nodes < 20 group I, the 3 years survival rate of 3 years were 100%, 5 year survival rate was respectively, the survival rate was 67%. All cases underwent resection of the para aortic lymph nodes, and the number of negative lymph nodes was more than 20. No survival rate was analyzed.
conclusion
1, the ideal resection of the para aortic lymph nodes can reduce the recurrence rate of patients with stage III endometrial carcinoma, but it is not significant for the prognosis of stage I and stage II patients.
2, the total number of lymph node excision is more than 20, which can reduce the recurrence rate of patients with stage III endometrial cancer, and the number of negative lymph nodes more than 20 can not affect the survival time of patients.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R737.33

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