發(fā)布時(shí)間：2018-04-09 17:35

  本文選題：食管胃交界癌　切入點(diǎn)：生存率　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:食管胃交界癌是最常見的消化道惡性腫瘤之一,我國是世界上食管胃交界癌的高發(fā)地區(qū)之一,食管胃交界癌的診治工作一直是我國醫(yī)學(xué)研究的重點(diǎn)。目前手術(shù)切除是食管胃交界癌的主要治療方法。鑒于此,本研究對(duì)河北醫(yī)科大學(xué)第四醫(yī)院東院胸外科2010年1月至2014年1月間行食管胃交界癌根治術(shù)的217例病人進(jìn)行回顧性研究,分析術(shù)后的生存分布,研究影響生存的預(yù)后因素,以期待為制定更為精準(zhǔn)的外科處理策略提供一定參考。方法:選取于我科行手術(shù)治療的273例食管胃交界癌病人,對(duì)其進(jìn)行術(shù)后調(diào)查隨訪,對(duì)符合入組條件的217例病人資料采用壽命表法進(jìn)行生存分析,并繪制生存曲線,采用Cox比例風(fēng)險(xiǎn)模型進(jìn)行多因素分析,將年齡、性別、手術(shù)方式、病理組織學(xué)類型、其分化程度G、浸潤(rùn)深度T、淋巴結(jié)清掃數(shù)目及陽性數(shù)目,作為協(xié)變量納入檢驗(yàn)�？偨Y(jié)食管胃交界癌的最優(yōu)手術(shù)方式。結(jié)果:1食管胃交界癌術(shù)后病人3、5年生存率分別為62%、50%,術(shù)后病人中位生存期為60個(gè)月,累積生存曲線可見Fig.1。2 Log-rank單因素分析結(jié)果表明:不同手術(shù)徑路,腫瘤分化程度G,浸潤(rùn)深度T,有無腹腔淋巴結(jié)轉(zhuǎn)移(尤其是胃左動(dòng)脈旁淋巴結(jié)、賁門旁淋巴結(jié)、胃小彎淋巴結(jié)),殘端是否陽性,術(shù)后是否發(fā)生復(fù)發(fā)或轉(zhuǎn)移及術(shù)前胃鏡判斷腫瘤侵及齒線上距離是影響食管胃交界癌預(yù)后的因素;而年齡、有無心腦血管疾病及糖尿病、病理組織學(xué)類型、有無脈管瘤栓、縱隔淋巴結(jié)是否有轉(zhuǎn)移(尤其是食管下段旁淋巴結(jié)是否轉(zhuǎn)移)、術(shù)前胃鏡示侵及胃的范圍都不是影響食管胃交界癌預(yù)后的因素。詳細(xì)數(shù)據(jù)見Table1。3 Cox比例風(fēng)險(xiǎn)模型多因素分析結(jié)果表明:在調(diào)整了入組的其他因素的混雜效應(yīng)情況下,年齡、腹腔淋巴結(jié)是否發(fā)生轉(zhuǎn)移、殘端是否陽性、向上侵及食管長(zhǎng)度及手術(shù)方式是影響食管胃交界癌預(yù)后的因素。而且,隨著年齡增長(zhǎng),每增加1歲,食管胃交界癌病人術(shù)后死亡風(fēng)險(xiǎn)增加7%;腹腔淋巴結(jié)發(fā)生轉(zhuǎn)移和殘端陽性都是食管胃交界癌術(shù)后的危險(xiǎn)因素;術(shù)前胃鏡顯示上侵及食管長(zhǎng)度每增加1cm,相對(duì)應(yīng)食管胃交界癌的病人術(shù)后死亡風(fēng)險(xiǎn)增加9%;不同手術(shù)徑路中不同水平進(jìn)行亞變量分析得出經(jīng)腹部相對(duì)經(jīng)胸部增加了術(shù)后病人的死亡系數(shù)。具體數(shù)據(jù)詳見Table 2。結(jié)論:1經(jīng)手術(shù)干預(yù)后食管胃交界癌病人的術(shù)后生存率有所提高,尤其是經(jīng)胸的手術(shù)路徑較經(jīng)腹的術(shù)后生存率高。2對(duì)于年齡較大、腹腔淋巴結(jié)已發(fā)生轉(zhuǎn)移、食管胃交界癌上侵食管的長(zhǎng)度越長(zhǎng)的病人,預(yù)后較差。
[Abstract]:Objective: esophageal and gastric borderline carcinoma is one of the most common malignant tumors of digestive tract in China. The diagnosis and treatment of esophagogastric borderline carcinoma has been the focus of medical research in China.At present, surgical resection is the main treatment of esophageal and gastric junction cancer.In view of this, 217 patients who underwent radical resection of esophageal and gastric junction cancer from January 2010 to January 2014 in the Department of Thoracic surgery, Eastern Hospital, fourth Hospital of Hebei Medical University, were retrospectively studied and their survival distribution was analyzed.To study the prognostic factors affecting survival and to provide some reference for the development of more accurate surgical management strategy.Methods: 273 patients with esophageal and gastric borderline carcinoma who were operated in our department were investigated and followed up after operation. 217 patients who met the condition of admission were analyzed by life table method and the survival curve was drawn.Cox proportional risk model was used for multivariate analysis. Age, sex, operation mode, histopathologic type, differentiation degree, depth of invasion, number of lymph node dissection and number of positive lymph nodes were included as covariate test.Objective: to summarize the optimal surgical methods of esophageal and gastric junction carcinoma.Results the 3- and 5-year survival rates were 620.The median survival time was 60 months. The cumulative survival curve showed Fig.1.2 Log-rank single factor analysis.Tumor differentiation degree G, depth of invasion, abdominal lymph node metastasis (especially left gastric artery lymph node, paracardial lymph node, small gastric curvature lymph node, whether the stump is positive or not.Recurrence or metastasis after operation and the distance between the invasion of the tooth line and the preoperative gastroscope were the factors influencing the prognosis of esophageal and gastric junctional carcinoma, while age, cardiovascular and cerebrovascular diseases and diabetes, histopathological type, and vascular embolus were found.The mediastinal lymph node metastasis (especially the paracentral lymph node metastasis of the lower esophagus, the range of preoperative gastroscopy and gastric invasion) were not the factors influencing the prognosis of esophageal and gastric junction carcinoma.The results of multivariate analysis of Table1.3 Cox proportional risk model showed that age, abdominal lymph node metastasis, and stump were positive in the case of adjusting for the confounding effect of other factors in the group.The length of esophagus and the operative mode were the factors influencing the prognosis of esophageal and gastric junction carcinoma.Preoperative gastroscopy showed that with an increase of 1 cm in the length of the esophagus, the risk of death in patients corresponding to esophagogastric borderline carcinoma increased by 9. Subvariable analysis at different levels in different operative paths showed that the transabdominal operation was increased relative to that of the chest.After the death coefficient of patients.For more details, see Table 2.Conclusion the postoperative survival rate of patients with esophageal and gastric junctional carcinoma increased after intervention, especially the survival rate of the patients with transthoracic surgery was higher than that of the patients with abdominal cancer. 2. For the older patients, the abdominal lymph nodes had been metastasized.The longer the length of the esophagus invades the esophagus, the worse the prognosis is.
【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

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