【摘要】：背景：前列腺癌在歐美國(guó)家較為多見(jiàn)，在美國(guó)是因腫瘤引發(fā)男性死亡的第二大原因，其發(fā)病率在男性惡性腫瘤中排名第一�！�1】近年來(lái)，中國(guó)前列腺癌的發(fā)病率明顯上升，據(jù)上海市惡性腫瘤發(fā)病率統(tǒng)計(jì)，，至2007年為止，前列腺癌的發(fā)病率已上升至男性惡性腫瘤的第六位�！�2-3】。前列腺癌根治術(shù)是治療早期前列腺癌的重要方法之一，前列腺癌具有臨床表現(xiàn)差異較大、輔助檢查手段較多，術(shù)前治療方法多樣等特點(diǎn)。為了進(jìn)行大規(guī)模數(shù)據(jù)的收集、整理、分析，以及根據(jù)數(shù)據(jù)分析進(jìn)行前瞻性的研究，需要有較為完善的前列腺癌數(shù)據(jù)庫(kù)管理系統(tǒng)�？梢苑奖銓�(duì)所統(tǒng)計(jì)的數(shù)據(jù)進(jìn)行更深入的研究。 目的：探索、建立便于對(duì)前列腺癌病人資料進(jìn)行收集、管理以及查詢(xún)的前列腺癌數(shù)據(jù)庫(kù)。對(duì)統(tǒng)計(jì)到的病人進(jìn)行術(shù)后隨訪，了解術(shù)后尿控及性功能恢復(fù)情況。對(duì)前列腺癌術(shù)前相關(guān)資料結(jié)合術(shù)后隨訪情況進(jìn)行分析，希望找出更多的與前列腺癌手術(shù)及術(shù)后恢復(fù)有關(guān)的因素，并進(jìn)一步應(yīng)用與臨床。 方法：根據(jù)實(shí)際情況需要，使用聯(lián)眾科研工作站，對(duì)2009年2月至2012年10月在本科行恥骨后前列腺癌根治術(shù)病人的臨床資料進(jìn)行統(tǒng)計(jì)。統(tǒng)計(jì)病人共135例，并對(duì)納入的病人進(jìn)行術(shù)后電話隨訪，隨訪內(nèi)容主要為術(shù)后腫瘤復(fù)發(fā)情況及尿控、勃起功能情況。將得到的臨床資料以及術(shù)后隨訪資料進(jìn)行回顧性分析，以找出更多的與前列腺癌手術(shù)及術(shù)后恢復(fù)有關(guān)的因素。 結(jié)果：1）可獲得可靠術(shù)后病理者共134例，切緣陽(yáng)性及精囊腺或閉孔淋巴結(jié)陽(yáng)性共29例。29例中：Gleason評(píng)分7分21例（22.6%）、8分4例（40%）、9分4例（57.1%）。相比較下，切緣陰性中6分24例，7分72例，8分6例，9分3例。2）單純尿道殘端陽(yáng)性8例，單純周切緣陽(yáng)性5例，單純精囊腺侵犯4例，單純淋巴結(jié)侵犯2例，尿道殘端+周切緣陽(yáng)性4例，尿道殘端+精囊腺陽(yáng)性2例，周切緣+精囊腺陽(yáng)性1例，精囊腺+淋巴結(jié)陽(yáng)性2例，尿道殘端+周切緣+精囊腺陽(yáng)性1例。尿道殘端陽(yáng)性共15例（51.7%），周切緣陽(yáng)性共11例（37.9%），精囊腺陽(yáng)性共10例（34.4%），淋巴結(jié)陽(yáng)性共4例（13.8%）。3）術(shù)前術(shù)后均有Gleason評(píng)分者共132例，評(píng)分不一致60例，其中評(píng)分相差2分10例，相差1分50例。4）術(shù)前穿刺標(biāo)本描述陽(yáng)性針數(shù)者共89例，陽(yáng)性針數(shù)比例未超過(guò)33.3%有36例，陽(yáng)性針數(shù)比例超過(guò)33.3%有53例。術(shù)后切緣：陽(yáng)性針數(shù)未超過(guò)33.3%的切緣陽(yáng)性3例（8.3%），陽(yáng)性針數(shù)超過(guò)33.3%的切緣陽(yáng)性有14例（26.4%）。5）前列腺癌根治術(shù)共隨訪到病人94例，截至隨訪時(shí)共死亡5例，分別為：乙狀結(jié)腸癌伴肝轉(zhuǎn)移、原發(fā)性肺癌、老年癡呆、肺部轉(zhuǎn)移、死因不明各一例。6）根治術(shù)后尿控隨訪：隨訪到病人共有85人，現(xiàn)有尿失禁31人，主觀評(píng)分3分以上者16人。該16人中，5人曾行放療；1人術(shù)后出現(xiàn)淋巴瘺，引流34天，留置導(dǎo)尿48天；2人為術(shù)后4個(gè)月；1人術(shù)后出現(xiàn)尿瘺，引流22天，留置導(dǎo)尿21天；1人生化復(fù)發(fā)，行內(nèi)分泌治療；1人尿道殘端陽(yáng)性。 結(jié)論：前列腺癌數(shù)據(jù)庫(kù)的構(gòu)建為前列腺癌臨床及基礎(chǔ)研究提供了良好的平臺(tái)，經(jīng)過(guò)進(jìn)一步完善，可結(jié)合隨訪內(nèi)容對(duì)前列腺癌的研究有更積極的意義。在前列腺癌的各項(xiàng)臨床資料中，前列腺癌穿刺標(biāo)本Gleason評(píng)分與術(shù)后病理切緣之間無(wú)相關(guān)性而穿刺針數(shù)的陽(yáng)性比例與術(shù)后病理切緣之間有相關(guān)性。前列腺穿刺標(biāo)本與根治標(biāo)本的Gleason評(píng)分一致性較為一般，多數(shù)情況穿刺標(biāo)本評(píng)分偏低，少數(shù)評(píng)分偏高。前列腺癌術(shù)前血清PSA值與Gleason評(píng)分呈正相關(guān)。術(shù)后尿失禁情況與病理切緣陽(yáng)性之間無(wú)明確關(guān)系但可能與行放療關(guān)系密切。
[Abstract]:Background: Prostate cancer is seen more in Europe, and in the United States is the second major cause of death for men in the United States, the incidence of which is ranked first among men's malignancies.[1] In recent years, the incidence of prostate cancer in China has increased significantly. According to the statistics of the incidence of malignant tumor in Shanghai, the incidence of prostate cancer has risen to the sixth place of male malignant tumor until 2007.[2-3]. Radical operation of prostate cancer is one of the most important methods for the treatment of early prostate cancer. In order to carry out large-scale data collection, collation, analysis and prospective research based on data analysis, there is a need for a more perfect database management system for prostate cancer. more in-depth study of the data being counted can be facilitated. Objective: To explore and establish the number of prostate cancers convenient for the collection, management and inquiry of prostate cancer patients. According to the database, postoperative follow-up was performed on patients with statistics for postoperative urine control and sexual function recovery. in ord to find out more relevant factors related to prostate cancer surgery and postoperative recovery, and to further their application to that follow-up of prostate cancer. Clinical and Methods: According to the actual situation, the clinical resources of the patients undergoing radical operation of pubic bone after suprapubic prostate cancer from February 2009 to October 2012 were studied by using the joint scientific research workstation. Materials were counted. 135 patients were counted, and postoperative telephone follow-up was performed on the patients included. The follow-up contents were mainly postoperative tumor recurrence and urine control. Functional status. Retrospective analysis of the clinical data and post-operative follow-up data to find out more for prostate cancer surgery and post-operative recovery Results: 1) There were 134 cases with reliable postoperative pathology, 29 cases were positive for resection margin and 29 cases of positive or closed-hole lymph nodes. Among 29 cases, Gleason score was 7 in 21 cases (22. 6%), 8 in 4 cases (40%), 9 points 4. (57. 1%). In contrast, there were 6 points, 24 cases, 72 cases in 7 points, 8 in 6 cases, 9 in 3 cases. 2) There were 8 positive cases of simple urethral stump, 5 cases of simple peripheral edge, 4 cases of simple salivary gland invasion, 2 cases of simple lymph node invasion, 6 cases of urethral stump. 4 cases of positive peripheral margin positive, 2 cases of urethral stump + salivary gland positive, 1 case of peripheral resection margin + salivary gland positive, 2 cases of salivary gland + lymph node positive, 2 cases of urethral stump + week resection. There were 15 cases (51. 7%) of positive urethral stump positive, 11 cases (37.9%) in peripheral resection margin, 10 cases (34. 4%) of salivary gland positive and 4 cases of lymph node positive (13. 8%). There were 132 cases with Gleason score before operation and 60 cases were not consistent. Among them, there were 132 cases with Gleason score before operation. The number of positive needles was not more than 33. 3% in 36 cases, and the number of positive needles was more than 3. 3. 3% had 53 cases. After operation, the number of positive needles was not more than 33. 3%, 3 cases (8.3%) were positive, and the number of positive needles exceeded 33. 3%, 14 cases (26. 4%) were positive. 5) Radical operation of prostate cancer was followed up to 94 cases, and 5 cases died as of follow-up. Postoperative urinary control follow-up: A total of 85 patients, 31 patients with urinary incontinence, and subjective scores were followed up. Among them, 16 were treated with radiotherapy, 5 had radiotherapy, 1 had lymphatic drainage, 34 days of drainage, 48 days for indwelling, 4 months after operation, 1 after the operation, urinary excretion, drainage for 22 days, indwelling for 21 days, biochemical relapse, and endocrine therapy. Conclusion: The construction of prostate cancer database provides a good platform for clinical and basic research of prostate cancer. The study of cancer has more positive significance. In the clinical data of prostate cancer, the Gleason score of prostate cancer puncture specimen has no correlation with the postoperative pathological margin, and the positive ratio of puncture needle number There was a correlation between the posterior pathological margins. The consistency of Gleason score between the prostate puncture specimen and the radical specimen was more common, and most cases were punctured. Low scoring, high scores of scores. Serum PSA values prior to prostate cancer and Gl There was no definite relationship between postoperative urinary incontinence and pathological margin.
【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R737.25

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