本文選題：子宮肉瘤 + 術(shù)前診斷　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：背景及目的:子宮肉瘤為臨床上少見(jiàn)的婦科惡性腫瘤。目前尚缺乏特異的腫瘤標(biāo)志物及輔助檢查方法,早期或術(shù)前診斷困難,常被誤診為子宮良性腫瘤,如子宮肌瘤、子宮腺肌癥(瘤),延誤病情及手術(shù)方式不當(dāng)造成手術(shù)病理分期提高或多次手術(shù)創(chuàng)傷,嚴(yán)重影響患者預(yù)后和生活質(zhì)量。本文通過(guò)對(duì)子宮肉瘤組及對(duì)照組(子宮良性腫瘤組)的術(shù)前不同指標(biāo)的統(tǒng)計(jì)學(xué)分析,建立子宮肉瘤術(shù)前診斷評(píng)分系統(tǒng)(Preoperative Sarcoma Score,PSS),以期提高子宮肉瘤術(shù)前診斷率;并通過(guò)分析誤診病例的臨床資料,爭(zhēng)取避免診療誤區(qū)、避免錯(cuò)誤的治療手段。方法:1.采用回顧性、分組對(duì)照的方法,收集2003年1月~2016年6月在青島大學(xué)附屬醫(yī)院婦科住院經(jīng)病理診斷明確的子宮肉瘤、子宮良性腫瘤病例。經(jīng)嚴(yán)格入組篩選標(biāo)準(zhǔn),選取入組病例研究組子宮肉瘤組48例,對(duì)照組子宮良性腫瘤組90例,對(duì)兩組的臨床表現(xiàn)、實(shí)驗(yàn)室指標(biāo)、影像學(xué)檢查等臨床資料進(jìn)行單因素及多因素Logistic相關(guān)回歸分析,建立相應(yīng)預(yù)測(cè)評(píng)分系統(tǒng),通過(guò)受試者工作特性(ROC)曲線得出鑒別子宮良惡性最佳分界值,并計(jì)算ROC曲線下面積檢驗(yàn)該評(píng)分系統(tǒng)效能。2.選取本院2003年1月~2016年6月間首診或外院轉(zhuǎn)入的子宮肉瘤誤診病例15例,將誤診病例分為腹腔鏡組和開腹組,并分析臨床資料及隨訪預(yù)后。結(jié)果:1.共納入48名子宮肉瘤患者和90例子宮良性腫瘤,比較兩組相關(guān)臨床資料,經(jīng)單因素分析有意義指標(biāo)是年齡、CA125、LDH、彩超檢查特征(內(nèi)部血流、血流信號(hào)豐富、邊界、內(nèi)部回聲、腫瘤最大直徑),進(jìn)一步行二元Logistic相關(guān)回歸分析得出LDH、彩超檢查提示的邊界欠清及內(nèi)部回聲呈不均質(zhì)或混合回聲是診斷子宮肉瘤的獨(dú)立危險(xiǎn)因素,制定子宮肉瘤術(shù)前診斷評(píng)分系統(tǒng)。該評(píng)分系統(tǒng)分值為0~4分,其預(yù)測(cè)的一致性較好(P=0.438)。受試者工作特征(ROC)曲線下面積是0.961(95%CI[0.922,0.999]),說(shuō)明該評(píng)分系統(tǒng)區(qū)分度較好,最佳分界值為1.5分,特異度97.8%,敏感度83.3%,準(zhǔn)確度92.8%,陰性預(yù)測(cè)值91.7%,陽(yáng)性預(yù)測(cè)值95.2%。2.誤診患者年齡結(jié)構(gòu)主要集中于育齡期女性;15例誤診患者術(shù)前均考慮“子宮肌瘤”,術(shù)后病理有5例(33%)報(bào)告錯(cuò)誤;腹腔鏡組在子宮肉瘤盆腔種植轉(zhuǎn)移率(75%,3/4)及復(fù)發(fā)率(75%,3/4)方面均高于開腹組(27.3%,50%)。結(jié)論:1.子宮肉瘤的術(shù)前診斷評(píng)分系統(tǒng)(PSS),能夠較好地對(duì)子宮腫瘤患者進(jìn)行良惡性風(fēng)險(xiǎn)分層,可以為子宮肉瘤與子宮良性腫瘤的臨床鑒別診斷提供初步依據(jù)。2.造成誤診及后果的原因有病理報(bào)告錯(cuò)誤、忽視年輕未育患者、絕經(jīng)后患者手術(shù)方式選擇不恰當(dāng)?shù)?另外腹腔鏡下分碎器的應(yīng)用可能有引起未預(yù)料子宮肉瘤盆腹腔內(nèi)種植轉(zhuǎn)移及增加術(shù)后復(fù)發(fā)機(jī)會(huì)的風(fēng)險(xiǎn),應(yīng)引起臨床醫(yī)師重視。
[Abstract]:Background & objective: uterine sarcoma is a rare gynecologic malignant tumor. At present, there are no specific tumor markers and auxiliary examination methods. It is difficult to diagnose early or pre-operatively, and is often misdiagnosed as a benign uterine tumor, such as uterine leiomyoma. Adenomyosis of uterus (adenomyosis) caused by delayed condition and improper operation mode resulted in the improvement of surgical pathological stage or multiple surgical trauma, which seriously affected the prognosis and quality of life of the patients. In order to improve the preoperative diagnosis rate of uterine sarcoma, a preoperative Sarcoma score system was established by statistical analysis of different preoperative indexes in uterine sarcoma group and control group (uterine benign tumor group). By analyzing the clinical data of misdiagnosed cases, we try to avoid misdiagnosis and treatment. Method 1: 1. Cases of uterine sarcoma and benign uterine tumor in gynecological hospital of Qingdao University from January 2003 to June 2016 were collected by retrospective and controlled methods. According to strict screening criteria, 48 cases of uterine sarcoma and 90 cases of benign tumor of uterus were selected in the study group and the control group respectively. The clinical manifestations and laboratory indexes of the two groups were analyzed. The clinical data such as imaging examination were analyzed by univariate and multivariate Logistic correlation regression analysis, and the corresponding predictive scoring system was established. The best value of differentiation between benign and malignant uterus was obtained by using the operating characteristics of the subjects. The area under the ROC curve was calculated to test the effectiveness of the scoring system. Fifteen misdiagnosed cases of uterine sarcoma from January 2003 to June 2016 were divided into laparoscopy group and open group. The clinical data and prognosis were analyzed. The result is 1: 1. A total of 48 patients with uterine sarcoma and 90 patients with benign uterine tumors were enrolled. The clinical data of the two groups were compared. The significant indexes of univariate analysis were age CA125 LDH, color Doppler ultrasonography (internal blood flow, abundant blood flow signal, boundary, internal echo). The maximum diameter of the tumor was determined by binary Logistic correlation regression analysis. The results of color Doppler ultrasonography showed that the boundary was unclear and the internal echo was heterogeneous or mixed echo was an independent risk factor for the diagnosis of uterine sarcoma. To establish a preoperative diagnostic scoring system for uterine sarcoma. The score of this scoring system is 0 ~ 4, and the prediction consistency is good. The area under the operating characteristic curve of the subjects was 0.961(95%CI [0.922 鹵0.999], which indicated that this scoring system had a good degree of differentiation, the best threshold was 1.5, the specificity was 97.8, the sensitivity was 83.3 and the accuracy was 92.8b, the negative predictive value was 91.7, and the positive predictive value was 95.2.2. The age structure of misdiagnosed patients was mainly focused on 15 misdiagnosed women of childbearing age. "uterine leiomyoma" was considered before operation. The rate of pelvic implantation and metastasis of uterine sarcoma in laparoscopic group (75 / 4) and recurrence rate (75 / 4) were higher than that in laparotomy group (27.3%). Conclusion 1. The preoperative diagnostic scoring system of uterine sarcoma (PSS) can better stratify the risk of benign and malignant uterine tumors and provide a preliminary basis for clinical differential diagnosis between uterine sarcoma and benign uterine tumors. The causes of misdiagnosis and its consequences were wrong pathological report, neglect of young unfertile patients, improper choice of surgical methods for postmenopausal patients, etc. In addition, the application of laparoscopic shredder may lead to unexpected intraperitoneal implantation metastasis of uterine sarcoma and increase the chance of recurrence after operation, which should be paid attention to by clinicians.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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