本文選題：宮頸腺癌　切入點(diǎn)：卵巢轉(zhuǎn)移率　出處：《山東大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:在我國(guó),宮頸癌是女性患者中發(fā)病率第五位的惡性腫瘤,是女性生殖系統(tǒng)發(fā)病率最高的惡性腫瘤,也是每年死亡人數(shù)最多的婦科惡性腫瘤。隨著社會(huì)的發(fā)展和性觀念的改變,宮頸癌的發(fā)病出現(xiàn)了年輕化的趨勢(shì)。與此同時(shí),宮頸腺癌的發(fā)病率相對(duì)于宮頸鱗狀細(xì)胞癌發(fā)病率逐漸上升。傳統(tǒng)的觀點(diǎn)認(rèn)為腺癌患者在手術(shù)的過程中要同時(shí)切除雙側(cè)附件,但是由于逐年增多的年輕患者對(duì)于卵巢功能的需求讓我們不得不考慮保留卵巢功能的可行性。目的:分析宮頸腺癌發(fā)生卵巢轉(zhuǎn)移的高危因素以及保留卵巢與切除卵巢的腺癌患者預(yù)后情況是否存在差異,探討宮頸腺癌患者保留卵巢可行性。方法:通過山東大學(xué)齊魯醫(yī)院電子病歷系統(tǒng)檢索宮頸腺癌患者資料,收集自2005年1月至2016年12月之間的宮頸腺癌患者病歷,篩選出初診患者并于齊魯醫(yī)院接受手術(shù)治療的宮頸腺癌患者233例。其中保留卵巢功能的患者44例,切除卵巢的患者189例,其中8例患者發(fā)現(xiàn)卵巢轉(zhuǎn)移。將189例切除卵巢的患者按照卵巢轉(zhuǎn)移和無卵巢轉(zhuǎn)移分為兩組,比較兩組患者的年齡、腫瘤的組織分化程度及臨床分期、腫瘤最大徑、宮旁浸潤(rùn)、宮體浸潤(rùn)、陰道殘端、輸卵管轉(zhuǎn)移、間質(zhì)浸潤(rùn)深度、淋巴脈管間隙浸潤(rùn)(LVSI)及淋巴結(jié)轉(zhuǎn)移情況,分析與卵巢轉(zhuǎn)移相關(guān)的高危因素。通過log-rank檢驗(yàn)的方法比較保留卵巢功能和切除卵巢的患者的生存曲線,分析術(shù)后生存時(shí)間是否存在顯著差異。結(jié)果:(1)宮頸腺癌卵巢轉(zhuǎn)移率為3.43%。(2)宮頸腺癌患者總體平均年齡為45.0±9.92歲,卵巢轉(zhuǎn)移和無卵巢轉(zhuǎn)移的患者平均年齡分別為45.5土7.9歲和45.0± 10.0歲,年齡因素與卵巢轉(zhuǎn)移無明顯相關(guān)性。(3)單因素分析結(jié)果:臨床分期、組織分化程度、宮旁浸潤(rùn)、陰道殘端、輸卵管轉(zhuǎn)移、宮頸間質(zhì)浸潤(rùn)深度、宮體浸潤(rùn)、LVSI和淋巴結(jié)轉(zhuǎn)移情況與卵巢轉(zhuǎn)移有相關(guān)性。(4)多因素logistic回歸分析結(jié)果:宮旁浸潤(rùn)(+)、陰道殘端(+)、宮頸間質(zhì)浸潤(rùn)深度1/2、LVSI(+)是卵巢轉(zhuǎn)移的高危因素。(5)log-rank生存曲線分析結(jié)果:宮頸腺癌患者總體的5年生存率為91.73%;保留卵巢與切除卵巢的患者生存曲線沒有顯著的差異。結(jié)論:患者的年齡與卵巢轉(zhuǎn)移無明顯相關(guān)性,對(duì)于宮旁浸潤(rùn)(-)、陰道殘端(-)、宮頸間質(zhì)浸潤(rùn)深度≤1/2、LVSI(-)的年輕患者,可選擇保留卵巢功能的治療方案,結(jié)論還需大樣本研究進(jìn)一步證實(shí)。
[Abstract]:Background: in China, cervical cancer is a malignant tumor with the highest incidence in female reproductive system. It is also the most common gynecological malignancy with the highest number of deaths each year. With the development of society and the change of sexual attitudes, the incidence of cervical cancer is becoming younger. At the same time, The incidence of adenocarcinoma of the cervix is increasing relative to that of squamous cell carcinoma of the cervix. However, due to the increasing demand of young patients for ovarian function, we have to consider the feasibility of preserving ovarian function. Objective: to analyze the high risk factors of ovarian metastasis in cervical adenocarcinoma, and to analyze the risk factors of ovarian preservation and ovariectomy. Whether there is a difference in prognosis in patients with ovarian adenocarcinoma, Methods: the data of patients with cervical adenocarcinoma were searched by electronic medical record system in Qilu Hospital of Shandong University from January 2005 to December 2016. A total of 233 cases of cervical adenocarcinoma were selected and treated in Qilu Hospital. Among them, 44 were patients with ovarian function and 189 were ovariectomized. The patients were divided into two groups according to ovarian metastasis and no ovarian metastasis. The age, tumor tissue differentiation, clinical stage, tumor maximum diameter, para-uterine infiltration were compared between the two groups. Uterine body invasion, vaginal stump, fallopian tube metastasis, depth of interstitial infiltration, lymphatic vascular space infiltration, LVSIand lymph node metastasis. The high risk factors associated with ovarian metastasis were analyzed. The survival curves of patients with ovarian function and ovariectomized were compared by log-rank test. Results the average age of patients with cervical adenocarcinoma was 45.0 鹵9.92 years old. The mean age of patients with ovarian metastasis and non-metastasis were 45.5 鹵7.9 years and 45.0 鹵10.0 years, respectively. There was no significant correlation between age factors and ovarian metastasis. The results of univariate analysis were as follows: clinical stage, degree of tissue differentiation, para-uterine invasion, vaginal stump, tubal metastasis, depth of cervical interstitial infiltration. Results of multivariate logistic regression analysis: para-uterine invasion (logistic), vaginal stump (P < 0.01), cervical interstitial invasion depth (1 / 2) LVSI () were high risk factors for ovarian metastasis. The overall 5-year survival rate of patients with cervical adenocarcinoma was 91.73. There was no significant difference in survival curve between patients with ovarian preservation and ovariectomized. Conclusion: there is no significant correlation between age and ovarian metastasis. For the young patients with periuterine invasion, vaginal stump and cervical interstitial infiltration 鈮，

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