本文選題：神經(jīng)節(jié)苷脂 + GM-1　； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:宮頸癌、子宮內(nèi)膜癌、卵巢癌為女性生殖系統(tǒng)常見(jiàn)的三大惡性腫瘤,發(fā)病率呈逐年上升且年輕化趨勢(shì)。婦科惡性腫瘤手術(shù)一般需行盆腔淋巴結(jié)切除,但與盆腔淋巴結(jié)相伴有許多血管和神經(jīng),走形迂曲,分布密度大,因盆腔淋巴結(jié)切除風(fēng)險(xiǎn)較大,術(shù)中易損傷血管、淋巴管及神經(jīng),造成術(shù)中、術(shù)后相關(guān)并發(fā)癥,是婦科的氋難度手術(shù)。周圍神經(jīng)包括閉孔神經(jīng)是一種較高級(jí)的組織,非常脆弱,易受機(jī)械及電熱刺激的損傷,婦科惡性腫瘤行盆腔淋巴結(jié)切除術(shù)易損傷閉孔神經(jīng),使患側(cè)出現(xiàn)下肢的疼痛、麻木,運(yùn)動(dòng)障礙,并出現(xiàn)股內(nèi)側(cè)皮膚感覺(jué)障礙等。神經(jīng)損傷后會(huì)發(fā)生一系列的變化,因而相比其他組織而言,修復(fù)也會(huì)困難得多。神經(jīng)節(jié)苷脂(gangliosides)是含唾液酸的一族異構(gòu)的鞘糖脂,存在于大多數(shù)哺乳動(dòng)物細(xì)胞膜中,能夠有效抑制神經(jīng)細(xì)胞凋亡、促進(jìn)受損部位修復(fù)及其功能恢復(fù)。其中單唾液酸四己糖神經(jīng)節(jié)苷酯(monosialotetrahexosyl gangliosides,GM-1)是哺乳類動(dòng)物神經(jīng)節(jié)苷脂的主要種類。GM-1的發(fā)現(xiàn)與成功提取,直接為外周神經(jīng)損傷的治療提供了一條嶄新的途徑,通過(guò)生物技術(shù)從根本上促進(jìn)外周神經(jīng)的修復(fù),最大程度地恢復(fù)外周神經(jīng)原有的功能。本實(shí)驗(yàn)及研究的目的是觀察婦科惡性腫瘤盆腔淋巴結(jié)切除術(shù)后閉孔神經(jīng)損傷的相關(guān)影響因素,以及單唾液酸四己糖神經(jīng)節(jié)苷脂納(GM-1)對(duì)婦科惡性腫瘤盆腔淋巴結(jié)切除術(shù)后閉孔神經(jīng)損傷修復(fù)治療效果的初步評(píng)估,旨在為治療婦科惡性腫瘤手術(shù)后閉孔神經(jīng)損傷的治療提供新的思路。方法:1觀察2015年4月至2016年12月我院652例婦科惡性腫瘤患者,行盆腔淋巴結(jié)切除術(shù)后的出現(xiàn)的相關(guān)并發(fā)癥,分析此652例患者的相關(guān)臨床資料,對(duì)年齡、體重指數(shù)、腫瘤類型、內(nèi)科合并癥、術(shù)前腹部手術(shù)史、手術(shù)方式、術(shù)中出血量、盆腔淋巴結(jié)切除個(gè)數(shù)、盆腔淋巴結(jié)陽(yáng)性個(gè)數(shù)、是否同時(shí)行腹主動(dòng)脈旁淋巴結(jié)切除以及術(shù)前是否行新輔助化療進(jìn)行統(tǒng)計(jì)處理和分析,研究閉孔神經(jīng)損傷的相關(guān)因素。2將74例婦科惡性腫瘤行婦科手術(shù)切除盆腔淋巴結(jié)后閉孔神經(jīng)出現(xiàn)損傷癥狀的患者隨機(jī)分為觀察組(34例)和對(duì)照組(40例),觀察組給予常規(guī)治療+gm-1靜脈滴注,對(duì)照組給予常規(guī)治療。根據(jù)患者癥狀的嚴(yán)重程度,以及患者自己的意愿,選擇合適的治療方案。分別記錄并進(jìn)行對(duì)比研究分析用藥期間患者下肢疼痛感、麻木癥狀、皮膚溫度感覺(jué)異常癥狀的改善及肌力恢復(fù)情況,以及兩組患者各項(xiàng)癥狀完全恢復(fù)所需的平均時(shí)間。3統(tǒng)計(jì)學(xué)分析將臨床記錄數(shù)據(jù)及術(shù)后隨訪數(shù)據(jù)輸入excel電子表格,建立數(shù)據(jù)庫(kù)。數(shù)據(jù)分析采用spss22.0統(tǒng)計(jì)軟件進(jìn)行處理。用x2檢驗(yàn)檢測(cè)臨床相關(guān)因素指標(biāo)(患者年齡、體重指數(shù)、腫瘤類型、手術(shù)方式、出血量、盆腔淋巴結(jié)切除個(gè)數(shù)、盆腔淋巴結(jié)陽(yáng)性數(shù),術(shù)前行新輔助化療、是否行腹主動(dòng)脈旁淋巴結(jié)清除、術(shù)中出血量)與閉孔神經(jīng)損傷構(gòu)成比的關(guān)系。將與閉孔神經(jīng)損傷的相關(guān)的單因素放入logistic回歸模型作為自變量,將閉孔神經(jīng)損傷和閉孔神經(jīng)未損傷作為因變量進(jìn)行回歸分析。gm-1的藥物療效及閉孔神經(jīng)恢復(fù)率用百分率表示,療效結(jié)果采用四格表x2檢驗(yàn)。統(tǒng)計(jì)閉孔神經(jīng)損傷各癥狀平均恢復(fù)時(shí)間用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,采取t檢驗(yàn)。p0.05差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1婦科惡性腫瘤盆腔淋巴結(jié)清掃術(shù)后并發(fā)癥發(fā)生情況盆腔淋巴結(jié)清掃術(shù)后最易發(fā)生術(shù)后感染,其次是淋巴囊腫,閉孔神經(jīng)損傷以及下肢水腫的發(fā)生率也較大,乳糜漏的發(fā)生率最低。2閉孔神經(jīng)損傷的單因素分析1)年齡與體重指數(shù):年齡、體重指數(shù)(是否肥胖)與閉孔神經(jīng)損傷的發(fā)生未發(fā)現(xiàn)明顯相關(guān)性,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。2)是否合并內(nèi)科并發(fā)癥以及術(shù)前是否有腹部手術(shù)史:合并內(nèi)科并發(fā)癥以及術(shù)前具有腹部手術(shù)史并不增加閉孔神經(jīng)損傷幾率,差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)3)婦科惡性腫瘤和手術(shù)方式(開(kāi)腹手術(shù)和腹腔鏡手術(shù)):子宮頸癌,子宮內(nèi)膜癌,應(yīng)用腹腔鏡與閉孔神經(jīng)損傷密切相關(guān)(p0.05)。4)盆腔淋巴結(jié)清掃個(gè)數(shù)與盆腔淋巴結(jié)陽(yáng)性數(shù):閉孔神經(jīng)損傷的發(fā)生與盆腔淋巴結(jié)清掃個(gè)數(shù)有關(guān),差異有統(tǒng)計(jì)學(xué)差異(P0.05),與盆腔淋巴結(jié)陽(yáng)性個(gè)數(shù)無(wú)關(guān),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5)是否行腹主動(dòng)脈旁淋巴結(jié)清除與術(shù)前是否行新輔助化療:二者與閉孔神經(jīng)損傷的發(fā)生無(wú)明顯的相關(guān)性(P0.05)。6)術(shù)中出血量:術(shù)中出血量越大越易發(fā)生閉孔神經(jīng)損傷,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3閉孔神經(jīng)損傷的多因素分析對(duì)影響閉孔神經(jīng)損傷的因素進(jìn)行多元逐步回歸分析得出,手術(shù)方式(開(kāi)腹、腹腔鏡)、術(shù)中出血量、盆腔淋巴結(jié)清掃數(shù)目與閉孔神經(jīng)損傷的發(fā)生差異有統(tǒng)計(jì)學(xué)意義(P0.05),為閉孔神經(jīng)損傷的獨(dú)立危險(xiǎn)因素。4 GM-1治療閉孔神經(jīng)損傷的近期療效觀察兩組病例均獲隨訪,1周內(nèi),兩組病人的肌力恢復(fù)情況和皮膚感覺(jué)障礙的改善無(wú)明顯不同,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),但疼痛癥狀改善及麻木癥狀改善觀察組明顯優(yōu)于對(duì)照組,且差異有統(tǒng)計(jì)學(xué)意義(P0.05)。5 GM-1治療閉孔神經(jīng)損傷的遠(yuǎn)期療效觀察兩組病人均獲隨訪,1年內(nèi),兩組病人閉孔神經(jīng)損傷的各癥狀平均恢復(fù)時(shí)間無(wú)明顯統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:1婦科惡性腫瘤盆腔淋巴結(jié)清掃術(shù)后最易發(fā)生術(shù)后感染,其次為淋巴囊腫。2宮頸癌與內(nèi)膜癌較卵巢癌閉孔神經(jīng)發(fā)生的幾率大,腹腔鏡手術(shù)較開(kāi)腹手術(shù)閉孔神經(jīng)損傷的幾率大。盆腔淋巴結(jié)清掃個(gè)數(shù)越多,及術(shù)中出血量越多,越易發(fā)生閉孔神經(jīng)損傷。3 GM-1在婦科惡性腫瘤盆腔淋巴結(jié)切除術(shù)后閉孔神經(jīng)損傷的近期恢復(fù)具有有效和促進(jìn)作用。但遠(yuǎn)期效果并不明朗。
[Abstract]:Objective: cervical cancer, endometrial cancer and ovarian cancer are the three common malignant tumors in the female reproductive system. The incidence of cancer is increasing year by year and young. The operation of gynecologic malignant tumors usually needs pelvic lymph node resection, but there are many vessels and nerves associated with pelvic lymph nodes. It is easy to damage the blood vessels, lymphatic vessels and nerves during the operation, which causes intraoperative and postoperative complications. It is a difficult operation in gynecology. The peripheral nerve, including the obturator nerve, is a more advanced tissue. It is very vulnerable and easily damaged by mechanical and electrothermal stimulation. Pelvic lymph node excision is easy to damage the obturator nerve in gynecologic malignant tumors, making it easy to damage the obturator nerve. The pain, numbness, dyskinesia, and sensory disorders of the medial femoral skin appear on the side of the lower limb. A series of changes will occur after nerve injury, and the repair is much more difficult than other tissues. The ganglioside (gangliosides) is a group of isomeric sheaths containing sialic acid in most mammalian cell membranes. The four hexose Ganglioside (monosialotetrahexosyl gangliosides, GM-1), one of the main types of gangliosides of mammalian animals, can be found and successfully extracted, and the direct connection is a new treatment for the treatment of peripheral nerve injury. The purpose of this experiment and study is to observe the related factors of the obturator nerve injury after pelvic lymphadenectomy in gynecologic malignant tumors, and the single sialic acid four hexose Ganglioside (GM-1) to gynecology. A preliminary evaluation of the effect of repair of obturator nerve injury after pelvic lymphadenectomy for malignant tumors is designed to provide new ideas for the treatment of obturator nerve injury after gynecologic malignant tumor surgery. 1: 652 cases of gynecologic malignancies in our hospital from April 2015 to December 2016 were observed after pelvic lymphadenectomy. Related complications, the related clinical data of the 652 patients were analyzed, including age, body mass index, tumor type, internal medicine complication, history of abdominal surgery, surgical methods, intraoperative bleeding, number of pelvic lymph nodes, the number of pelvic lymph nodes positive, whether the lymph nodes were removed at the same time, and whether neoadjuvant chemotherapy was performed before the operation. Statistical processing and analysis, the related factors of the obturator nerve injury.2 were divided into the observation group (34 cases) and the control group (34 cases) and the control group (40 cases), 74 cases of gynecologic malignant tumor underwent gynecologic surgery. The observation group was given routine treatment of intravenous drip, and the control group was given routine treatment. According to the severity of the patient's symptoms and the patient's own will, choose the appropriate treatment. Record and compare the lower extremity pain, numbness, the skin temperature sensation abnormal symptoms and the muscle strength recovery during the medication, and the average time.3 required for the complete recovery of the two groups of patients. The clinical records and postoperative follow-up data were entered into the Excel spreadsheet to establish the database. The data analysis was processed by the spss22.0 statistical software. The clinical related factors were detected by x2 test (patient's age, body mass index, tumor type, operation mode, bleeding volume, the number of pelvic lymphadenectomy, pelvic lymphadenectomy. Sex number, neoadjuvant chemotherapy before operation, the relationship between para aortic lymph node clearance, intraoperative hemorrhage volume and the ratio of obturator nerve injury. The single factor related to the obturator nerve injury was put into the logistic regression model as the independent variable, and the obturator nerve injury and the obturator nerve were not damaged as the dependent variable for the regression analysis of.Gm-1 The efficacy of the drug and the recovery rate of the obturator nerve were indicated by the percentage of the four lattice x2 test. The average recovery time of the symptoms of the obturator nerve injury was indicated by the mean mean difference (x + s), and the.P0.05 difference was statistically significant by the t test. Results: 1 the complications of the pelvic lymph node dissection of the malignant tumor of gynecologic tumor Postoperative infection was most likely to occur after cavity lymph node dissection, followed by lymphatic cysts, obturator nerve injury and lower limb edema, the incidence of chylous leakage was the lowest in the single factor analysis of.2 obturator nerve injury. 1) age and body mass index: age, body mass index (no obesity) and obturator nerve injury were not found to be obvious No statistically significant difference (P0.05).2) the complication of internal medicine and the history of abdominal surgery before operation: complications of internal medicine and the history of abdominal surgery did not increase the risk of obturator nerve injury, there was no statistical difference (P0.05) 3) gynecologic malignancies and surgical methods (laparotomy and laparoscopy): Cervical cancer, endometrial carcinoma, the use of laparoscopy and obturator nerve injury closely related (P0.05).4) the number of pelvic lymph node dissection and pelvic lymph node positive number: the occurrence of the obturator nerve injury and the number of pelvic lymph node dissection, the difference is statistically significant (P0.05), not related to the number of pelvic lymph node positive, there is no statistical difference (P0 .05).5) whether or not para aortic lymph node clearance and preoperative neoadjuvant chemotherapy: there is no significant correlation between the two and the occurrence of obturator nerve injury (P0.05).6) the amount of bleeding during the operation: the greater the amount of bleeding in the operation, the more easily the obturator nerve injury, the difference is statistically significant (P0.05) the multifactor analysis of the obturator nerve injury to the obturator, which affects the obturator. Multiple stepwise regression analysis of the factors of nerve injury showed that the operation mode (laparotomy, laparoscope), intraoperative bleeding, the number of pelvic lymph node dissection and the occurrence of obturator nerve injury were statistically significant (P0.05), which was an independent risk factor of obturator nerve injury by.4 GM-1 for the treatment of obturator nerve injury in the near future. There was no significant difference between the recovery of muscle strength and the improvement of skin sensory disturbance in the two groups within 1 weeks. The difference was not statistically significant (P0.05), but the improvement of pain symptoms and the improvement of numbness symptoms in the observation group were obviously superior to those of the control group, and the difference was statistically significant (P0.05) the long-term effect of.5 GM-1 in the treatment of obturator nerve injury was two. The patients were followed up, and the average recovery time of the two groups of patients with obturator nerve injury had no significant difference in 1 years (P0.05). Conclusion: 1 after pelvic lymph node dissection of gynecologic malignant tumors, postoperative infection was the most likely to occur, followed by lymphatic cysts.2 cervical cancer and endometrial carcinoma more likely than ovarian cancer. The higher the number of pelvic lymph node dissection and the more intraoperative bleeding, the more easily the obturator nerve injury.3 GM-1 will be effective and useful for the immediate recovery of obturator nerve injury after pelvic lymphadenectomy for gynecologic malignant tumors.

【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)】：R737.3

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