本文選題：宮頸癌 + 新輔助化療　； 參考：《鄭州大學(xué)》2016年碩士論文

【摘要】：背景宮頸癌是一種常見惡性腫瘤,其發(fā)病率居?jì)D科惡性腫瘤第二,僅次于乳腺癌。近年來宮頸癌發(fā)病率呈逐年上升趨勢,宮頸癌患者年輕化趨勢明顯。為應(yīng)對宮頸癌發(fā)病的新趨勢,新輔助化療(NACT)被逐漸的認(rèn)可和推廣應(yīng)用。新輔助化療(NACT)可實(shí)現(xiàn)縮小病灶體積和范圍、改善宮旁浸潤狀況、改善手術(shù)情況,提高對腫瘤病灶的手術(shù)切除率,及病灶在放射治療階段對放射治療的敏感性;同時還可使微轉(zhuǎn)移病灶得到清除或有效的抑制。TP方案作為新輔助化療方案的一種,其臨床用藥不斷升級出新。作為鉑類和紫杉醇類的升級藥物,力樸素、多西他賽、奧沙利鉑等在臨床上得以逐漸推廣應(yīng)用。目的對比、探討在宮頸癌新輔助化療階段,力樸素與奧沙利鉑組合、多西他賽與奧沙利鉑組合的TP方案的療效及化療副反應(yīng)。方法選取2012年9月至2015年12月鄭州大學(xué)人民醫(yī)院收治的117例宮頸癌患者為研究對象。參照FIGO標(biāo)準(zhǔn)臨床分析分為Ⅰb2、Ⅱa2期。其中35例Ⅰb2、Ⅱa2期患者列為對照組A組,該組經(jīng)過術(shù)前常規(guī)檢查,直接實(shí)施廣泛性子宮切除術(shù)+盆腔淋巴結(jié)清掃術(shù);82例Ⅰb2、Ⅱa2期患者列為實(shí)驗(yàn)組,該組先行實(shí)施新輔助化療兩個療程,再行廣泛性子宮切除術(shù)+盆腔淋巴結(jié)清掃術(shù);實(shí)驗(yàn)組又分為TP1、TP2組,各41例,TP1組實(shí)施力樸素與奧沙利鉑組合的新輔助化療;TP2組實(shí)施多西他賽與奧沙利鉑組合的新輔助化療。比較對照組、實(shí)驗(yàn)組手術(shù)情況、術(shù)后并發(fā)癥和術(shù)后病理狀況。比較TP1組、TP2組間化療有效性、化療毒副作用;化療后手術(shù)情況、術(shù)后并發(fā)癥和術(shù)后病理狀況。結(jié)果實(shí)驗(yàn)組、對照組患者的年齡分布、病理類型、病灶組織學(xué)分級均無統(tǒng)計(jì)學(xué)差異,P0.05。實(shí)驗(yàn)組82例患者,化療總有效率(CR+PR)96.3%;TP1組41例患者,化療有效率(CR+PR)97.6%,TP2組41例患者,化療有效率(CR+PR)95.2%,TP1、TP2組間化療有效率無統(tǒng)計(jì)學(xué)差異,P0.05。實(shí)驗(yàn)組82例患者,鱗癌78例、腺癌4例,鱗癌化療總有效率97%,腺癌化療總有效率75%;病理類型不同,化療有效率差異有統(tǒng)計(jì)學(xué)意義,P0.05。實(shí)驗(yàn)組82例患者經(jīng)過2個療程的化療后,出現(xiàn)化療毒副作用表征的71例,主要表現(xiàn)為胃腸道副作用和血液學(xué)毒性副作用,并且毒副作用程度較輕微;TP1、TP2組間血液學(xué)毒性反應(yīng):白細(xì)胞及中性粒細(xì)胞減少,兩組間有統(tǒng)計(jì)學(xué)差異,P0.05;血紅蛋白減少兩組間比較無統(tǒng)計(jì)學(xué)差異,P0.05。實(shí)施根治性手術(shù)時,實(shí)驗(yàn)組、對照組的手術(shù)時間和淋巴結(jié)切除數(shù)無統(tǒng)計(jì)學(xué)差異,P0.05;但術(shù)中出血量有統(tǒng)計(jì)學(xué)差異,P0.05。本次研究術(shù)后并發(fā)癥發(fā)生36例,其中對照組術(shù)后并發(fā)癥13例(37.1%),實(shí)驗(yàn)組23例(28.1%),兩組術(shù)后并發(fā)癥無顯著差異,P0.05;TP1和TP2組間比較,針對感染、術(shù)后血栓及其他等情況各組間無顯著統(tǒng)計(jì)學(xué)差異,P0.05;針對淋巴囊腫和尿潴留并發(fā)癥存在統(tǒng)計(jì)學(xué)差異,P0.05。實(shí)驗(yàn)組與對照組間、實(shí)驗(yàn)組內(nèi)TP1、TP2組間對陰道切緣陽性率無統(tǒng)計(jì)學(xué)差異,P0.05;淋巴結(jié)轉(zhuǎn)移、脈管浸潤陽性率差異有統(tǒng)計(jì)學(xué)差異,P0.05。結(jié)論應(yīng)用力樸素與奧沙利鉑組合、多西他賽與奧沙利鉑組合的新輔助化療臨床應(yīng)用可行,療效明顯;并且在后續(xù)實(shí)施根治性手術(shù)治療時,出血量少,術(shù)后并發(fā)癥少,值得臨床推薦應(yīng)用。力樸素與奧沙利鉑組合、多西他賽與奧沙利鉑組合用藥方案化療整體有效率接近,但相較多西他賽與奧沙利鉑組合的化療方案,力樸素與奧沙利鉑組合化療后毒副作用低;手術(shù)情況更好;術(shù)后淋巴結(jié)、尿潴留并發(fā)癥出現(xiàn)的幾率更低;陰道切緣陽性率、淋巴結(jié)轉(zhuǎn)移、脈管浸潤陽性率等病理性反應(yīng)更低。
[Abstract]:Background cervical cancer is a common malignant tumor, the incidence of which is second of gynecologic malignant tumor, second only to breast cancer. In recent years, the incidence of cervical cancer is increasing year by year, and the trend of the young of cervical cancer patients is obvious. In order to cope with the new trend of cervical cancer, new adjuvant chemotherapy (NACT) has been gradually approved and popularized. New adjuvant chemotherapy (NAC T) can reduce the size and scope of the lesion, improve the status of the paravatal infiltration, improve the operation, improve the resection rate of the tumor, and the sensitivity of the lesion to the radiotherapy at the stage of radiation therapy. At the same time, the micrometastases can be removed or effectively suppressed by the.TP regimen as a new adjuvant chemotherapy scheme. As an upgrading drug of platinum and paclitaxel, it is gradually popularized as an upgrade drug for platinum and taxol, docetaxel and oxaliplatin. Objective to compare the efficacy and side effects of the TP regimen in the new adjuvant chemotherapy stage of cervical cancer, the combination of Austin and oxaliplatin, and the combination of docetaxel and oxaliplatin. 117 cases of cervical cancer treated in the people's Hospital of Zhengzhou University from September 2012 to December 2015 were studied. According to the clinical analysis of FIGO standard, the clinical analysis was divided into I B2 and II A2 stage. 35 of them were I B2, and the patients of stage II A2 were listed as the control group A. The group underwent routine examination before operation, and the extensive hysterectomy plus pelvic lymph node dissection; 8 2 cases of I B2 and stage II A2 were listed as the experimental group. The group was given two courses of neoadjuvant chemotherapy, and then extensive hysterectomy and pelvic lymph node dissection. The experimental group was divided into TP1, group TP2, 41 cases, and group TP1 to carry out new adjuvant chemotherapy with the combination of austere and oxaliplatin, and group TP2 to carry out the new adjuvant of the combination of docetaxel and oxaliplatin in the group TP2 Chemotherapy, compared with the control group, the operation situation, postoperative complications and postoperative pathological conditions in the experimental group, compared with group TP1, group TP2, chemotherapy and side effects, postoperative operation, postoperative complications and postoperative pathological conditions. Results of the experimental group and the control group, the age distribution, pathological type, and histological classification of the focus were not statistically poor. P0.05. experimental group 82 patients, chemotherapy total efficiency (CR+PR) 96.3%, TP1 group 41 patients, chemotherapy efficiency (CR+PR) 97.6%, TP2 group 41 patients, chemotherapy effective (CR+PR) 95.2%, TP1, TP2 group effectiveness rate of no statistically significant difference, P0.05. experimental group 82 patients, squamous carcinoma 78 cases, adenocarcinoma 4 cases, squamous cancer chemotherapy total efficiency 97%, adenocarcinoma chemotherapy is always The efficiency was 75%, the pathological type was different, the difference of the effective rate of chemotherapy was statistically significant. After 2 courses of chemotherapy, 82 patients in the P0.05. experimental group had 71 cases of toxic and side effects of chemotherapy. The main manifestations were the side effects of the gastrointestinal tract and the side effects of Hematology, and the toxic side effects were mild; the hematological toxicity reaction between group TP2 and group TP1: white thin. Cell and neutrophils decreased, there was a statistical difference between the two groups, P0.05, and there was no statistical difference between the two groups. There was no statistical difference between the operation time and the number of lymph nodes in the control group when the radical operation was performed by P0.05., P0.05. However, there was a statistical difference in the amount of blood in the operation, and P0.05. was this time to study the postoperative complications. There were 36 cases, including 13 cases (37.1%) of postoperative complications in the control group and 23 cases (28.1%) in the experimental group (28.1%). There was no significant difference in postoperative complications between the two groups. There was no significant difference between the groups of P0.05, TP1 and TP2. There was no significant difference between the two groups for infection, postoperative thrombosis and other cases. There were statistical differences in lymphatic cysts and urinary retention complications, P0.05. experimental group. In the experimental group, there was no statistical difference between the TP1 and TP2 groups in the experimental group. The difference in the positive rate of P0.05, lymph node metastasis and pulse tube infiltration was statistically different. The application of new adjuvant chemotherapy for the combination of force simple and oxaliplatin, and the combination of docetaxel and oxaliplatin in the P0.05. conclusion was feasible, and the curative effect was obvious; and in the follow-up. There were fewer bleeding and fewer complications after radical operation. It was worthy of clinical application. The combination of force simple and oxaliplatin combined with oxaliplatin combined with chemotherapy was close to the overall efficiency, but compared with the chemotherapy regimen of the combination of docetaxel and oxaliplatin, the toxic side of the combination chemotherapy of the combination of oxaliplatin and the combination of oxaliplatin and oxaliplatin Low use, better operation, lower incidence of postoperative lymph nodes and urinary retention complications, lower vaginal margin positive rate, lymph node metastasis, and positive rate of vascular infiltration, and so on.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R737.33

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