本文選題：子宮內(nèi)膜癌 + 腹主動脈旁淋巴結(jié)��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:子宮內(nèi)膜癌是一組來源子宮內(nèi)膜的上皮性的惡性腫瘤,是女性生殖系統(tǒng)三大惡性腫瘤之一,占女性全部生殖系統(tǒng)惡性腫瘤的20%~30%,并且其發(fā)病率逐年升高,在許多西方發(fā)達(dá)國家,子宮內(nèi)膜癌的發(fā)病率高居生殖道惡性腫瘤的首位。淋巴結(jié)的轉(zhuǎn)移是影響子宮內(nèi)膜癌患者預(yù)后的非常重要的因素,而盆腔淋巴結(jié)轉(zhuǎn)移與腹主動脈旁淋巴結(jié)轉(zhuǎn)移對預(yù)后有著不同的提示作用。本研究通過回顧性分析子宮內(nèi)膜癌患者的臨床病理資料探討盆腔及腹主動脈旁淋巴結(jié)轉(zhuǎn)移的子宮內(nèi)膜癌的臨床病理特征及其相關(guān)因素。方法:選取自2008年1月至2014年12月于河北醫(yī)科大學(xué)第四醫(yī)院婦科住院并經(jīng)手術(shù)病理組織學(xué)證實(shí)為子宮內(nèi)膜癌的患者1445例,且所有患者均行全子宮、雙附件及盆腔±腹主動脈旁淋巴結(jié)的切除,對該組所有患者臨床、病理及隨訪資料進(jìn)行詳細(xì)查閱記錄,并建立臨床隨訪資料Excel數(shù)據(jù)庫,應(yīng)用SPSS16.0統(tǒng)計軟件對這些病例與臨床資料進(jìn)行統(tǒng)計學(xué)分析,單因素分析采用卡方檢驗(yàn)及Fisher確切概率法,多因素分析采用二元Logistic回歸模型,P0.05為差異有統(tǒng)計學(xué)意義。結(jié)果:1本研究共納入子宮內(nèi)膜癌患者1445例,其中該組患者的年齡分布范圍為28~77歲,平均發(fā)病年齡53.76±8.375歲,中位數(shù)年齡為55歲,其中55歲者720例(49.8%),≥55歲者725例(50.2%)。絕經(jīng)后診斷為子宮內(nèi)膜癌患者有884例,占61.2%,未絕經(jīng)者561例,占38.8%;絕經(jīng)患者的平均年齡57.54歲,年齡分布為57.54±6.757歲。體重指數(shù)BMI25Kg/m2者454例,占31.4%,BMI≥25 Kg/m2者991例,占68.6%。最小體重指數(shù)15 Kg/m2,最大49 Kg/m2,平均體重指數(shù)為26.28±4.0311 Kg/m2。絕經(jīng)后陰道出血為首要癥狀者1052例,占72.8%,陰道排液者103例,占7.1%,月經(jīng)異常者124例,占8.6%,其他癥狀包括腹痛、腹脹、體檢發(fā)現(xiàn)者166例,占11.5%。直系親屬癌癥病史者共194例,占13.4%,其中子宮內(nèi)膜癌患者4例,卵巢癌2例,宮頸癌2例,食道癌48例,賁門癌10例,胃癌40例,肺癌39例,乳腺癌6例,肝癌20例,直腸癌10例,胰腺癌6例,甲狀腺癌1例,腎癌1例,牙齦癌1例,膽囊癌1例,喉癌1例,血液系統(tǒng)疾病2例。合并高血壓者461例,占31.9%,合并糖尿病者111例,占7.7%,同時合并高血壓和糖尿病61例,占4.2%,合并不孕者69例,占4.8%。2本組1445例子宮內(nèi)膜癌患者中行開腹子宮內(nèi)膜癌根治術(shù)者手術(shù)770例,占53.3%,行腹腔鏡下手術(shù)者675例,占46.7%。高分化G1者79例,占5.5%,中分化G2者1097例,占75.9%,低分化G3者269例,占18.6%。無肌層浸潤者147例,占10.2%,淺肌層浸潤者1002例,占69.3%,深肌層浸潤者296例,占20.5%。存在脈管瘤栓者95例,占6.6%,無脈管瘤栓者1350例,占93.4%。同時存在宮頸間質(zhì)受侵者277例,占19.2%,無宮頸間質(zhì)受侵者1168例,占80.8%。同時伴附件轉(zhuǎn)移者76例,占5.3%。術(shù)前CA125≥35U/ml者341例,占23.6%。Ⅰ期1047例,占72.5%,Ⅱ期211例,占14.6%,Ⅲ期176例,占12.2%,Ⅳ期11例,占0.7%。子宮內(nèi)膜樣腺癌1366例占94.5%,非宮內(nèi)膜樣癌79例,其中包括混合癌7例,漿乳癌35例,透明細(xì)胞癌23例,小細(xì)胞癌5例,粘液腺癌9例。3本組1445例子宮內(nèi)膜癌患者中,共109例子宮內(nèi)膜癌發(fā)生淋巴結(jié)轉(zhuǎn)移,其中盆腔淋巴結(jié)轉(zhuǎn)移而腹主動脈旁淋巴結(jié)未轉(zhuǎn)移者77例,占70.6%,腹主動脈旁淋巴結(jié)轉(zhuǎn)移而盆腔淋巴結(jié)未轉(zhuǎn)移者13例,占11.9%,盆腔及腹主動脈旁淋巴結(jié)同時轉(zhuǎn)移者19例,占17.4%。結(jié)論:1體重指數(shù)BMI、血清CA125、組織分級、肌層浸潤、脈管瘤栓、宮頸間質(zhì)受侵、附件轉(zhuǎn)移、病理類型、手術(shù)方式是子宮內(nèi)膜癌盆腔及腹主動脈旁淋巴結(jié)轉(zhuǎn)移的相關(guān)危險因素。2深肌層浸潤、脈管瘤栓、附件轉(zhuǎn)移是子宮內(nèi)膜癌盆腔及腹主動脈旁淋巴結(jié)轉(zhuǎn)移的獨(dú)立危險因素。3子宮內(nèi)膜癌盆腔淋巴結(jié)轉(zhuǎn)移的發(fā)生率高于腹主動脈旁淋巴結(jié)轉(zhuǎn)移的發(fā)生率。
[Abstract]:Objective: endometrial carcinoma is a group of epithelial malignant tumors that come from the endometrium. It is one of the three major malignant tumors of the female reproductive system, which accounts for the 20%~30% of all female malignant tumors of the reproductive system, and its incidence is increasing year by year. In many western developed countries, the incidence of endometrium cancer is the highest in the malignant tumor of the reproductive tract. The metastasis of the pelvic lymph nodes and the lymph node metastasis of the abdominal aorta have different prognostic effects on the prognosis of the patients with endometrial carcinoma. This study is a retrospective analysis of the intrauterine and intrauterine lymph node metastases of the pelvic and abdominal aorta by a retrospective analysis of the clinicopathological data of endometrial cancer patients. The clinicopathological features and related factors of membrane cancer. Methods: from January 2008 to December 2014, 1445 patients with endometrial cancer confirmed by gynaecology in fourth hospital of Hebei Medical University were confirmed by surgical histopathology, and all patients were treated with total uterus, double appendage and pelvic abdominal aorta paraaortic lymph node resection. The patients' clinical, pathological and follow-up data were recorded in detail, and the Excel database of clinical follow-up data was established. The statistical analysis of these cases and clinical data was carried out with SPSS16.0 statistical software. The single factor analysis adopted chi square test and the exact probability of Fisher, and the multifactor analysis adopted the two yuan Logistic regression model, and the P0.05 was poor. Results: 1, 1445 cases of endometrial cancer were included in this study. The age distribution of the patients was 28~77 years old, the average age of onset was 53.76 + 8.375 years, the median age was 55 years, 720 (49.8%) in 55 years old, 725 cases (50.2%) in those aged over 55 years, and 884 cases of endometrial cancer in the postmenopausal patients, accounting for 61.2%. There were 561 cases without menopause, accounting for 38.8%, the average age of menopause was 57.54 years old and the age distribution was 57.54 + 6.757 years. The body mass index BMI25Kg/m2 was 454 cases, 31.4%, and BMI > 25 Kg/m2, accounting for 68.6%. minimum body mass index 15 Kg/m2 and maximum 49 Kg/m2. The average body mass index was 26.28 + 4.0311 Kg/m2. postmenopausal vaginal bleeding as the primary symptom. 72.8%, 103 cases of vaginal discharge, 7.1%, 124 cases of abnormal menstruation, 8.6%, other symptoms including abdominal pain, abdominal distention, 166 cases of physical examination, accounting for 194 cases of 11.5%. direct relatives cancer history, accounting for 13.4%, including 4 cases of endometrial cancer, 2 cases of ovarian cancer, 2 cases of cervical cancer, esophagus carcinoma 48 cases, gastric cardia 10 cases, gastric cancer 40 cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancers There were 6 cases of cancer, 20 cases of liver cancer, 10 cases of rectal cancer, 6 cases of pancreatic cancer, 1 cases of thyroid cancer, 1 cases of renal carcinoma, 1 cases of gingiva cancer, 1 cases of gall bladder cancer, 1 cases of larynx, 2 cases of blood system diseases, 461 cases of hypertension, 31.9%, and 111 cases with diabetes, combined with hypertension and diabetes, accounting for 4.8%.2 cases. In patients with endometrial carcinoma, 770 cases were operated on radical resection of endometrial carcinoma, accounting for 53.3% and 675 cases of laparoscopic surgery, accounting for 79 cases of 46.7%. highly differentiated G1, 5.5% in G2, 1097 in G2, 269 in low differentiated G3, 147 in 18.6%. without myometrium infiltration, 10.2%, 1002 in superficial myometrium infiltration, 69.3%, 296 in deep myometrium infiltration. In 20.5%., there were 95 cases of vascular tumor embolus, 6.6% and 1350 cases without vascular tumor thrombus, 277 cases of cervical interstitial invasion and 1168 cases of cervical interstitial invasion, 1168 cases of 80.8%. and 76 cases of CA125 more than 35U/ml before 5.3%., accounting for 1047 cases in 23.6%. I stage 1047, 72.5%, 211 cases in stage II, 14.6%, III There were 176 cases, 12.2% and 11 cases, 1366 cases of 0.7%. endometrioid adenocarcinoma, 94.5% non endometrioid carcinoma, 79 cases of non endometrioid carcinoma, including 7 cases of mixed carcinoma, 35 cases of plasma breast cancer, 23 cases of clear cell carcinoma, 5 cases of small cell carcinoma, 9 cases of mucous adenocarcinoma and 1445 cases of endometrial carcinoma, including lymph node metastasis in endometrial carcinoma, including pelvic lymphatic lymph node metastasis. There were 77 cases of metastasis and non metastasis of abdominal aorta lymph node, accounting for 70.6%, 13 cases of abdominal lymph node metastasis and non metastasis of pelvic lymph node, 11.9%, 19 cases of pelvic and abdominal lymph node metastases, accounting for 17.4%.: 1 body weight index BMI, serum CA125, tissue classification, myometrium infiltration, vascular tumor thrombus, cervical interstitial invasion, attached to the cervix, attached to the cervix of the cervix. The risk factors of pelvic and Pararal lymph node metastasis in endometrial carcinoma.2 deep muscular layer infiltration, vascular tumor thrombus, accessory metastasis is an independent risk factor for pelvic and abdominal aortic lymph node metastasis in endometrial carcinoma.3, the incidence of pelvic lymph node metastasis in endometrium carcinoma is higher than that of abdominal initiative. The incidence of para - pulse lymph node metastasis.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.33

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