本文選題：卵巢癌 + 首診相關(guān)因素　； 參考：《黑龍江中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：目的： 通過回顧性分析卵巢癌患者的首診相關(guān)因素,探討卵巢癌診斷延誤的因素,及診斷延誤與卵巢腫瘤分期的對(duì)應(yīng)關(guān)系；統(tǒng)計(jì)卵巢癌患者中醫(yī)證型分布特點(diǎn)。從而為臨床卵巢癌的早發(fā)現(xiàn)、早治療提供參考意見。 方法： 對(duì)2012年5月-2013年10月在黑龍江中醫(yī)藥大學(xué)附屬第一醫(yī)院婦科門診及其哈爾濱醫(yī)科大學(xué)第三附屬醫(yī)院婦科病房的74例術(shù)后卵巢癌患者進(jìn)行首診相關(guān)因素的分析,及體質(zhì)情況調(diào)查,對(duì)卵巢癌患者一般資料及首次發(fā)病的臨床表現(xiàn)、病理特征、中醫(yī)體質(zhì)及影響其就診的相關(guān)因素進(jìn)行回顧性分析。 結(jié)果： 1.從患者一般資料得出：本次研究中患者發(fā)病年齡在20-74歲,45-55歲發(fā)病率為41.9%；居住地中農(nóng)村及非省會(huì)城市比例分別為28.4%、51.4%；文化程度為中學(xué)以下水平比例占62.1%；新農(nóng)合和社會(huì)醫(yī)保比例分別是52.7%、23%,而自費(fèi)占2.7%；已婚占78.4%,未婚、離異或喪偶的占21.6%；就診信息中家人推薦最高占25.6%；初診醫(yī)療機(jī)構(gòu)非省級(jí)綜合醫(yī)院占64%,其中年齡、醫(yī)療保障對(duì)就診單位的選擇p0.05,就診費(fèi)用來源、文化程度和婚況p0.05；誤診概率為44.6%；就診時(shí)間最短為0天,最長達(dá)1825天,延遲診斷發(fā)生率為21.6%(16例)；對(duì)延誤診斷的影響因素中年齡、居住地、就診機(jī)構(gòu)、文化程度、費(fèi)用來源、醫(yī)療保障、婚況和就診意愿有統(tǒng)計(jì)學(xué)意義(p0.05)。 2.從患者的疾病信息得出：卵巢癌患者首發(fā)癥狀出現(xiàn)概率由高到低依次為腹脹、下腹包塊、下腹墜痛、陰道不規(guī)則流血、腹腔積液、膀胱刺激癥狀和胃腸道癥狀、淋巴結(jié)腫大、貧血、消瘦。首診的病理類型卵巢上皮性癌66例(89.2%),性索間質(zhì)瘤2例(2.7%)卵巢生殖細(xì)胞瘤6例(8.1%)。卵巢癌的發(fā)病部位雙側(cè)發(fā)病為41例占55.4%,左側(cè)、右側(cè)發(fā)病分別為25.7%、18.9%。臨床分期較集中在Ⅲ期,調(diào)查中人數(shù)上Ⅲ期Ⅳ期Ⅱ期)Ⅰ期,Ⅲ期人數(shù)最多,Ⅰ期則最少。卵巢癌發(fā)病部位上看單側(cè)發(fā)病多于早期,概率較高的為左側(cè)Ⅰ期比例占12.2%,右側(cè)Ⅱ期占6.8%,而雙側(cè)多晚期,雙側(cè)Ⅲ期占41.9%。 3.從影響分期情況得出：患者的診斷延遲情況分為就診延遲和確診延遲。16名(21.6%)病人發(fā)生診斷延遲現(xiàn)象,平均延遲378.18天。不同年齡文化程度、居住地、費(fèi)用來源、醫(yī)療保障對(duì)卵巢癌病人就診延遲差異均無統(tǒng)計(jì)學(xué)意義(P0.05)；婚姻狀況差異有統(tǒng)計(jì)學(xué)意義(p0.05)。不同年齡、文化程度、婚姻狀況對(duì)卵巢癌病人是否發(fā)生確診延遲現(xiàn)象均無統(tǒng)計(jì)學(xué)意義(P0.05),誤診、醫(yī)療機(jī)構(gòu)有統(tǒng)計(jì)學(xué)意義(P0.05)。診斷延遲與臨床分期的調(diào)查中,卵巢癌早期患者的診斷延遲3例,晚期診斷延遲13例。卵巢癌主動(dòng)就診的患者27例(36.5%),被動(dòng)就診47例(63.5%)；卵巢癌早期患者中主動(dòng)就診20例,被動(dòng)就診9例；晚期患者主動(dòng)就診7例,被動(dòng)就診38例。 4.從中醫(yī)證型的研究得出：發(fā)病較高的是氣滯、血瘀型,發(fā)病人數(shù)分別為22人(占調(diào)查人數(shù)29.7%)、29人(占調(diào)查人數(shù)39.2%)；其次為熱毒型有13人(占調(diào)查人數(shù)17.6%)、痰濕型有10人(占調(diào)查人數(shù)13.5%)。 結(jié)論： 1.對(duì)卵巢癌患者就診行為有統(tǒng)計(jì)學(xué)意義的影響因素包括年齡、文化程度、費(fèi)用來源、婚況、家庭支持、就診意愿等。 2.卵巢癌首診年齡集中在45-55歲之間；首發(fā)癥狀以下腹痛、腹脹、下腹包塊、陰道不規(guī)則流血為主；發(fā)病部位概率雙側(cè)左側(cè)右側(cè)；中醫(yī)證型分布情況血瘀型氣滯型熱毒型痰濕型。 3.就診延遲時(shí)間與卵巢癌臨床分期呈正相關(guān)；卵巢癌發(fā)病部位單側(cè)發(fā)病多早期,雙側(cè)多晚期。
[Abstract]:Purpose :

To investigate the factors of diagnosis delay of ovarian cancer and the correlation between diagnosis delay and ovarian tumor stage by retrospective analysis of the factors related to the first diagnosis of ovarian cancer .
In order to provide a reference for early detection and early treatment of ovarian cancer .

Method :

In May of 2012 to October 2013 , 74 cases of ovarian cancer patients in the First Affiliated Hospital of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine and the Third Affiliated Hospital of Harbin Medical University were analyzed , and the physical constitution investigation was carried out , and the general data of ovarian cancer patients and the clinical manifestation , pathological characteristics , the constitution of Chinese medicine and the related factors affecting them were analyzed retrospectively .

Results :

1 . From the general data of the patients , the age of the patients in this study was 20 - 74 years , and the incidence of 45 - 55 years was 41.9 % ;
The urban proportion of rural and non - provincial capitals in the place of residence is 28 . 4 % and 51 . 4 % , respectively .
The level of culture is 62.1 % in the middle school ;
The proportion of the new agricultural and social medical insurance was 52.7 % , 23 % , and the self - cost accounted for 2.7 % ;
78.4 % of married , unmarried , divorced or widows accounted for 21.6 % ;
The family recommended the highest rate of 25.6 % in the information of medical treatment ;
The non - provincial comprehensive hospitals in the first medical institution account for 64 % , among them the age , the choice of medical security to the treatment unit , the source of medical expenses , the degree of culture and the marital status p0.01 ;
The probability of misdiagnosis was 44.6 % .
The shortest time was 0 days , up to 1,825 days , and the rate of delayed diagnosis was 21.6 % ( 16 cases ) .
There was significant difference in age , place of residence , medical institution , degree of culture , source of cost , medical security , marriage status and willingness to visit in the influence factors of delay diagnosis ( p . 05 ) .

2 . From the patient ' s disease information , the probability of onset of initial symptoms in ovarian cancer patients was from high to low in order of abdominal distension , lower abdominal mass , lower abdomen falling pain , irregular vaginal bleeding , abdominal dropsy , bladder irritation symptoms and gastrointestinal symptoms , lymph node enlargement , anemia and wasting .

3 . The diagnosis delay of the patients was divided into the diagnosis delay and the diagnosis delay . The average delay was 378.18 days in 16 patients ( 21.6 % ) . There was no significant difference between the different ages and cultures , the place of residence , the source of cost and the medical security for ovarian cancer patients ( P0.05 ) .
There was a significant difference in the marital status ( P 0.05 ) . There was no statistical significance ( P0.05 ) in the diagnosis of ovarian cancer patients with different ages , cultures and marital status ( P0.05 ) . In the investigation of the diagnosis delay and clinical stage , the diagnosis delay of early stage patients was delayed in 3 cases , and the late diagnosis was delayed in 13 cases .
In the early stage of ovarian cancer , 20 cases were active and 9 cases were passively visited ;
In the advanced patients , 7 cases were actively visited and 38 cases were passively visited .

4 . From the study of syndrome type of TCM , the incidence of qi stagnation and blood stasis were 22 ( 29 . 7 % ) and 29 ( 39.2 % of the survey ) respectively .
There were 13 persons ( 17.6 % of the survey ) and 10 persons ( 13.5 % of the survey ) in the hot - toxin type .

Conclusion :

1 . The factors that affect the behavior of ovarian cancer patients include age , degree of culture , source of cost , marriage status , family support , doctor ' s willingness , etc .

2 . The first diagnosis of ovarian cancer was between 45 and 55 years old ;
The first symptoms were abdominal pain , abdominal distension , lower abdominal mass and irregular vaginal bleeding .
Two - sided left - hand right side of incidence part probability ;
Traditional Chinese medicine syndrome type distribution condition blood stasis type heat toxin type phlegm wet type .

3 . The delay time was positively correlated with the clinical stage of ovarian cancer .
In the pathogenesis of ovarian cancer , the onset of one - sided disease was early , bilateral and late .
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R737.31

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本文編號(hào)：1949386