發(fā)布時(shí)間：2018-06-02 14:08

  本文選題：食管鱗癌 + 多原發(fā)癌��； 參考：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文

【摘要】：第一部分食管鱗癌相關(guān)多原發(fā)癌的臨床特點(diǎn)總結(jié)與分析博士研究生：賀舜導(dǎo)師：王貴齊北京協(xié)和醫(yī)學(xué)院中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院[背景與目的]食管鱗狀細(xì)胞癌是我國常見的惡性腫瘤,隨著診斷技術(shù)的進(jìn)步,越來越多的證據(jù)表明,食管鱗癌的發(fā)生往往是多病灶起源,同時(shí)伴有其他部位或器官的多原發(fā)現(xiàn)像,本研究總結(jié)我院一段時(shí)期內(nèi)食管鱗癌的臨床特點(diǎn),分析食管鱗癌相關(guān)多原發(fā)癌的相關(guān)臨床特征,為食管鱗癌的診斷及治療提供依據(jù)與線索。[病例與方法]回顧分析中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院2012年1月-2014年12月診治的原發(fā)性食管鱗癌患者3104例。結(jié)合患者相關(guān)診療資料,按照多原發(fā)癌的診斷標(biāo)準(zhǔn)分為多原發(fā)癌組與非多原發(fā)癌組,分析比較兩組的相關(guān)臨床特點(diǎn)。[結(jié)果]11.9%的食管鱗癌發(fā)生了其他部位多原發(fā)癌；72.4%的多原發(fā)癌為同時(shí)性多原發(fā)癌；多原發(fā)癌組以頭頸部多原發(fā)癌以及胃多原發(fā)癌最為常見,分別占6.8%及4.2%,其次為肺以及其他部位；頭頸部多原發(fā)癌病例中食管多發(fā)病灶存在的比例要明顯高于胃多原發(fā)癌及非多原發(fā)癌病例。[結(jié)論]食管鱗癌相關(guān)多原發(fā)癌是一種常見的臨床現(xiàn)象,以同時(shí)性多原發(fā)癌為常見,部位又以頭頸部及胃部多原發(fā)最為常見,而食管鱗癌中食管多發(fā)病灶的存在提示頭頸部多原發(fā)癌發(fā)生的可能性高,了解這些臨床特點(diǎn)有助于食管鱗癌相關(guān)多原發(fā)癌的診斷以及早期治療。第二部分超聲內(nèi)鏡診斷食管癌N分期的研究【背景與目的】食管癌的N分期不僅能夠決定患者預(yù)后,對于患者選取何種治療方式也起著決定性的作用。超聲內(nèi)鏡(EUS)能夠提供其他檢查技術(shù)所不能提供的信息,在食管癌N分期方面具有一定的優(yōu)勢,但目前所報(bào)道的該診斷的準(zhǔn)確性數(shù)據(jù)差異較大,同時(shí)缺少我國食管癌人群的相關(guān)數(shù)據(jù)。本研究目的在于尋找EUS判斷淋巴結(jié)良惡性的最優(yōu)診斷標(biāo)準(zhǔn)。[病例與方法]回顧性分析中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院2014年1月-2014年6月間123例手術(shù)食管癌患者。記錄術(shù)前超聲內(nèi)鏡下所探及的淋巴結(jié)相關(guān)參數(shù)(①長徑,②短徑,③短長徑比,④是否為低回聲,邊界是否光滑,⑤是否圓形或橢圓型,⑥是否低回聲,⑦超聲內(nèi)鏡下發(fā)現(xiàn)的淋巴結(jié)數(shù)目,⑧超聲內(nèi)鏡診斷腫瘤的T分期,⑨淋巴結(jié)所在位置)。對比術(shù)前超聲內(nèi)鏡探掃的淋巴結(jié)與術(shù)后清掃對應(yīng)區(qū)域淋巴結(jié)病理診斷結(jié)果,應(yīng)用統(tǒng)計(jì)學(xué)方法分析超聲內(nèi)鏡探掃淋巴結(jié)各參數(shù)指標(biāo)與淋巴結(jié)轉(zhuǎn)移的關(guān)系,尋找判斷淋巴結(jié)轉(zhuǎn)移的最佳診斷標(biāo)準(zhǔn)。[結(jié)果]82.4%的超聲內(nèi)鏡所探掃到的淋巴結(jié)能夠與手術(shù)病理相對應(yīng)。ROC曲線分析判斷長徑、短徑以及超聲內(nèi)鏡下發(fā)現(xiàn)淋巴結(jié)數(shù)目等3個(gè)參數(shù)指標(biāo)診斷淋巴結(jié)良惡性的最佳臨界值分別為 7.5mm,5.5mm以及2。單因素卡方檢驗(yàn)提示有8個(gè)參數(shù)指標(biāo)(長徑7.5mm,短徑5.5mmm,圓型,低回聲,邊界是否光滑,是否為病變旁淋巴結(jié),超聲內(nèi)鏡下發(fā)現(xiàn)淋巴結(jié)數(shù)2,超聲內(nèi)鏡診斷為T3/4分期)用于判斷淋巴結(jié)良惡性具有顯著性意義。ROC曲線分析顯示超聲內(nèi)鏡改良標(biāo)準(zhǔn)(7個(gè)參數(shù))在判斷單個(gè)淋巴結(jié)良惡性準(zhǔn)確性要優(yōu)于常規(guī)標(biāo)準(zhǔn)(4個(gè)參數(shù)),AUC (0.801 VS 0.779);多因素logistic回歸分析顯示短徑5.5mm,圓型,病變旁淋巴結(jié),低回聲是淋巴結(jié)轉(zhuǎn)移獨(dú)立的危險(xiǎn)因素。改良標(biāo)準(zhǔn)與常規(guī)標(biāo)準(zhǔn)均取最佳臨界值時(shí)(改良標(biāo)準(zhǔn)≥5個(gè)指標(biāo)為陽性,常規(guī)標(biāo)準(zhǔn)≥3個(gè)指標(biāo)為陽性),對食管癌N分期的診斷準(zhǔn)確性分別為58%以及74.1%。改良標(biāo)準(zhǔn)要優(yōu)于常規(guī)標(biāo)準(zhǔn)。[結(jié)論]超聲內(nèi)鏡診斷食管癌淋巴結(jié)轉(zhuǎn)移有較好的準(zhǔn)確性,多個(gè)參數(shù)指標(biāo)組合成的改良標(biāo)準(zhǔn)有助于提高淋巴結(jié)轉(zhuǎn)移診斷的準(zhǔn)確性。
[Abstract]:Part 1: a summary and analysis of the clinical characteristics of multiple primary carcinomas associated with squamous cell carcinoma of the esophagus: Dr. Ho Shun's tutor: the Cancer Hospital of the Chinese Academy of Medical Sciences, the Beijing Academy of Medical Sciences, Wang You Qi, [background and purpose] the squamous cell carcinoma of the esophagus is a common malignant tumor in China. With the progress of diagnostic techniques, more and more evidence shows the esophagus. The occurrence of squamous cell carcinoma is often the origin of multifocal lesions, accompanied by multiple original images of other parts or organs. This study summarizes the clinical features of squamous carcinoma of the esophagus in our hospital for a period of time and analyzes the clinical features of multiple primary cancers related to squamous carcinoma of the esophagus, providing evidence and clues for the diagnosis and treatment of squamous carcinoma of the esophagus. 3104 cases of primary squamous carcinoma of the esophagus were diagnosed and treated by the Cancer Hospital of the Chinese Academy of Medical Sciences in December -2014 January 2012. According to the related diagnosis and treatment data of the patients, the clinical characteristics of the two groups were analyzed and compared in accordance with the diagnostic criteria of the multiple primary cancer, and the related clinical features of the two groups were analyzed and compared. [results] the other parts of the esophageal squamous cell carcinoma occurred in other parts. Multiple primary carcinomas, 72.4% of multiple primary cancers were simultaneous multiple primary carcinomas; multiple primary carcinomas in the head and neck and gastric multiple primary cancers were the most common in the multiple primary cancer groups, accounting for 6.8% and 4.2% respectively, followed by the lung and other parts, and the presence of multiple primary cancers in the head and neck cases was significantly higher than that of the gastric multiple primary and non multiple primary cancers. [Conclusion] the multiple primary carcinoma of esophageal squamous cell carcinoma is a common clinical phenomenon. Multiple primary carcinoma is common with simultaneous multiple primary cancer. The most common sites are the head, neck and stomach. The presence of multiple esophageal foci in the squamous carcinoma of the esophagus suggests the high availability of multiple primary cancers in the head and neck. Understanding these clinical features helps the esophagus. Diagnosis and early treatment of squamous carcinoma related multiple primary carcinomas. Second partial endoscopic ultrasonography in the diagnosis of N staging of esophageal cancer [background and purpose] N staging of esophageal cancer not only determines the prognosis of the patients, but also plays a decisive role in the treatment of the patients. EUS can provide other examination techniques. The information provided has a certain advantage in the N staging of esophageal cancer, but the accuracy data of this diagnosis are very different at the present time, and there is a lack of relevant data in the population of esophageal cancer in our country. The purpose of this study is to find the optimal diagnostic criteria for EUS to judge the benign and malignant lymph nodes. 123 cases of surgical esophagus cancer patients in Hospital Cancer Hospital, January 2014 -2014 year June. The parameters of lymph node related to endoscopic ultrasonography were recorded (length diameter, short diameter, short diameter ratio, whether low echo, smooth boundary, round or elliptical, or not low echo, and the number of lymph nodes found under ultrasound endoscopy) The T staging of the tumor was diagnosed by endoscopic ultrasonography and the location of the lymph nodes). Compared with the pathological diagnosis of lymph nodes in the lymph nodes and the postoperative scavenging, the relationship between the parameters of the endoscopy and the lymph node metastasis was analyzed by the statistical method, and the best diagnosis of lymph node metastasis was found. [results] the optimal critical value of 3 parameters for diagnosing lymph nodes, such as the length of the length, the short diameter, and the number of lymph nodes found under endoscopic ultrasonography, was 7.5mm, 5.5mm and 2. single factor chi square tests suggested that there were 8 parameters in the lymph nodes detected by endoscopic ultrasonography of]82.4%. Indexes (long diameter 7.5mm, short diameter 5.5mmm, round type, low echo, smooth boundary, whether the lymph nodes are adjacent to the lesions, the number of lymph nodes 2 and T3/4 staging by endoscopic ultrasonography) is significant for the diagnosis of lymph node benign and malignant.ROC curve analysis shows that the improved standard of endoscopic ultrasonography (7 parameters) is to judge the single lymph node good The malignant accuracy was superior to the conventional standard (4 parameters), AUC (0.801 VS 0.779). The multiple factor Logistic regression analysis showed that the short diameter 5.5mm, the round type, the paramillary lymph nodes, the low echo were the risk factors for the independent lymph node metastasis. The improved standard and the conventional standard were all the best critical values (the improved standard > 5 indicators were positive, and the conventional standard was more than 3. The diagnostic accuracy of N staging for esophageal carcinoma is 58% and the standard of 74.1%. improvement is better than that of the conventional standard. [Conclusion] the diagnosis of lymph node metastasis of esophageal cancer by endoscopic ultrasonography is better. The improved standard of multiple parameter combinations is helpful to improve the accuracy of lymph node metastasis diagnosis.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R735.1

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 何長媛;多原發(fā)癌2例報(bào)道[J];四川腫瘤防治;2000年02期

2 黃燕南;多原發(fā)癌4例[J];實(shí)用醫(yī)學(xué)雜志;2000年02期

3 劉桂蘭;多原發(fā)癌1例[J];實(shí)用醫(yī)學(xué)雜志;2000年10期

4 祝梅華,張冬梅;多原發(fā)癌1例[J];實(shí)用醫(yī)學(xué)雜志;2000年12期

5 周定安,牛瑞霞;多原發(fā)癌25例臨床分析[J];陜西醫(yī)學(xué)雜志;2002年01期

6 王亞兵,王家和;必須重視多原發(fā)癌的臨床研究[J];腫瘤學(xué)雜志;2002年05期

7 陳愛巧;多原發(fā)癌一例[J];河南腫瘤學(xué)雜志;2003年03期

8 朱正秋,趙晶;多原發(fā)癌2例報(bào)告[J];徐州醫(yī)學(xué)院學(xué)報(bào);2004年01期

9 張振平,王保平,許延發(fā);多原發(fā)癌12例臨床分析[J];陜西醫(yī)學(xué)雜志;2004年05期

10 李學(xué),賈立群,李佩文;多原發(fā)癌(4種癌)1例[J];中日友好醫(yī)院學(xué)報(bào);2004年05期

相關(guān)會(huì)議論文 前10條

1 鄒浩元;張漢雄;黎榮光;;多原發(fā)癌23例報(bào)告[A];2000全國腫瘤學(xué)術(shù)大會(huì)論文集[C];2000年

2 侯勁松;黃洪章;陳偉良;潘朝斌;;多原發(fā)癌(附11例報(bào)告)[A];第一屆全國口腔頜面部腫瘤學(xué)術(shù)會(huì)議論文匯編[C];2001年

3 周水洪;魯裕玉;汪審清;徐盈盈;凌玲;林山;;喉多原發(fā)癌[A];2005年浙江省耳鼻咽喉科學(xué)術(shù)會(huì)議論文匯編[C];2005年

4 王玨;林勝友;;33例多原發(fā)癌臨床分析[A];浙江省中晚期腫瘤姑息治療研討會(huì)資料匯編[C];2007年

5 倪新初;孫蘇平;張旭光;于靜萍;王堅(jiān);李毅;;12例多原發(fā)癌臨床分析[A];中華醫(yī)學(xué)會(huì)放射腫瘤治療學(xué)分會(huì)六屆二次暨中國抗癌協(xié)會(huì)腫瘤放療專業(yè)委員會(huì)二屆二次學(xué)術(shù)會(huì)議論文集[C];2009年

6 李靈花;;消化道多原發(fā)癌13例臨床分析[A];西部大開發(fā) 科教先行與可持續(xù)發(fā)展——中國科協(xié)2000年學(xué)術(shù)年會(huì)文集[C];2000年

7 劉康龍;莫逸;;21例多原發(fā)癌SPECT全身骨掃描顯像的臨床分析[A];中華醫(yī)學(xué)會(huì)第九次全國核醫(yī)學(xué)學(xué)術(shù)會(huì)議論文摘要匯編[C];2011年

8 崔青皓;孔大陸;潘亞文;王殿昌;;老年大腸癌病人的多原發(fā)癌——附23例分析[A];第六次全國大腸癌會(huì)議暨中日韓大腸癌會(huì)議論文匯編[C];1998年

9 梁立治;李道成;黃欣;吳秋良;;子宮內(nèi)膜癌并多原發(fā)癌[A];2000全國腫瘤學(xué)術(shù)大會(huì)論文集[C];2000年

10 程寶貞;;27例食管多原發(fā)癌的放療分析[A];山西省抗癌協(xié)會(huì)第六屆腫瘤學(xué)術(shù)交流會(huì)論文匯編[C];2003年

相關(guān)重要報(bào)紙文章 前1條

1 宋奇思;多原發(fā)癌不是轉(zhuǎn)移癌[N];家庭醫(yī)生報(bào);2007年

相關(guān)博士學(xué)位論文 前1條

1 賀舜;一、食管鱗癌相關(guān)多原發(fā)癌的臨床特點(diǎn)總結(jié)分析 二、超聲內(nèi)鏡診斷食管癌N分期的研究[D];北京協(xié)和醫(yī)學(xué)院;2015年

相關(guān)碩士學(xué)位論文 前9條

1 王海瓊;130例與胃癌相關(guān)的多原發(fā)癌的臨床分析[D];大連醫(yī)科大學(xué);2015年

2 趙丹;多原發(fā)癌臨床研究[D];廣西醫(yī)科大學(xué);2010年

3 馬建華;上消化呼吸道多原發(fā)癌3例報(bào)告與文獻(xiàn)復(fù)習(xí)[D];浙江大學(xué);2010年

4 陳貽梆;49例肺癌相關(guān)多原發(fā)癌臨床分析[D];廣西醫(yī)科大學(xué);2015年

5 王紹成;甲狀腺多原發(fā)癌臨床研究[D];浙江大學(xué);2010年

6 張慧瑋;~（18）F-FDG PET/CT顯像在肺癌相關(guān)雙原發(fā)腫瘤中的臨床應(yīng)用研究[D];復(fù)旦大學(xué);2010年

7 張立萬;~(18)F-FDG PET/CT對消化道惡性腫瘤伴肺轉(zhuǎn)移瘤與多原發(fā)癌的鑒別價(jià)值[D];福建醫(yī)科大學(xué);2013年

8 朱從月;p21、p73及PTEN在頭頸部多原發(fā)癌中的表達(dá)及意義[D];福建醫(yī)科大學(xué);2006年

9 胡海燕;青島地區(qū)乳腺、甲狀腺多原發(fā)癌患者乳腺癌組織、甲狀腺癌組織中RETmRNA的表達(dá)[D];青島大學(xué);2010年

，

本文編號：1969041