本文選題：卵巢成熟性畸胎瘤惡變 + 危險(xiǎn)因素��； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:探討卵巢成熟性畸胎瘤惡變的危險(xiǎn)因素和分析影響預(yù)后的相關(guān)因素,以提高對(duì)卵巢成熟性畸胎瘤惡變的認(rèn)識(shí),為其規(guī)范治療和改善預(yù)后提供一定幫助。方法:將吉林大學(xué)第一醫(yī)院2010年12月至2015年12月收治的20例卵巢成熟性畸胎瘤惡變患者設(shè)為研究組,隨機(jī)抽取同期住院治療的40例卵巢成熟性畸胎瘤患者為對(duì)照組,通過分析兩組患者在年齡、腫瘤大小、影像學(xué)特點(diǎn)及腫瘤標(biāo)志物方面的差異,了解卵巢成熟性畸胎瘤惡變的危險(xiǎn)因素,并分析卵巢成熟性畸胎瘤惡變患者的年齡、腫瘤大小、腫瘤標(biāo)志物、組織學(xué)類型及手術(shù)病理分期這些因素與預(yù)后的相關(guān)性。統(tǒng)計(jì)學(xué)方法:采用SPSS19.0進(jìn)行描述性統(tǒng)計(jì)分析,單因素分析采用t檢驗(yàn)、方差分析,計(jì)數(shù)資料采用c2檢驗(yàn)。預(yù)后生存情況應(yīng)用Kaplan-Meier法,p0.05有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.研究組患者年齡為23~75歲,平均年齡為46.20±13.11歲;對(duì)照組患者年齡為9~57歲,平均年齡為30.75±11.76歲。兩組比較p0.05,差異有統(tǒng)計(jì)學(xué)意義。2.研究組患者的腫瘤直徑為5~16.1cm,平均直徑為9.92±3.03cm;對(duì)照組患者的腫瘤直徑為2~15.7cm,平均直徑為6.57±3.18cm。兩組比較p0.05,差異有統(tǒng)計(jì)學(xué)意義。3.兩組患者的超聲聲像中均可見短線樣或團(tuán)塊樣回聲,研究組超聲提示腫瘤可見血流信號(hào)者8例,未見血流信號(hào)者12例,陽性率為40%;對(duì)照組超聲提示腫瘤可見血流信號(hào)者5例,未見血流信號(hào)者35例,陽性率為12.5%。兩組比較p0.05,差異有統(tǒng)計(jì)學(xué)意義。4.兩組腫瘤標(biāo)志物陽性率比較,研究組CA125陽性率為60%,CA199陽性率為57.1%,CEA陽性率為28.6%,AFP陽性率為6.7%,SCC-Ag的陽性率為28.6%;對(duì)照組CA125陽性率為17.5%,CA199陽性率為51.4%,CEA陽性率為0,AFP陽性率為2.6%,SCC-Ag的陽性率為0。兩組CA125、CEA及SCC-Ag的陽性率比較p0.05,差異有統(tǒng)計(jì)學(xué)意義;兩組CA199及AFP的陽性率比較p0.05,差異無統(tǒng)計(jì)學(xué)意義。5.20例卵巢成熟性畸胎瘤惡變患者以平均年齡46歲為分界,其中46歲以下9例,生存8例,死亡1例,生存率為88.9%;46歲以上11例,生存7例,死亡4例,生存率為63.6%。兩組的生存率比較p0.05,差異無統(tǒng)計(jì)學(xué)意義。6.20例卵巢成熟性畸胎瘤惡變患者的腫瘤大小以中位數(shù)9cm為分界,其中9cm以下8例,生存7例,死亡1例,生存率為87.5%;9cm以上12例,生存8例,死亡4例,生存率為66.7%。兩組的生存率比較p0.05,差異有統(tǒng)計(jì)學(xué)意義。7.20例卵巢成熟性畸胎瘤惡變患者以術(shù)前各腫瘤標(biāo)記物的陰性與陽性結(jié)果為界,各分為兩組,其中CA125陽性組患者12例,生存9例,死亡3例,生存率為75%,陰性組患者8例,生存6例,死亡2例,生存率為75%;CA199陽性組患者6例,生存4例,死亡2例,生存率為66.7%,陰性組患者8例,生存5例,死亡3例,生存率為62.5%;CEA陽性組患者4例,生存3例,死亡1例,生存率為75%,陰性組患者10例,生存6例,死亡4例,生存率為60%;AFP陽性組患者1例,生存1例,死亡0例,生存率為100%,陰性組患者14例,生存9例,死亡5例,生存率為64.3%;SCC-Ag陽性組患者4例,生存1例,死亡3例,生存率為25%,陰性組患者14例,生存12例,死亡2例,生存率為85.7%。其中SCC-Ag的陽性組與陰性組患者的生存率比較p0.05,差異有統(tǒng)計(jì)學(xué)意義;CA125、CEA、CA199及AFP的陽性組與陰性組患者的生存率比較p0.05,差異無統(tǒng)計(jì)學(xué)意義。8.20例卵巢成熟性畸胎瘤惡變患者中8例鱗癌患者中生存6例,死亡2例,生存率為75%;7例類癌患者中生存6例,死亡1例,生存率為85.7%;5例其他組織學(xué)類型中生存2例,死亡3例,生存率為60%。三組的生存率比較,p0.05,差異無統(tǒng)計(jì)學(xué)意義。9.本研究中卵巢成熟性畸胎瘤惡變的手術(shù)病理分期是根據(jù)FIGO(2000年)的原發(fā)性卵巢惡性腫瘤手術(shù)病理分期標(biāo)準(zhǔn)進(jìn)行分期。Ⅰ期患者16例,生存15例,死亡1例,生存率為93.7%;Ⅱ期及Ⅲ期患者4例,均死亡,生存率為0;兩組患者的生存率比較,P0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論:1、卵巢成熟性畸胎瘤惡變的危險(xiǎn)因素包括年齡、腫瘤大小、超聲提示腫瘤的血流信號(hào)及腫瘤標(biāo)志物CA125、CEA及SCC-Ag,其中年齡及腫瘤大小與卵巢成熟性畸胎瘤惡變呈正相關(guān),超聲提示腫瘤存在血流信號(hào)及腫瘤標(biāo)志物CA125、CEA及SCC-Ag陽性的卵巢成熟性畸胎瘤應(yīng)警惕惡變可能。2、卵巢成熟性畸胎瘤惡變的預(yù)后相關(guān)因素包括腫瘤大小、腫瘤標(biāo)志物SCC-Ag及手術(shù)病理分期,其中腫瘤直徑大于9cm、腫瘤標(biāo)志物SCC-Ag陽性及手術(shù)病理分期Ⅱ期及Ⅱ期以上者預(yù)后較差。
[Abstract]:Objective: To explore the risk factors of ovarian mature teratoma and to analyze the related factors that affect the prognosis of ovarian mature teratoma, in order to improve the understanding of ovarian mature teratoma, and to provide some help for its standardized treatment and improvement of prognosis. Methods: 20 cases of ovarian mature teratoma treated in No.1 Hospital of Jilin University from December 2010 to December 2015. 40 patients with mature teratoma of the ovary were randomly selected as the control group. The risk factors of ovarian mature teratoma in two groups were analyzed by analyzing the age, tumor size, imaging characteristics and tumor markers, and the malignant changes of ovarian mature teratoma were analyzed. The correlation between the age, tumor size, tumor markers, histological type and surgical pathological staging. Statistical methods: descriptive statistical analysis was carried out by SPSS19.0, t test, variance analysis, and C2 test were used for single factor analysis. Kaplan-Meier method was applied to the prognosis of survival, and P0.05 was statistically significant. Results: the age of the 1. study group was 23~75 years old, the average age was 46.20 + 13.11 years old, the control group was 9~57 years old and the average age was 30.75 + 11.76 years old. The two groups were compared with P0.05. The difference was statistically significant in the.2. study group, the diameter of the tumor was 5~16.1cm, the average diameter was 9.92 + 3.03cm; the tumor diameter of the control group was 2~15.7cm, The average diameter of the 6.57 + 3.18cm. two groups was compared with P0.05. The difference was statistically significant in.3. two groups of patients with short line or lump like echo. In the study group, 8 cases of blood flow signal were seen in the tumor, 12 cases of blood flow signal were not seen, the positive rate was 40%. The control group showed 5 cases of blood flow signal in tumor. No blood was found in the control group. Flow signal 35 cases, positive rate was 12.5%. two groups compared P0.05, the difference was statistically significant.4. two group of tumor markers positive rate comparison, the study group CA125 positive rate was 60%, CA199 positive rate was 57.1%, CEA positive rate was 28.6%, AFP positive rate was 6.7%, SCC-Ag positive rate was 28.6%, the control group CA125 positive rate was 17.5%, CA199 positive rate was 51.4%, CEA. The positive rate was 0, the positive rate of AFP was 2.6%, the positive rate of SCC-Ag was 0. two CA125, the positive rate of CEA and SCC-Ag was P0.05, the difference was statistically significant. The positive rate of CA199 and AFP in the two group was P0.05, and the difference was not statistically significant in.5.20 cases of ovarian mature teratoma with the average age of 46 years, among which 9 cases under 46 years of age were 8, and survival 8 was 8. For example, 1 cases of death, the survival rate was 88.9%, 11 cases above 46 years old, 7 cases of survival, 4 cases of death, survival rate of 63.6%. two group was P0.05, the difference was not statistically significant, the size of the tumor size of.6.20 cases of ovarian mature teratoma was demarcation with median 9cm, of which 8 cases below 9cm, 7 cases, 1 cases, survival rate 87.5%, and 9cm above 12 For example, 8 cases of survival, 4 cases of death, survival rate of group 66.7%. two, the survival rate was P0.05, the difference was statistically significant,.7.20 cases of ovarian mature teratoma with negative and positive results were divided into two groups, of which 12 cases in the CA125 positive group, 9 cases of survival, 3 cases of death, the survival rate of 75%, negative group suffering. There were 8 cases, 6 cases of survival, 2 cases of death, the survival rate was 75%, 6 cases of CA199 positive group, 4 cases of survival, 2 cases of death, 66.7% of the survival rate, 8 cases in negative group, 5 cases of survival, 3 cases of survival, survival rate of 62.5%, survival rates of 4 cases, survival rates, survival rates, survival rates, AFP Yang There were 1 cases in the sex group, 1 cases of survival and 0 cases of death, the survival rate was 100%, the negative group was 14, the survival was 9, the survival rate was 64.3%, the SCC-Ag positive group was 4, 1, 3, the survival rate was 25%, the survival rate was 14, the survival rate was 85.7%. and the survival rate of the positive and negative group of SCC-Ag was the survival rate. Compared with P0.05, the difference was statistically significant, the survival rate of CA125, CEA, CA199, AFP and negative group was P0.05, and there was no statistically significant difference between 8 cases of ovarian mature teratoma patients and 6 cases of squamous cell carcinoma, 2 cases died, and the survival rate was 75%; 7 cases of cancer patients survived, 1 cases died, and the survival rate was 85.7%. In 5 other histological types, 2 cases were survived, 3 cases died, survival rate was 60%. three, the survival rate was compared, P0.05, the difference was not statistically significant. The pathological staging of ovarian mature teratoma in this study was based on the pathological staging of primary ovarian malignant tumors in FIGO (2000). 16 cases of stage I patients were born. There were 15 cases of death, 1 cases of death, the survival rate was 93.7%, and 4 cases in stage II and stage III were all dead and the survival rate was 0. The survival rate of the two groups was compared, P0.05, the difference was statistically significant. Conclusion: 1, the risk factors of ovarian mature teratoma include age, tumor size, blood flow signal of tumor and tumor markers CA125, CEA and SCC-Ag Age and tumor size are positively related to ovarian mature teratoma malignancy. Ultrasound suggests that the tumor has a blood flow signal and a tumor marker CA125. CEA and SCC-Ag positive ovarian mature teratoma should be vigilant for the possible.2. The prognostic factors of ovarian mature teratoma include tumor size, tumor marker SCC-Ag, and the prognosis of ovarian mature teratoma. Surgical staging, with tumor diameter larger than 9cm, tumor marker SCC-Ag positive, and stage of surgery and stage II and stage II, had poor prognosis.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.31

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