本文選題：子宮肉瘤　切入點(diǎn)：復(fù)發(fā)　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的:分析子宮肉瘤術(shù)后復(fù)發(fā)患者的臨床特征、影響因素及預(yù)后情況。研究方法:收集1999年12月至2013年12月期間山東大學(xué)齊魯醫(yī)院收治的子宮肉瘤患者的臨床資料,105例符合入組標(biāo)準(zhǔn),其中復(fù)發(fā)者49例。與同期未復(fù)發(fā)者(56例)對(duì)比,分析子宮肉瘤復(fù)發(fā)患者的臨床特征、復(fù)發(fā)部位、復(fù)發(fā)時(shí)間、復(fù)發(fā)相關(guān)因素、復(fù)發(fā)后治療及預(yù)后情況。應(yīng)用SPSS 19.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。所有檢驗(yàn)方法認(rèn)為P0.05有統(tǒng)計(jì)學(xué)差異。結(jié)果:1.復(fù)發(fā)部位:單純局部復(fù)發(fā)率為36.73%,單純遠(yuǎn)處轉(zhuǎn)移率為42.85%,局部復(fù)發(fā)合并遠(yuǎn)處轉(zhuǎn)移率為20.41%。局部復(fù)發(fā)患者的5年死亡率為66.1%,遠(yuǎn)處轉(zhuǎn)移患者的5年死亡率為85.7%,局部復(fù)發(fā)合并遠(yuǎn)處轉(zhuǎn)移患者的5年死亡率90.0%,有統(tǒng)計(jì)學(xué)差異(P0.05)。2.復(fù)發(fā)時(shí)間:平均復(fù)發(fā)時(shí)間20.67±23.77月,中位復(fù)發(fā)時(shí)間12.00月。2年內(nèi)復(fù)發(fā)率為63.27%,2～5年復(fù)發(fā)率為24.29%,5年以上復(fù)發(fā)率12.24%。且不同復(fù)發(fā)時(shí)間的死亡率有統(tǒng)計(jì)學(xué)差異(P0.05)。3.病理特點(diǎn):①Ⅰ期、Ⅱ期、Ⅲ期與Ⅳ期復(fù)發(fā)率分別為28.4%、57.1%、88.9%及100%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。②子宮平滑肌肉瘤、子宮內(nèi)膜間質(zhì)肉瘤、子宮腺肉瘤和未分化肉瘤復(fù)發(fā)率分別為56.8%、38.3%、27.3%和100%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。③全組有60例患者行淋巴結(jié)清掃術(shù),其中復(fù)發(fā)組27例,未復(fù)發(fā)組33例。復(fù)發(fā)組淋巴結(jié)轉(zhuǎn)移率為7.4%,未復(fù)發(fā)組淋巴結(jié)轉(zhuǎn)移率為6.1%,無統(tǒng)計(jì)學(xué)差異(P0.05)。④腫瘤最大直徑5cm的復(fù)發(fā)率(45.12%)顯著高于直徑≤5cm的復(fù)發(fā)率(14.81%),差異有統(tǒng)計(jì)學(xué)意義(P=0.002)。4.手術(shù)范圍:①58例行子宮切除+雙側(cè)附件切除+盆腔淋巴結(jié)清掃術(shù)士腹主動(dòng)脈旁淋巴結(jié)清掃術(shù),29例行全子宮切除+雙側(cè)附件/單側(cè)附件切除術(shù),12例行全子宮切除術(shù)/全子宮+雙側(cè)輸卵管切除術(shù),4例行單純腫瘤病灶切除術(shù)。2例患者具體手術(shù)方式不詳。復(fù)發(fā)率分別為:43.1%、44.8%、58.3%及50%。各手術(shù)范圍對(duì)比,復(fù)發(fā)率無統(tǒng)計(jì)學(xué)差異(P0.05)。②以是否行淋巴結(jié)清掃術(shù)分為兩組,復(fù)發(fā)率無統(tǒng)計(jì)學(xué)差異(P0.05)。5.術(shù)后輔助治療:術(shù)后化療55例,術(shù)后未輔助治療37例,術(shù)后大劑量孕激素治療9例,術(shù)后放療3例,術(shù)后放化療1例。各治療方法比較,復(fù)發(fā)率無統(tǒng)計(jì)學(xué)差異(P=0.157)。6.復(fù)發(fā)后治療:49例復(fù)發(fā)患者,以復(fù)發(fā)后是否行手術(shù)治療分為手術(shù)組和非手術(shù)組。①手術(shù)組5年死亡率57.1%,非手術(shù)組5年死亡率89.5%,差異有統(tǒng)計(jì)學(xué)意義(P=0.022)。②復(fù)發(fā)后平均生存時(shí)間24.1 ±31.25月,中位生存時(shí)間10月。手術(shù)組復(fù)發(fā)后平均生存時(shí)間39.43±39.95月,中位生存時(shí)間27月,非手術(shù)組平均生存時(shí)間16.21 ± 16.83月,中位生存時(shí)間10月。差異有統(tǒng)計(jì)學(xué)意義(P=0.01)。7.單因素分析示,年齡、分期、病理類型及腫瘤大小是影響復(fù)發(fā)的主要因素;多因素分析示,年齡和分期是影響復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。對(duì)局部復(fù)發(fā)和遠(yuǎn)處轉(zhuǎn)移分別進(jìn)行分析,年齡和分期是局部復(fù)發(fā)和遠(yuǎn)處轉(zhuǎn)移的獨(dú)立危險(xiǎn)因素。8.復(fù)發(fā)患者預(yù)后的影響因素分析示,年齡、復(fù)發(fā)時(shí)間及復(fù)發(fā)后治療是影響復(fù)發(fā)患者預(yù)后的獨(dú)立危險(xiǎn)因素。結(jié)論:1.子宮肉瘤易復(fù)發(fā),局部復(fù)發(fā)率及遠(yuǎn)處轉(zhuǎn)移率均較高。2.復(fù)發(fā)多發(fā)生于2年內(nèi),復(fù)發(fā)時(shí)間越早,預(yù)后越差。3.年齡及分期是子宮肉瘤復(fù)發(fā)的獨(dú)立危險(xiǎn)因素。4.年齡越大、復(fù)發(fā)時(shí)間越早是影響復(fù)發(fā)患者預(yù)后的獨(dú)立危險(xiǎn)因素,復(fù)發(fā)后手術(shù)治療是復(fù)發(fā)患者預(yù)后的保護(hù)因素。5.子宮肉瘤惡性程度高,復(fù)發(fā)轉(zhuǎn)移發(fā)生早,預(yù)后差,亟待行之有效的輔助治療方案用于預(yù)防復(fù)發(fā)及改善預(yù)后。
[Abstract]:Objective: to analyze the clinical characteristics of patients with postoperative recurrence of uterine sarcoma, influencing factors and prognosis. Methods: the clinical data collected from December 1999 to December 2013 at the Qilu Hospital of Shandong University from uterine sarcoma patients, 105 patients met the inclusion criteria, including 49 cases of recurrence. Compared with non recurrence group (56 cases) comparative analysis. The clinical characteristics of patients with uterine sarcoma recurrence site of recurrence, recurrence time, recurrence related factors, treatment and prognosis after recurrence. SPSS 19 software was used for statistical analysis. All test methods that P0.05 there were significant differences. Results: 1. sites of recurrence: simple local recurrence rate was 36.73%, only the distant metastasis rate was 42.85%, the rate of transfer local recurrence and distant recurrence of 20.41%. patients 5 year mortality rate was 66.1%, distant metastasis 5 years mortality rate was 85.7%, local recurrence and distant metastasis In 5 years the mortality rate was 90%, there was significant difference (P0.05).2. recurrence time: the mean recurrence time was 20.67 + 23.77 months, the median time to relapse was 12 months.2 years, the recurrence rate was 63.27%, the 2~5 year recurrence rate was 24.29%, there were significant differences in the 5 years recurrence rate of 12.24%. and different time of recurrence (P0.05 death rate.3. features: 1) the pathological stage I, II, III and IV recurrence rates were 28.4%, 57.1%, 88.9% and 100%, the difference was statistically significant (P0.05). The leiomyosarcoma of the uterus, endometrial stromal sarcoma, uterine sarcoma and undifferentiated flesh tumor recurrence rates were 56.8%, 38.3%, 27.3% and 100%, the difference was statistically significant (P0.05). The whole group of 60 patients underwent lymph node dissection, the recurrence group of 27 cases and 33 non recurrent cases. The recurrence rate of lymph node metastasis was 7.4%, recurrence rate of lymph node metastasis was 6.1%, there was no significant difference (P0.05) of the tumor. Maximum diameter Size of the recurrence rate of 5cm (45.12%) was significantly higher than the diameter is less than or equal to the recurrence rate of 5cm (14.81%), the difference was statistically significant (P=0.002).4. surgery: 58 cases underwent hysterectomy and bilateral oophorectomy and pelvic lymphadenectomy were paraaortic lymph node dissection, 29 cases underwent hysterectomy and bilateral / unilateral accessory appendix resection, 12 underwent hysterectomy / hysterectomy + bilateral tubal resection, 4 cases underwent tumor resection, the specific methods of operation of.2 patients is unknown. The recurrence rate was 43.1%, 44.8%, 58.3% and 50%. respectively the scope of operation contrast, recurrence rate had no significant difference (P0.05). According to whether for lymph node dissection were divided into two groups, the recurrence rate was no significant difference (P0.05) adjuvant therapy after.5. surgery: 55 cases of postoperative chemotherapy, without adjuvant therapy in 37 patients after operation, 9 cases of high dose progesterone treatment after surgery, 3 cases of postoperative radiotherapy and chemotherapy after operation in 1 cases. The treatment method The recurrence rate comparison, no statistically significant difference (P=0.157).6. recurrence after treatment: 49 cases of patients with recurrence, recurrence after surgical treatment were divided into operation group and non operation group. The operation group for 5 years the mortality rate was 57.1%, the non operation group 5 years the mortality rate was 89.5%, the difference was statistically significant (P=0.022). The average recurrence the survival time was 24.1 + 31.25 months, the median survival time of recurrence after surgery group in October. The average survival time was 39.43 + 39.95 months, the median survival time was 27 months, the non operation group the average survival time was 16.21 + 16.83 months, the median survival time in October. The difference was statistically significant (P =0.01), age, stage of.7. the single factor, pathological type and tumor size were the main factors influencing recurrence; multivariate analysis showed that age and stage are the independent risk factors of recurrence. The local recurrence and distant metastasis were analyzed, the age and stage is local recurrence and distant metastasis The prognostic factors of patients with independent risk factors for the recurrence of.8. analysis showed that age, time to recurrence and recurrence after treatment were independent prognostic factors of recurrence. Conclusion: Patients with 1. uterine sarcoma recurrence, local recurrence rate and distant metastasis rate were high.2. recurrence occurred in 2 years, the recurrence time earlier, prognosis the difference of age and.3. staging were independent risk factors of recurrence of uterine sarcoma.4. older, earlier recurrence were independent prognostic factors of relapse, recurrence after surgery is a protective factor for prognosis of patients with recurrent uterine sarcoma.5. high degree of malignancy, recurrence and early metastasis, poor prognosis, to be effective auxiliary treatments to prevent recurrence and improve the prognosis.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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