本文選題：胃癌　切入點(diǎn)：肝轉(zhuǎn)移　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:通過(guò)回顧性分析胃癌肝轉(zhuǎn)移的臨床病理特征及可能影響患者預(yù)后的有關(guān)因素,進(jìn)而分析胃癌原發(fā)灶與肝臟轉(zhuǎn)移灶之間的內(nèi)在聯(lián)系,通過(guò)其內(nèi)在的聯(lián)系可能為獲得治療胃癌肝轉(zhuǎn)移和預(yù)測(cè)胃癌肝轉(zhuǎn)移預(yù)后帶來(lái)新的方向。方法:回顧性分析河北醫(yī)科大學(xué)第四醫(yī)院病案室2000年1月至2014年1月歸檔的胃癌肝轉(zhuǎn)移患者的病案資料。同時(shí)分別記錄這些病例原發(fā)灶部分臨床病理特征;其中包括:年齡、性別、腫瘤部位、腫瘤大小、腫瘤的大體類型、漿膜侵犯、分化程度、脈管癌栓、淋巴結(jié)轉(zhuǎn)移、腹膜轉(zhuǎn)移、手術(shù)性質(zhì)、肝轉(zhuǎn)移部位以及肝轉(zhuǎn)移時(shí)機(jī)等情況,然后用EXCEL建立胃癌肝轉(zhuǎn)移原發(fā)灶臨床病理特征的數(shù)據(jù)庫(kù),翻閱部分病例,并對(duì)這些患者進(jìn)行定期的隨訪。統(tǒng)計(jì)分析軟件采用的是SPSS21.0軟件包,使用卡方檢驗(yàn)的方法將該資料同一因素的相關(guān)性進(jìn)行統(tǒng)計(jì)學(xué)分析,然后采用logistic回歸來(lái)分析胃癌肝轉(zhuǎn)移的高危因素,將P0.05認(rèn)為在有統(tǒng)計(jì)學(xué)方面具有意義。結(jié)果:1胃癌肝轉(zhuǎn)移患者的男女比例為2.03:1;中老年人居多,其中患病平均年齡為58歲;原發(fā)病灶位于賁門部者有206例,占43.0%;原發(fā)病灶最大直徑大于5cm者有287例,占60.2%;原發(fā)病灶侵及漿膜層者有317例(66.3%);低分化腺癌者有380例,占79.4%;中分化腺癌者有92例,占19.3%;高分化腺癌者有6例,占1.3%;脈管癌栓者有317例(66.3%);胃癌大體分型中Bormann I型者有72例(15.0%),Bormann II型者有87例(18.3%),Bormann III型者有299例(62.5%),Bormann IV型20例者有(4.2%);淋巴結(jié)轉(zhuǎn)移者有436例(91.2%);腹膜轉(zhuǎn)移者有103例(21.6%);行根治性手術(shù)者有104例(21.8%);胃癌轉(zhuǎn)移至肝左葉者有95例(19.8%),轉(zhuǎn)移至肝右葉163例有(34.2%),肝左右兩葉均轉(zhuǎn)移者有220例(46.0%);胃癌同時(shí)性肝轉(zhuǎn)移者有141例(29.6%),胃癌異時(shí)性肝轉(zhuǎn)移者有337例(70.4%)。胃癌術(shù)后肝上出現(xiàn)轉(zhuǎn)移灶最短的時(shí)間為1.2個(gè)月,最長(zhǎng)的時(shí)間為38月,術(shù)后出現(xiàn)轉(zhuǎn)移的平均時(shí)間為9個(gè)月。其中血液檢測(cè)發(fā)現(xiàn)AFP陽(yáng)性8例,再次查閱2000-2014年期間共15704例胃癌歸檔病案資料,發(fā)現(xiàn)AFP陽(yáng)性胃癌患者共有13例,表明AFP陽(yáng)性的胃癌肝轉(zhuǎn)移率非常高(61.53%)2通過(guò)將胃癌原發(fā)灶部位和肝轉(zhuǎn)移灶經(jīng)卡方檢驗(yàn)后,P0.05,沒有統(tǒng)計(jì)學(xué)意義,說(shuō)明上述二者之間無(wú)明顯相關(guān)性。結(jié)論:1胃癌原發(fā)灶組織中出現(xiàn)脈管癌栓、侵及漿膜、淋巴結(jié)轉(zhuǎn)移、腹膜轉(zhuǎn)移、肝轉(zhuǎn)移時(shí)機(jī)都是影響肝轉(zhuǎn)移患者預(yù)后的高危因素。其中的腹膜轉(zhuǎn)移、漿膜受侵、肝轉(zhuǎn)移時(shí)機(jī)三者在胃癌肝轉(zhuǎn)移患者的預(yù)后是獨(dú)立的危險(xiǎn)因素。2胃癌肝轉(zhuǎn)移的原發(fā)灶部位與轉(zhuǎn)移灶部位無(wú)明顯差異;
[Abstract]:Objective: to analyze the clinicopathological features of liver metastasis of gastric cancer and the related factors that may affect the prognosis of gastric cancer, and to analyze the relationship between the primary tumor of gastric cancer and the hepatic metastasis. It may bring a new direction to the treatment of liver metastasis of gastric cancer and predict the prognosis of hepatic metastasis of gastric cancer through its internal relationship. Methods: retrospective analysis of the medical records department of the fourth Hospital of Hebei Medical University from January 2000 to January 2014 was carried out. The medical records of patients with liver metastasis of gastric cancer were recorded, and some clinicopathological features of the primary lesions were recorded. These include: age, sex, tumor location, tumor size, gross type of tumor, serosal invasion, differentiation, vascular tumor embolus, lymph node metastasis, peritoneal metastasis, surgical nature, location of liver metastasis and timing of liver metastasis. Then EXCEL was used to establish a database of clinicopathological features of primary liver metastases of gastric cancer, and some cases were reviewed, and these patients were followed up regularly. SPSS21.0 software package was used for statistical analysis. The correlation of the same factor was statistically analyzed by chi-square test, and then logistic regression was used to analyze the high risk factors of liver metastasis of gastric cancer. Results the ratio of male to female was 2.03: 1 in patients with liver metastases from gastric cancer. The majority of middle-aged and elderly people, with an average age of 58 years, had 206 cases of primary lesions located in the cardia. The largest diameter of the primary lesion was larger than 5cm in 287 cases (60.2%); the primary lesion involved serous layer in 317 cases (66.3%); the poorly differentiated adenocarcinoma in 380 cases (79.4%); the moderately differentiated adenocarcinoma in 92 cases (19.3%); the highly differentiated adenocarcinoma in 6 cases. There were 317 cases with vessel tumor embolus, 72 cases with Bormann type I, 87 cases with type 18.3C, 87 cases with Bormann III type 18.3C, 20 cases with Bormann IV type, 436 cases with lymph node metastasis, 91.2i cases with lymph node metastasis, 103 cases with peritoneal metastasis and 21.6 cases with radical mastectomy. There were 104 cases of operation, 95 cases of gastric cancer metastasis to liver Zuo Ye, 163 cases to right lobe of liver, 220 cases to right lobe of liver, 220 cases to both sides of liver, 141 cases to simultaneous liver metastasis, 337 cases to abnormal liver metastasis and 70.4 cases to gastric cancer, respectively, to the patients with liver cancer and to the liver, and to the right lobe of the liver, to the right lobe of the liver, to the right lobe of the liver, to 220 cases to the right lobe of the liver and to the right lobe of the liver, to the right and to the right lobes of the liver. The shortest time of liver metastasis after operation was 1.2 months. The longest time was 38 months, and the average time of metastasis was 9 months. Among them, 8 cases were found to be positive for AFP by blood test, and 13 cases were found to be positive for AFP in the 15704 cases of gastric cancer archived from 2000 to 2014. The results showed that the liver metastasis rate of AFP positive gastric cancer was very high. There was no statistical significance by chi-square test on the location of primary gastric cancer and liver metastasis. Conclusion the vascular tumor embolus, involving serous membrane, lymph node metastasis and peritoneal metastasis were found in the primary tissues of gastric cancer. The timing of liver metastasis is a high risk factor for the prognosis of patients with liver metastasis. The prognosis of patients with liver metastasis is an independent risk factor .2 there is no significant difference between the primary and metastatic sites of liver metastasis of gastric cancer.
【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)】：R735.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陳凜;李佶陽(yáng);;胃癌肝轉(zhuǎn)移的外科綜合治療[J];外科理論與實(shí)踐;2015年01期

2 衛(wèi)勃;劉國(guó)曉;;胃癌肝轉(zhuǎn)移的機(jī)制[J];中華胃腸外科雜志;2014年07期

3 于先強(qiáng);鄭志超;;胃癌肝轉(zhuǎn)移治療研究進(jìn)展[J];現(xiàn)代腫瘤醫(yī)學(xué);2013年10期

4 鄭朝旭;鄭榮壽;陳萬(wàn)青;;中國(guó)2009年胃癌發(fā)病與死亡分析[J];中國(guó)腫瘤;2013年05期

5 盧宏霞;楊牡丹;高峻;;金龍膠囊聯(lián)合化療治療胃癌肝轉(zhuǎn)移的臨床觀察[J];中國(guó)腫瘤臨床;2012年24期

6 ;Prognosis of HER2 over-expressing gastric cancer patients with liver metastasis[J];World Journal of Gastroenterology;2012年19期

7 支波波;林雨冬;高遠(yuǎn);吳德柱;杜京麗;;替吉奧聯(lián)合奧沙利鉑治療胃癌伴肝轉(zhuǎn)移1例報(bào)告[J];實(shí)用癌癥雜志;2012年01期

8 郭s，

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