本文選題：口腔黏膜原發(fā)黑色素瘤 + 臨床特點(diǎn)��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:本文旨在對(duì)青島大學(xué)附屬醫(yī)院口腔頜面外科2000年1月至2015年12月住院的26例口腔黏膜原發(fā)黑色素瘤患者的病例資料進(jìn)行回顧性研究,描述其病例特點(diǎn)及生存資料,探討影響其臨床預(yù)后的相關(guān)因素。為我院及國(guó)內(nèi)口腔黏膜原發(fā)黑色素瘤病的診治及預(yù)后工作完善病例資料及提供數(shù)據(jù)支持,有助于提高對(duì)本病的認(rèn)識(shí)和診治水平,改善患者的預(yù)后。資料與方法:收集我科最近16年的26例口腔黏膜原發(fā)黑色素瘤患者的病例資料,所有病例均由組織病理學(xué)確診。統(tǒng)計(jì)分析26例患者的臨床特點(diǎn),并找出患者性別、年齡、臨床分期、不同治療方式與疾病預(yù)后間的關(guān)系。且對(duì)所有治療患者隨訪總生存期,估計(jì)治療患者的3年、5年生存率和中位生存期。所有統(tǒng)計(jì)分析都采用SPSS19.0軟件包,以P0.05為顯著性標(biāo)準(zhǔn)。預(yù)后單因素分析采用Kaplan-Meier法并繪制生存曲線,Log-rank檢驗(yàn),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:26例口腔黏膜原發(fā)黑色素瘤患者中,男性15例,女性11例,男女比為1.36:1�？傮w發(fā)病年齡在40歲左右,發(fā)病高峰年齡在50~70歲,中位發(fā)病年齡為53歲。發(fā)病部位中,原發(fā)于腭黏膜12例(46.15%)、牙齦黏膜11例(42.31%)、頰黏膜3例(11.54%)。III期患者8例,IVA期患者16例,兩者之比為1:2,2例患者主動(dòng)放棄治療。16例患者出現(xiàn)頸淋巴結(jié)轉(zhuǎn)移,轉(zhuǎn)移率為61.54%。行單純?cè)l(fā)灶擴(kuò)大切除術(shù)或冷凍術(shù)的患者均2人,其復(fù)發(fā)率為50%和100%;原發(fā)灶擴(kuò)大切除術(shù)+冷凍術(shù)的患者共6人,復(fù)發(fā)率為50%;原發(fā)灶擴(kuò)大切除術(shù)+冷凍術(shù)+頸淋巴結(jié)清掃術(shù)的患者共10人,復(fù)發(fā)率為30%;原發(fā)灶擴(kuò)大切除術(shù)+冷凍術(shù)+頸淋巴結(jié)清掃術(shù)+生物免疫化療的患者共4人,均無(wú)復(fù)發(fā)及頸淋巴結(jié)轉(zhuǎn)移和遠(yuǎn)處轉(zhuǎn)移,且其平均生存時(shí)間為8年10個(gè)月。24例患者的3年、5年生存率分別為41.7%和25%,中位生存期為30個(gè)月,III期和IVA期患者的3年、5年生存率分別為25%、25%;50%、25%。單因素預(yù)后分析顯示,患者性別、年齡(≥56歲和56歲)和臨床分期(III期和IVA期)與患者的預(yù)后相關(guān)性沒(méi)有統(tǒng)計(jì)學(xué)差異(P0.05),不同治療方式之間差異有統(tǒng)計(jì)學(xué)意義,即不同治療方式與患者的預(yù)后存在相關(guān)性(P0.05)。結(jié)論:1.青大附院口腔黏膜原發(fā)黑色素瘤患者男:女=1.36:1,總體高發(fā)年齡為50~70歲。高發(fā)部位為腭部黏膜和牙齦黏膜。2.青大附院口腔黏膜原發(fā)黑色素瘤患者IVA期(16例):III期(8例)=2:1。行原發(fā)灶擴(kuò)大切除術(shù)+冷凍術(shù)+頸淋巴結(jié)清掃術(shù)+生物免疫化療的患者生存時(shí)間、局部復(fù)發(fā)和頸淋巴結(jié)轉(zhuǎn)移及遠(yuǎn)處轉(zhuǎn)移均優(yōu)于單純行原發(fā)灶擴(kuò)大切除術(shù)+冷凍術(shù)+頸部淋巴結(jié)清掃術(shù)的患者。3.24例患者的3年、5年生存率分別約為41.7%和25%,中位生存期為30個(gè)月。4.24例患者口腔黏膜原發(fā)黑色素瘤的預(yù)后與患者的性別、年齡和臨床分期相關(guān)性無(wú)統(tǒng)計(jì)學(xué)差異,與患者的不同治療方式差異有統(tǒng)計(jì)學(xué)意義。
[Abstract]:Objective: to study retrospectively the data of 26 patients with primary melanoma of oral mucosa who were hospitalized in oral and maxillofacial surgery of affiliated Hospital of Qingdao University from January 2000 to December 2015, and to describe their case characteristics and survival data. Objective: to explore the related factors affecting the clinical prognosis. To improve the case data and provide data support for the diagnosis, treatment and prognosis of oral mucosal primary melanoma in our hospital and China, it is helpful to improve the understanding and diagnosis of the disease and improve the prognosis of the patients. Materials and methods: 26 cases of oral mucosal primary melanoma in our department were collected in recent 16 years. All cases were confirmed by histopathology. The clinical characteristics of 26 patients were analyzed and the relationship between sex, age, clinical stage, different treatment methods and the prognosis of the disease was found out. The 3 -, 5-year survival rate and median survival time were estimated for all patients. All statistical analysis were carried out with SPSS19.0 software package, with P0.05 as the significant standard. The prognostic univariate analysis was performed by Kaplan-Meier method and the survival curve was plotted by Log-rank test. The difference was statistically significant with P0.05. Results among 26 cases of oral mucosal primary melanoma, 15 cases were male and 11 cases were female, the ratio of male to female was 1.36: 1. The age of onset was about 40 years old, the peak age was 50 ~ 70 years old, the median age was 53 years old. Among them, 12 cases originated from palatal mucosa, 11 cases from gingival mucosa and 42.31%, and 3 cases from buccal mucosa from stage 11.54 to stage III in 8 cases with IVA stage. The ratio of the two cases was 1: 22%, 2 patients gave up treatment voluntarily, 16 patients had cervical lymph node metastasis, the metastasis rate was 61.54. The recurrence rate was 50% and 100%, and 6 patients were treated with expanded resection of primary focus or cryopreservation. The recurrence rate was 50. 10 patients were treated with expanded resection of primary focus and frozen neck lymph node dissection, and the recurrence rate was 300.The total number of patients treated with biological immunotherapy for primary tumor resection and frozen neck lymph node dissection was 4. There was no recurrence, cervical lymph node metastasis and distant metastasis, and the mean survival time was 8 years, 10 months, and 24 cases, the 5-year survival rate was 41.7% and 25%, the median survival time was 30 months and 3 years for stage III and IVA patients, and the 5-year survival rate was 250.2550 and 2525, respectively. Univariate prognostic analysis showed that there was no significant difference between sex, age (鈮，

本文編號(hào)：1788615