發(fā)布時(shí)間：2018-03-25 03:38

  本文選題：結(jié)腸鏡　切入點(diǎn)：結(jié)腸癌　出處：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)對(duì)結(jié)腸癌患者進(jìn)行根治術(shù)后定期結(jié)腸鏡檢查隨訪,利于早期發(fā)現(xiàn)術(shù)后的復(fù)發(fā)病灶以及結(jié)腸息肉等結(jié)腸病變,探討定期結(jié)腸鏡隨訪檢查和鏡下對(duì)癥治療對(duì)降低結(jié)腸癌復(fù)發(fā)率、提高術(shù)后生存率的臨床意義;并對(duì)所有患者的臨床病理特征及可能會(huì)影響結(jié)腸癌術(shù)后復(fù)發(fā)的多種因素進(jìn)行分析,探討影響結(jié)腸癌患者術(shù)后生存預(yù)后的因素。方法:對(duì)濰坊市人民醫(yī)院2013年12月~2014年12月收治的共445例已行結(jié)腸癌根治術(shù)(包括結(jié)腸鏡手術(shù)和開(kāi)腹手術(shù)患者)且有組織病理學(xué)診斷為結(jié)腸癌的患者進(jìn)行定期結(jié)腸鏡隨訪檢查,包括升結(jié)腸癌130例,橫結(jié)腸癌70例,降結(jié)腸癌95例,乙狀結(jié)腸癌150例。收集所有患者住院期間的臨床病理資料,包括性別、年齡、原發(fā)腫瘤的部位、原發(fā)腫瘤的組織學(xué)類型及TNM分期、分化程度、淋巴結(jié)轉(zhuǎn)移情況、以及術(shù)前血清癌胚抗原(CEA)的水平。隨訪過(guò)程中,結(jié)腸鏡檢查對(duì)可疑結(jié)腸病變?nèi)』顧z標(biāo)本送病理科做進(jìn)一步檢查,抽血檢測(cè)CEA的水平,發(fā)現(xiàn)結(jié)腸息肉后及時(shí)行鏡下高頻電或圈套器套扎術(shù)治療。對(duì)發(fā)現(xiàn)可疑病變的復(fù)查者進(jìn)一步做多普勒彩超和CT檢查,判斷術(shù)后有無(wú)復(fù)發(fā)。根據(jù)結(jié)腸鏡和影像檢查結(jié)果,以及病理檢查結(jié)果,進(jìn)一步分析結(jié)腸癌患者的性別、年齡、淋巴結(jié)轉(zhuǎn)移、術(shù)前血清中CEA水平、腫瘤原發(fā)部位以及原發(fā)腫瘤的病理類型及TNM分期對(duì)結(jié)腸癌術(shù)后預(yù)后和復(fù)發(fā)的影響。結(jié)果:所有結(jié)腸癌患者術(shù)后兩年內(nèi)每6個(gè)月進(jìn)行一次結(jié)腸鏡檢查,共檢出吻合口復(fù)發(fā)癌40例,多原發(fā)癌28例,吻合口炎45例,腺瘤性息肉51例,共105枚,均行結(jié)腸鏡下高頻電摘除或圈套器套扎術(shù)治療。隨訪結(jié)果顯示:結(jié)腸癌根治術(shù)后患者的復(fù)發(fā)情況與原發(fā)癌發(fā)病時(shí)患者的年齡、性別以及原發(fā)癌的部位關(guān)系并不大,無(wú)統(tǒng)計(jì)學(xué)意義;結(jié)腸癌的復(fù)發(fā)與原發(fā)腫瘤的病理類型、分化程度以及TNM分期密切相關(guān),復(fù)發(fā)率分別為高分化腺癌(14.3%),中分化腺癌(18.3%),低分化腺癌(27.9%),乳頭狀腺癌(4.7%),以及粘液腺癌(15.3%),Ⅰ期患者(9.1%),Ⅱ期患者(11.7%),Ⅲ期患者(22%),Ⅳ期患者(33.9%);結(jié)腸癌患者術(shù)前血清中CEA水平以及是否已發(fā)生淋巴結(jié)轉(zhuǎn)移也是影響根治術(shù)后患者復(fù)發(fā)率和生存率的重要因素,其中原發(fā)癌患者血清中CEA水平越高,以及發(fā)生淋巴結(jié)轉(zhuǎn)移者,術(shù)后復(fù)發(fā)率顯著增高,復(fù)發(fā)率分別為CEA水平≥25 ng/ml的患者21.5%,CEA水平介于5~25ng/ml之間的患者16.8%,CEA水平≤5ng/ml患者5.7%。因此,CEA水平以及淋巴結(jié)轉(zhuǎn)移情況可以作為指導(dǎo)臨床治療方案實(shí)施的重要參考依據(jù)。結(jié)論:1.結(jié)腸癌患者術(shù)后定期隨訪是結(jié)腸癌手術(shù)治療后一個(gè)不可缺少的重要環(huán)節(jié),是目前根治術(shù)后隨訪最有效的檢查手段。2.通過(guò)結(jié)腸鏡能夠?qū)Y(jié)腸息肉直接行電凝切除,有效阻斷腺瘤性息肉等癌前病變向癌癥轉(zhuǎn)化,對(duì)降低結(jié)腸癌術(shù)后的再?gòu)?fù)發(fā)具有較大的臨床價(jià)值。3.結(jié)腸癌患者術(shù)后復(fù)發(fā)與患者發(fā)病時(shí)的年齡、性別以及原發(fā)腫瘤的位置相關(guān)性不大。4.結(jié)腸癌的復(fù)發(fā)與原發(fā)腫瘤的病理類型、分化程度以及TNM分期密切相關(guān),其中原發(fā)癌病理類型分化程度越低,TNM分期等級(jí)越高,結(jié)腸癌術(shù)后的復(fù)發(fā)率越高。5.結(jié)腸癌患者術(shù)前血清中CEA水平以及是否已發(fā)生淋巴結(jié)轉(zhuǎn)移也是影響根治術(shù)后患者復(fù)發(fā)率和生存率的重要因素,其中原發(fā)癌患者血清中CEA水平越高,以及發(fā)生淋巴結(jié)轉(zhuǎn)移者,術(shù)后復(fù)發(fā)率顯著增高,因此,CEA水平以及淋巴結(jié)轉(zhuǎn)移情況可以作為指導(dǎo)臨床治療方案實(shí)施的重要參考依據(jù)。
[Abstract]:Objective: through regular follow-up colonoscopy after radical resection of colon cancer patients, to early detection of postoperative recurrence of colon polyps and colon lesions and lesions of regular colonoscopy and endoscopic follow-up examination, symptomatic treatment to reduce the recurrence rate of colon cancer, the clinical significance of improving survival rate; and the analysis of the will effect of postoperative colon cancer recurrence factors and clinical pathological features of all patients, the prognostic factors of survival of patients with colon cancer. Methods: the Weifang People's Hospital in December 2013 ~2014 year in December from a total of 445 patients with colon cancer resection (including colonoscopy surgery and open surgery patients) and tissue pathology the diagnosis of colon cancer patients with regular colonoscopy follow-up examination, including 130 cases of ascending colon cancer, 70 transverse colon, descending colon cancer in 95 cases, 150 cases of sigmoid colon. Collect all Hospitalized patients during the clinical and pathological data, including gender, age, primary tumor site, tumor histological type and TNM stage, degree of differentiation, lymph node metastasis and preoperative serum carcinoembryonic antigen (CEA) level. During the follow-up, colonoscopy check on suspected colonic lesions from biopsy specimens were sent to the pathology department for further examination, serum CEA level, the timely endoscopic electrosurgical snare or ligation in the treatment of colonic polyps. Further found after Doppler ultrasound and CT examination of suspicious lesions were judged, postoperative recurrence. According to colonoscopy and imaging results, and the results of pathological examination, further analysis of colorectal cancer patients with sex, age, lymph node metastasis, preoperative serum CEA level, pathological type and TNM primary tumor site and primary tumor staging of colorectal cancer recurrence and prognosis 褰卞搷.緇撴灉:鎵，

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