本文選題：腎細(xì)胞癌 + 年齡　； 參考：《天津醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:調(diào)閱天津醫(yī)科大學(xué)第二醫(yī)院在2006年1月-2014年12月期間收治并行手術(shù)治療的腎細(xì)胞癌病人的流行病學(xué)現(xiàn)狀、臨床特征、手術(shù)治療方式等資料,從中進(jìn)行歸納、分析、總結(jié),進(jìn)而不斷提升我們對腎細(xì)胞癌的診斷及治療能力,更好地指導(dǎo)臨床工作,更好地為病患服務(wù)。方法:共調(diào)閱1619例腎細(xì)胞癌患者病例資料,按就診時(shí)間、姓名、性別、年齡、首發(fā)癥狀、臨床分期、病理類型、病理分級,手術(shù)方式,進(jìn)行記錄、歸納、賦值。其中將首發(fā)癥狀、臨床分期、病理類型、病理分級等臨床資料分為有臨床表現(xiàn)組和無臨床表現(xiàn)組進(jìn)行對比分析;計(jì)量資料用表示,如:年齡;計(jì)數(shù)資料使用頻數(shù)/百分比描述,如:性別、首發(fā)癥狀、臨床分期、病理結(jié)果、手術(shù)方式等;兩組計(jì)量資料比較,采用t檢驗(yàn)。比較構(gòu)成比和無序計(jì)數(shù)資料采用卡方檢驗(yàn)。等級資料的比較采用秩和檢驗(yàn)。以p0.05作為有統(tǒng)計(jì)學(xué)差異的標(biāo)準(zhǔn)。所有數(shù)據(jù)采用SPSS21.0統(tǒng)計(jì)軟件分析。結(jié)果:1619例腎細(xì)胞癌病人中,男性為1151例(71.09%),女性為468例(28.91%),男性與女性的比例為2.46:1。病人首次就診年齡區(qū)間為16-88歲,主要以50~和60~兩個(gè)年齡段為主(2006年這兩個(gè)年齡組占本年度全部病人的56.14%,2007年占65.30%,2008年占64.24%,2009年占65.30%,2010年占57.90%,2011年占63.84%,2012年占64.57%,2013年占64.56%,2014年占70.09%)。1619例腎細(xì)胞癌病人的首次就診平均年齡為56.38±10.89歲,2006年-2014年我院腎細(xì)胞癌首次就診年齡平均值(單位為:歲)分別為53.57±12.07、55.75±11.21、55.76±10.33、56.14±10.64、57.00±11.56、57.16±10.31、57.26±10.74、57.28±11.41、57.49±10.15,每年病人平均年齡比較有統(tǒng)計(jì)學(xué)差異(P0.05),顯示腎細(xì)胞癌就診病人平均年齡有逐漸增高的趨勢。2006年-2014年我院腎細(xì)胞癌新發(fā)病例數(shù)(單位為:例)統(tǒng)計(jì)分別為:114、144、165、173、190、177、175、237、244,顯示我院腎細(xì)胞癌的年收治例數(shù)逐漸增高。臨床特征統(tǒng)計(jì)分析中,根據(jù)腎細(xì)胞癌病人首次就診有無臨床表現(xiàn),分為有臨床表現(xiàn)組(血尿、疼痛、腹部包塊、發(fā)熱、高血壓等)與無臨床表現(xiàn)組,進(jìn)行對比分析。首次就診有臨床表現(xiàn)組共計(jì)632例(39.04%),每年所占構(gòu)成比分別為43.76%、43.06%、41.82%、41.04%、40.53%、39.55%、37.71%、36.29%、33.20%,無臨床表現(xiàn)組共計(jì)987例(60.96%),每年所占構(gòu)成比分別為:56.24%、56.94%、58.18%、58.96%、59.47%、60.45%、62.29%、63.71%、66.80%,兩組比較存在統(tǒng)計(jì)學(xué)差異(p0.05),顯示首次就診有臨床表現(xiàn)的腎癌病人逐年減少,無臨床表現(xiàn)的腎癌病人逐年增加。比較臨床分期情況:有臨床表現(xiàn)組t1期占55.06%、t2期占20.41%、t3期占16.30%、t4期占8.23%,無臨床表現(xiàn)組t1期占83.28%、t2期占9.7%、t3期占6.99%、t4期占0%,兩組比較存在統(tǒng)計(jì)學(xué)差異(p0.05),顯示無臨床表現(xiàn)組臨床分期較有臨床表現(xiàn)組低。在1619例腎癌患者中,最常見的是無臨床表現(xiàn)、t1期患者,占50.77%。比較腫瘤直徑情況:有臨床表現(xiàn)組腎腫瘤直徑為5.57+3.26cm,無臨床表現(xiàn)組腎腫瘤直徑為4.45+1.75cm,兩組比較存在統(tǒng)計(jì)學(xué)差異(p0.05),顯示有臨床表現(xiàn)組腫瘤直徑比無臨床表現(xiàn)組直徑大。比較病理類型情況:有臨床表現(xiàn)組中常見病理類型占89.87%,少見類型占10.13%,無臨床表現(xiàn)組中等常見病理類型占97.26%,少見病理類型占2.74%,兩組比較存在統(tǒng)計(jì)學(xué)差異,(p0.05),顯示有臨床表現(xiàn)組中少見病理類型腎細(xì)胞癌比無臨床表現(xiàn)組多,無臨床表現(xiàn)組中常見病理類型比有臨床表現(xiàn)組多。比較兩組病理分級情況:有臨床表現(xiàn)組中1級103例(占16.3%)、2級361例(占57.12%)、3級129例(占20.41%)、4級39例(占6.17%),無臨床表現(xiàn)組中1級192例(占19.44%)、2級685例(占69.45%)、3級96例(占9.72%)、4級14例(占1.39%),兩組比較存在統(tǒng)計(jì)學(xué)差異(p0.05),有臨床表現(xiàn)組的病理分級在3級和4級的占比較多,說明有臨床表現(xiàn)組的病理分級高于無臨床表現(xiàn)組。手術(shù)治療方式統(tǒng)計(jì)分析中,行orn者共計(jì)1148例,占總例數(shù)70.91%,表明腎細(xì)胞癌的手術(shù)方式仍以orn為主;此外,2011年-2014年我院腎細(xì)胞癌腹腔鏡手術(shù)例數(shù)(單位為:例)分別為:14、69、98、110,顯示近年來腹腔鏡手術(shù)例數(shù)逐年增多。保留腎單位手術(shù)例數(shù)(單位為:例)分別為:27、29、49、65,顯示近年來保留腎單位手術(shù)例數(shù)逐年增多。結(jié)論:1、天津醫(yī)科大學(xué)第二醫(yī)院收治腎癌的新發(fā)病例數(shù)呈逐年遞增趨勢,其發(fā)病以男性為主,發(fā)病的高峰年齡在五十至七十歲之間�，F(xiàn)代醫(yī)學(xué)的進(jìn)步,也使得腎細(xì)胞癌能從健康體檢中早期發(fā)現(xiàn)和治療。因此提高人們健康意識,普及醫(yī)院和社區(qū)的查體,對早期發(fā)現(xiàn)腎細(xì)胞癌、提高生存質(zhì)量尤為重要。2、隨著科技的進(jìn)步,新的技術(shù)和各項(xiàng)檢查設(shè)備的應(yīng)用,醫(yī)生可以更加客觀和確切的診斷腎細(xì)胞癌,尤其是早期沒有癥狀的腎細(xì)胞癌。腎癌的診斷主要依靠影像學(xué)檢查。當(dāng)前越來越多的無臨床表現(xiàn)的腎細(xì)胞癌被及早發(fā)現(xiàn).,其臨床特征為臨床分期較低、腫瘤直徑小、病理分級較低、以透明細(xì)胞癌為主。3、目前為止早期腎細(xì)胞癌仍以外科手術(shù)治療為主,主流手術(shù)方式包括:根治性腎切除術(shù)和保留腎單位的腎部分切除術(shù)。值得一提的是,腹腔鏡手術(shù)由于創(chuàng)口小,解剖組織清楚,病人術(shù)后恢復(fù)快,痛苦小,已在腎細(xì)胞癌手術(shù)中占有越來越重要的地位,今后應(yīng)加大腹腔鏡手術(shù)在泌尿外科的應(yīng)用和科研投入。
[Abstract]:Objective: To review the epidemiological status, clinical features and surgical treatment methods of renal cell carcinoma patients treated in Second Hospital Affiliated to Tianjin Medical University during the period of January 2006 -2014 December, and to improve the diagnosis and treatment ability of renal cell carcinoma. Methods: a total of 1619 cases of patients with renal cell carcinoma were reviewed, according to the time of treatment, name, sex, age, first symptom, clinical stage, pathological type, pathological classification, operation mode, record, induction, assignment. The clinical data were divided into first symptom, clinical stage, pathological type and pathological classification. The clinical presentation group and the non clinical group were compared and analyzed; the measurement data were expressed as: age, the use frequency / percentage of the counting data, such as sex, first symptom, clinical stage, pathological result, operation mode, and the comparison of the two groups of measurement data, using t test. The data were compared with the rank sum test. P0.05 was used as a standard of statistical difference. All data were analyzed by SPSS21.0 statistical software. Results: among the 1619 patients with renal cell carcinoma, 1151 cases (71.09%), 468 women (28.91%), and the male and female ratio of 2.46: 1. were 16-88 years old for the first time, mainly with 50~ and 60. The two age groups accounted for 56.14% of all patients in 2006 (56.14% of all patients in the year, 65.30% in 2007, 64.24% in 2008, 65.30% in 2009, 57.90% in 2010, 63.84% in 2011, 64.57% in 2012, 64.56% in 64.56%, 70.09%). The average age of.1619 patients with renal cell carcinoma was 56.14% years old for the first time. The average age of the first diagnosis of renal cell carcinoma in our hospital in the past 014 years was 53.57 + 12.07,55.75 + 11.21,55.76 + 10.33,56.14 + 10.64,57.00 + 11.56,57.16 + 10.31,57.26 + 11.41,57.49 + 10.15 respectively. The average age of the patients was statistically different (P0.05) every year. The average age of renal cell cancer patients was gradually increased. The rising trend of the number of new cases of renal cell carcinoma in our hospital (.2006) in -2014 was 114144165173190177175237244, showing that the number of annual cases of renal cell carcinoma in our hospital increased gradually. In the statistical analysis of clinical features, there were no clinical manifestations according to the first visit of patients with renal cell carcinoma. Urine, pain, abdominal mass, fever, hypertension, etc. were compared with those without clinical manifestation. 632 cases (39.04%) were first treated with clinical manifestation, and the proportion of each year was 43.76%, 43.06%, 41.82%, 41.04%, 40.53%, 39.55%, 37.71%, 36.29%, 33.20%, and no clinical presentation group altogether 987 cases (60.96%), the proportion of each year was respectively as follows: 56.24%, 56.94%, 58.18%, 58.96%, 59.47%, 60.45%, 62.29%, 63.71%, 66.80%, two, there were statistical differences (P0.05), which showed that the first clinical manifestation of renal cancer patients decreased year by year, and no clinical manifestation of renal cancer patients increased year by year. Compared with the clinical stage, the T1 period was 55.06%, T2 period accounted for 20.41%, T3 period accounted for 16.30%, T4 The period accounted for 8.23%, the T1 period in the non clinical group was 83.28%, the T2 period accounted for 9.7%, the T3 period was 6.99%, the T4 period was 0%. The two groups had statistical difference (P0.05), which showed that the clinical stage without clinical manifestation was lower than that of the clinical group. In 1619 cases of renal cancer, the most common is the non clinical manifestation, the T1 stage patients were compared with the tumor diameter in 50.77%.: there were clinical cases in the 50.77%. The diameter of the renal tumor in the expression group was 5.57+3.26cm and the diameter of the renal tumor was 4.45+1.75cm in the non clinical group. There was a statistical difference between the two groups (P0.05). It showed that the diameter of the tumor in the clinical group was larger than that of the non clinical group. The pathological types were compared with the common pathological types in the clinical group, which accounted for 89.87% of the common pathological types, and the rare types were 10.13%. The common pathological types in the bed group were 97.26%, the rare pathological types accounted for 2.74%. There were statistical differences between the two groups, (P0.05). It showed that there were more rare pathological types of renal cell carcinoma in the clinical manifestation group than those without clinical manifestations. The common pathological types in the clinical group were more than those in the clinical manifestation group. The pathological classification of the two groups was compared with the clinical manifestations. There were 103 cases (16.3%), 361 cases (57.12%), 129 cases (20.41%), 4, 4, 4, 39 (6.17%), there were no significant differences (P0.05), and there were statistical differences (P0.05) in the group of clinical manifestations. The pathological classification of the clinical manifestation group was higher than that of the non clinical group. In the statistical analysis of the surgical treatment, 1148 cases of ORN were performed, accounting for 70.91% of the total number, indicating that the operation mode of renal cell carcinoma was still mainly Orn. In addition, the number of laparoscopy cases of renal cell carcinoma in our hospital in 2011 (unit: case) was 14,69,98110, respectively. The number of cases of laparoscopic surgery in recent years has increased year by year. The number of cases of unit preservation of kidney unit (unit as: 27,29,49,65), respectively, shows that the number of cases of renal unit operation in recent years increased year by year. Conclusion: 1, the number of new cases of renal cancer in Second Hospital Affiliated to Tianjin Medical University is increasing year by year, the incidence of which is mainly male and the peak of the disease. The progress of modern medicine has also led to the early discovery and treatment of renal cell cancer from healthy physical examination. Therefore, it is important to raise people's health awareness and popularize the physical examination of hospitals and communities. It is particularly important for the early detection of renal cell cancer and the improvement of the quality of life.2, with the progress of science and technology, new technology and various inspection equipment. The doctor can be more objective and accurate in the diagnosis of renal cell carcinoma, especially in the early non symptomatic renal cell carcinoma. The diagnosis of renal cell carcinoma is mainly based on imaging examination. More and more non clinical manifestations of renal cell carcinoma are found early. The clinical features are low clinical stage, small tumor diameter and low pathological grade. At present, the main.3 is clear cell carcinoma. At present, the early renal cell carcinoma is still mainly treated with surgical treatment. The main main surgical methods include radical nephrectomy and partial nephrectomy with preserved kidney unit. It is worth mentioning that the laparoscopic surgery has been performed in renal cell cancer surgery because of small wound, clear anatomical structure, quick recovery and little pain. It is becoming more and more important. In future, laparoscopic surgery should be applied and applied in Department of urology.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R737.11

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 段建敏,李智,秦大山,陳一戎;腎細(xì)胞癌患者血清中血管內(nèi)皮生長因子的表達(dá)[J];蘭州醫(yī)學(xué)院學(xué)報(bào);2000年04期

2 袁建峰;腫瘤相關(guān)胰蛋白酶抑制因子作為腎細(xì)胞癌預(yù)后的一個(gè)因素[J];中華泌尿外科雜志;2001年08期

3 段建敏,李智,秦大山,史庭凱,董馳;血管內(nèi)皮生長因子在腎細(xì)胞癌中的表達(dá)意義[J];中華泌尿外科雜志;2001年10期

4 李華,李玲;腎細(xì)胞癌的超聲診斷[J];中國超聲診斷雜志;2002年08期

5 卓棟,姜書傳,韓杰,程慶水;腎細(xì)胞癌尿激酶型纖溶酶原激活物表達(dá)的研究[J];皖南醫(yī)學(xué)院學(xué)報(bào);2002年04期

6 孫正船,曲延剛;腎細(xì)胞癌舌轉(zhuǎn)移1例[J];診斷病理學(xué)雜志;2002年05期

7 張秀華,李光明,郭素霞;P~(16)在腎細(xì)胞癌癌組織中表達(dá)的臨床意義探討[J];山東醫(yī)藥;2003年20期

8 王金根,張?jiān)?丁強(qiáng),陳波,金建軍,王忠;血管內(nèi)皮生長因子在腎細(xì)胞癌的表達(dá)及臨床意義[J];中華醫(yī)學(xué)雜志;2003年05期

9 彭作鋒,張功亮,王建,秦文,宋樂明,蔣叔凱;幼兒腎細(xì)胞癌一例報(bào)告[J];中華泌尿外科雜志;2004年02期

10 魏建平,杜聯(lián)芳,邢晉放,蘇一巾;腎細(xì)胞癌超聲表現(xiàn)分析[J];中國超聲診斷雜志;2005年09期

相關(guān)會(huì)議論文 前10條

1 張進(jìn);董柏君;陳勇輝;陳奇;陳海戈;薛蔚;周立新;劉東明;黃翼然;;7cm以內(nèi)腎細(xì)胞癌腫瘤大小與臨床病理相關(guān)性研究[A];第十六屆全國泌尿外科學(xué)術(shù)會(huì)議論文集[C];2009年

2 任曉蘇;毛澤慶;汝曉睿;史文生;張常青;;腎細(xì)胞癌的多層螺旋CT診斷[A];中華醫(yī)學(xué)會(huì)第十三屆全國放射學(xué)大會(huì)論文匯編（下冊）[C];2006年

3 劉躍新;畢維棋;陳山;張光銀;喬廬東;鄭宇朋;王偉;張波;;多房性腎細(xì)胞癌的診斷治療[A];第六次全國中西醫(yī)結(jié)合泌尿外科學(xué)術(shù)會(huì)議暨第二屆湖南省中西醫(yī)結(jié)合泌尿外科學(xué)術(shù)會(huì)議論文匯編[C];2007年

4 韓蘇軍;李長嶺;馬建輝;肖振東;壽建忠;肖澤均;田軍;王棟;畢新剛;管考鵬;魯力;石鴻哲;關(guān)有彥;;雙側(cè)腎細(xì)胞癌15例報(bào)告[A];第十五屆全國泌尿外科學(xué)術(shù)會(huì)議論文集[C];2008年

5 張開顏;邢金春;陳斌;劉榮福;王惠強(qiáng);陳實(shí)新;周中泉;莊炫;陳躍東;李偉;段波;劉菲;楊宇峰;周鑫;鄭嘉欣;曾彥愷;吳準(zhǔn);;多房性腎細(xì)胞癌的診斷治療[A];華東六省一市泌尿外科學(xué)術(shù)年會(huì)暨2011年浙江省泌尿外科、男科學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2011年

6 杜傳軍;徐杰;;腎細(xì)胞癌的外科治療(附315例報(bào)告)[A];第七次中國中西醫(yī)結(jié)合泌尿外科學(xué)術(shù)年會(huì)暨第二次廣東省中西醫(yī)結(jié)合泌尿外科學(xué)術(shù)年會(huì)論文集[C];2009年

7 杜傳軍;徐杰;;腎細(xì)胞癌的外科治療(附315例報(bào)告)[A];2009年浙江省男科、泌尿外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

8 耿敬姝;趙玉蘭;王艷穎;;腎細(xì)胞癌核形態(tài)定量分析的病理學(xué)研究[A];2000全國腫瘤學(xué)術(shù)大會(huì)論文集[C];2000年

9 詹敏;王穎斌;王輝萍;周樂;;手術(shù)治療腎細(xì)胞癌(附49例報(bào)告)[A];第三屆浙江中西部科技論壇論文集（第七卷 醫(yī)學(xué)、抗癌分卷）[C];2006年

10 那彥群;孫則禹;葉章群;孫穎浩;馬建輝;何志嵩;萬奔;米振國;杜林棟;周芳堅(jiān);胡志全;靳風(fēng)爍;黃翼然;戴玉田;宋毅;;腎細(xì)胞癌診治指南(2005試行版)[A];貴州省醫(yī)學(xué)會(huì)泌尿外科分會(huì)2006年學(xué)術(shù)年會(huì)論文匯編[C];2006年

相關(guān)重要報(bào)紙文章 前4條

1 紀(jì)小龍;血管平滑肌脂肪瘤·腎細(xì)胞癌[N];衛(wèi)生與生活報(bào);2007年

2 譯自《新英格蘭醫(yī)學(xué)雜志》2001年12月第345卷;轉(zhuǎn)移性腎細(xì)胞癌結(jié)合治療效佳[N];醫(yī)藥經(jīng)濟(jì)報(bào);2001年

3 徐述湘;索拉非尼抗腎細(xì)胞癌獲FDA批準(zhǔn)[N];中國醫(yī)藥報(bào);2006年

4 谷文;GSK公司申請將Pazopanib用于腎細(xì)胞癌治療[N];中國醫(yī)藥報(bào);2009年

相關(guān)博士學(xué)位論文 前10條

1 黃慶波;血管內(nèi)皮特異性因子DLL4在腎細(xì)胞癌腫瘤生長，侵襲，血管生成及血行轉(zhuǎn)移中的作用[D];中國人民解放軍醫(yī)學(xué)院;2015年

2 林友成;PIK3R1基因在腎細(xì)胞癌中的功能及調(diào)控機(jī)制研究[D];南方醫(yī)科大學(xué);2015年

3 呂蔡;miR-495靶向SATB1基因?qū)δI細(xì)胞癌調(diào)控作用的研究[D];武漢大學(xué);2015年

4 柳金順;腎細(xì)胞癌差異蛋白質(zhì)發(fā)現(xiàn)與篩選的實(shí)驗(yàn)研究[D];北京協(xié)和醫(yī)學(xué)院;2009年

5 陳軍;骨髓間充質(zhì)干細(xì)胞在腫瘤中的分布分化研究及腎細(xì)胞癌發(fā)病特點(diǎn)分析[D];山東大學(xué);2006年

6 李益飛;組蛋白去乙�；敢种苿⿲δI細(xì)胞癌增殖及凋亡影響[D];復(fù)旦大學(xué);2012年

7 魏賢莉;丹參酮ⅡA誘導(dǎo)腎細(xì)胞癌細(xì)胞凋亡及其分子機(jī)制[D];暨南大學(xué);2012年

8 王志新;羥基磷灰石納米粒子對人腎細(xì)胞癌786-0細(xì)胞作用的實(shí)驗(yàn)研究[D];吉林大學(xué);2008年

9 孫志霞;干擾Stat3的表達(dá)對腎細(xì)胞癌細(xì)胞系786-O影響的體內(nèi)外實(shí)驗(yàn)研究[D];吉林大學(xué);2012年

10 王t;腎細(xì)胞癌中原肌球蛋白1的表達(dá)水平及其臨床和腫瘤學(xué)意義[D];吉林大學(xué);2015年

相關(guān)碩士學(xué)位論文 前10條

1 張德福;腎細(xì)胞癌的腎外臨床特點(diǎn)及預(yù)后多因素分析[D];大連醫(yī)科大學(xué);2013年

2 楊建琪;腎細(xì)胞癌中WNK2基因甲基化狀態(tài)與mRNA表達(dá)的研究[D];河北醫(yī)科大學(xué);2015年

3 朱玲;腎細(xì)胞癌靶向治療藥物的有效性和安全性評價(jià)[D];四川醫(yī)科大學(xué);2015年

4 趙康樂;P19在腎細(xì)胞癌中表達(dá)以及Bev+Sor+Gem三線治療ⅡF及Ⅱ治療失敗的晚期腎細(xì)胞癌的研究[D];河南科技大學(xué);2015年

5 曹翔;腎細(xì)胞癌假包膜的MRI表現(xiàn)及在腫瘤剜除術(shù)中的意義[D];南京大學(xué);2014年

6 黃晉;腎癌臨床資料回顧性分析[D];天津醫(yī)科大學(xué);2015年

7 王海屹;腎細(xì)胞癌不同亞型3.0T磁共振影像鑒別診斷[D];中國人民解放軍軍醫(yī)進(jìn)修學(xué)院;2009年

8 來彥博;多層螺旋CT在腎細(xì)胞癌術(shù)前評估中的應(yīng)用研究[D];寧夏醫(yī)科大學(xué);2009年

9 王晟宏;腎細(xì)胞癌病理形態(tài)學(xué)、免疫表型與分子遺傳學(xué)研究[D];第三軍醫(yī)大學(xué);2010年

10 謝盛堂;165例腎細(xì)胞癌患者預(yù)后的多因素分析[D];新疆醫(yī)科大學(xué);2010年

，

本文編號：1847000