本文選題：內(nèi)生頸管型宮頸癌　切入點(diǎn)：臨床因素　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:內(nèi)生頸管型宮頸癌是一種少見(jiàn)的宮頸癌類型,因其早期缺乏典型的臨床癥狀,且病灶隱匿,臨床上常易漏診,本研究擬通過(guò)比較內(nèi)生頸管型宮頸癌與非內(nèi)生頸管型宮頸癌的臨床病理資料并對(duì)兩者進(jìn)行預(yù)后分析,來(lái)探討內(nèi)生頸管型宮頸癌的臨床病理特征及預(yù)后影響因素。以期達(dá)到早期識(shí)別,積極治療,從而提高內(nèi)生頸管型宮頸癌預(yù)后的目的。方法:收集2008年8月1日至2011年8月30日在河北醫(yī)科大學(xué)第四醫(yī)院婦科行手術(shù)治療的宮頸癌患者478例。篩選出內(nèi)生頸管型宮頸癌患者53例,非內(nèi)生頸管型宮頸癌患者425例,比較兩者臨床病理特征的差異,并對(duì)兩者的預(yù)后進(jìn)行單因素及多因素分析。結(jié)果:1與非內(nèi)生頸管型宮頸癌相比,內(nèi)生頸管型宮頸癌確診年齡≥50歲、一級(jí)親屬中有宮頸癌家族史、術(shù)后追加治療者所占比例高,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而孕產(chǎn)次、臨床癥狀、臨床分期與非內(nèi)生頸管型宮頸癌無(wú)明顯差異。2內(nèi)生頸管型宮頸癌中非鱗癌居多,更易發(fā)生頸管內(nèi)口受侵、宮體受侵、深肌層浸潤(rùn)及宮旁受侵(P0.05),但在術(shù)后腫瘤直徑、組織學(xué)分級(jí)、脈管瘤栓及淋巴結(jié)轉(zhuǎn)移方面與非內(nèi)生頸管型宮頸癌無(wú)明顯差異。3內(nèi)生頸管型宮頸癌與非內(nèi)生頸管型宮頸癌5年生存率分別為78.0%,88.2%,差異有統(tǒng)計(jì)學(xué)意義(P=0.041)。4多因素分析發(fā)現(xiàn),術(shù)后腫瘤直徑為影響內(nèi)生頸管型宮頸癌預(yù)后的獨(dú)立危險(xiǎn)因素。5單因素分析中,腫瘤直徑大于4cm、深肌層浸潤(rùn)、脈管瘤栓、宮頸管內(nèi)口受侵、宮旁受侵、淋巴結(jié)轉(zhuǎn)移是影響非內(nèi)生頸管型宮頸癌預(yù)后的相關(guān)危險(xiǎn)因素,腫瘤直徑、淋巴結(jié)轉(zhuǎn)移是影響非內(nèi)生頸管型宮頸癌預(yù)后的獨(dú)立危險(xiǎn)因素。6內(nèi)生頸管型宮頸癌手術(shù)前后腫瘤直徑的符合率為69.81%,術(shù)后腫瘤直徑顯著大于術(shù)前(P=0.001)。結(jié)論:1與非內(nèi)生頸管型宮頸癌相比,內(nèi)生頸管型宮頸癌患者被檢出時(shí)年齡較大,術(shù)后常常需要接受輔助治療。2內(nèi)生頸管型宮頸癌非鱗癌所占比例較高,更常出現(xiàn)深肌層浸潤(rùn)、頸管內(nèi)口受侵、宮體受侵、宮旁受侵。3內(nèi)生頸管型宮頸癌預(yù)后較非內(nèi)生頸管型宮頸癌差,且不易早期識(shí)別,因此需要加強(qiáng)對(duì)內(nèi)生頸管型宮頸癌的識(shí)別,術(shù)后管理及隨訪。4術(shù)后腫瘤直徑是影響內(nèi)生頸管型宮頸癌預(yù)后的獨(dú)立危險(xiǎn)因素。5腫瘤直徑、深肌層浸潤(rùn)、脈管瘤栓、宮頸管內(nèi)口受侵、宮旁受侵、淋巴結(jié)轉(zhuǎn)移是影響非內(nèi)生頸管型宮頸癌預(yù)后的相關(guān)危險(xiǎn)因素,腫瘤直徑、淋巴結(jié)轉(zhuǎn)移是影響非內(nèi)生頸管型宮頸癌預(yù)后的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: endogenetic cervical carcinoma is a rare type of cervical cancer. In this study, the clinicopathological data of endogenetic cervical carcinoma and non-endogenetic cervical carcinoma were compared and their prognosis was analyzed. To explore the clinicopathological features and prognostic factors of endogenetic cervical carcinoma, in order to achieve early identification and active treatment. Objective: to improve the prognosis of endogenetic cervical carcinoma. Methods: 478 cases of cervical cancer treated by gynecological surgery from August 1, 2008 to August 30, 2011 were selected. 53 cases of cervical cancer, 425 cases of cervical cancer with non-endogenetic cervical canal type were studied. The difference of clinicopathological features between them was compared, and the prognosis of them was analyzed by univariate and multivariate analysis. Results compared with non-endogenetic cervical carcinoma, the ratio of 1 to 1 was higher than that of non-endogenetic cervical carcinoma. The diagnosis age of endogenetic cervical carcinoma was more than 50 years old, the family history of cervical cancer was found in the first degree relatives, the proportion of patients who received additional treatment after operation was high, the difference was statistically significant (P 0.05). There was no significant difference between clinical staging and non-endogenetic cervical carcinoma. 2 the non-squamous cell carcinoma of endogenetic cervical carcinoma was more likely to occur intrauterine invasion, uterine body invasion, deep myometrial invasion and pariuterine invasion (P0.05), but the tumor diameter and histological grade were observed after operation. There was no significant difference in vascular embolus and lymph node metastasis between endogenetic cervical carcinoma and non-endogenetic cervical carcinoma. 3 the 5-year survival rate of endogenetic cervical carcinoma and non-endogenetic cervical carcinoma was 78.0 and 88.2, respectively. The difference was statistically significant (P < 0.01). Tumor diameter was an independent risk factor for the prognosis of endogenetic cervical carcinoma. The diameter of the tumor was more than 4 cm, deep muscle infiltration, vascular tumor embolus, cervical canal invasion, para-uterine invasion. Lymph node metastasis is a risk factor related to the prognosis of non-endogenous cervical carcinoma. Lymph node metastasis is an independent risk factor for the prognosis of non-endogenetic cervical carcinoma... The coincidence rate of tumor diameter before and after operation for endogenetic cervical carcinoma is 69. 81, and the diameter of tumor after operation is significantly larger than that of preoperatively. Compared with tubular cervical cancer, The patients with cervical carcinoma of endogenetic cervical canal were older when they were detected. 2. The proportion of non-squamous cell carcinoma of cervical cancer of endogenetic cervical canal type was high, and the infiltration of deep muscle layer, the invasion of intraspinal orifice and the invasion of uterine body were more common. The prognosis of endogenetic cervical canal cervical carcinoma is worse than that of non-endogenetic cervical carcinoma, and it is not easy to identify early, so it is necessary to strengthen the recognition of endogenetic cervical duct cervical carcinoma. Postoperative management and follow-up were independent risk factors for the prognosis of endogenetic cervical carcinoma. 5. The diameter of tumor, the infiltration of deep muscle layer, the embolus of vascular tumor, the invasion of cervical canal orifice, and the invasion of periuterine. Lymph node metastasis is a risk factor related to the prognosis of non-endogenous cervical carcinoma. Tumor diameter and lymph node metastasis are independent risk factors for the prognosis of non-endogenetic cervical carcinoma.
【學(xué)位授予單位】：河北醫(yī)科大學(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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本文編號(hào)：1688424