發(fā)布時(shí)間：2018-06-06 18:47

  本文選題：卵巢癌 + 化學(xué)療法��； 參考：《貴州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討卵巢癌術(shù)后行高精度持續(xù)循環(huán)腹腔熱灌注化療(HIPEC)應(yīng)用的安全性、近期療效及相關(guān)影響因素。方法:回顧性分析2015年1月至2016年8月在貴州省腫瘤醫(yī)院就診治療的上皮性卵巢癌患者89例,根據(jù)治療情況分為兩組,行HIPEC治療者46例(研究組),并同時(shí)術(shù)后聯(lián)合靜脈化療;單純靜脈化療者43例(對照組)。統(tǒng)計(jì)分析比較分析兩組治療、監(jiān)測過程中生命體征、血生化及電解質(zhì)波動(dòng)情況等安全性指標(biāo);分析影響HIPEC治療灌注次數(shù)的相關(guān)因素。結(jié)果:1、研究組在行HIPEC期間未出現(xiàn)骨髓抑制,后期靜脈化療過程中I-II級毒副反應(yīng)12例(26.1%),III-IV級毒副反應(yīng)13例(28.3%);對照組靜脈化療后I-II級毒副反應(yīng)17例(39.5%),III-IV級毒副反應(yīng)10例(23.3%);兩組對比差異無統(tǒng)計(jì)學(xué)意義(z=0.354,P=0.723)。兩組患者未出現(xiàn)陰道殘端愈合不良、腸瘺、感染、肝腎功能損傷等嚴(yán)重副反應(yīng)。2、術(shù)后一個(gè)月研究組CA125轉(zhuǎn)陰率45.7%(21/46),對照組37.2%(16/43),X2(P)=0.381(0.537),術(shù)后三個(gè)月研究組CA125轉(zhuǎn)陰率82.6%(38/46),對照組65.1%(28/43),X2(P)=0.917(0.338),研究組轉(zhuǎn)陰率高于對照組,但統(tǒng)計(jì)學(xué)無明顯差異(P0.05);研究組所有患者CA125值取中位數(shù),術(shù)前281.50U/ml,治療后50.75U/ml,z=5.053、P=0.001、P0.05;分析灌注完成情況,術(shù)后僅行一次HIPEC治療14人,兩次6人,完成三次治療共26人,術(shù)前CA125值取中位數(shù)分別為230.10U/ml、209.70U/ml、324.45U/ml,HIPEC治療完成后CA125取中位數(shù)分別為52.65U/ml、47.75U/ml、43.852U/ml,z=0.001、0.046、0.001,P0.05,因此雖灌注次數(shù)不同,三組患者CA125下降差值均有意義,HIPEC治療有效。3.影響HIPEC實(shí)施的因素:46例實(shí)施HIPEC治療104次,監(jiān)測治療過程中生命體征、血生化及電解質(zhì)波動(dòng)情,56.5%(26/46)完成三次,13.0%(6/46)兩次;30.4%(14/46)僅一次。治療過程中發(fā)生低鉀血癥發(fā)生率8.7%(9/104),低蛋白血癥發(fā)生率28.8%(30/104),但多未影響腹腔熱灌注順利實(shí)施。42.9%(6/14)是因經(jīng)濟(jì)原因僅灌注一次,7.14%(1/14)及28.6%(4/14)分別因低鉀血癥及低蛋白血癥未完成治療;完成兩次HIPEC治療的患者中有16.7%(1/6)因低蛋白血癥、50%(3/6)低鉀血癥而停止后續(xù)熱灌注治療,所有患者在口服或靜脈補(bǔ)鉀及白蛋白后糾正,且在治療過程中均未出現(xiàn)危及生命的嚴(yán)重毒副反應(yīng)。結(jié)論:1、上皮性卵巢癌手術(shù)后行高精度持續(xù)循環(huán)腹腔熱灌注化療治療安全可行;2、高精度持續(xù)循環(huán)腹腔熱灌注化療治療有效,近期療效優(yōu)于單純靜脈化療;3、經(jīng)濟(jì)因素是貴州等少數(shù)名族地區(qū)影響高精度持續(xù)循環(huán)腹腔熱灌注治療順利實(shí)施的主要因素之一
[Abstract]:Objective: to investigate the safety, short-term efficacy and related factors of high precision continuous circulatory intraperitoneal hyperthermic perfusion chemotherapy (HIPEC) for ovarian cancer. Methods: a retrospective analysis of 89 patients with epithelial ovarian cancer from January 2015 to August 2016 in Guizhou Provincial Oncology Hospital was performed. According to the treatment conditions, the patients were divided into two groups. 46 patients were treated with HIPEC (study group, combined with intravenous chemotherapy after operation). 43 cases were treated with intravenous chemotherapy (control group). The safety indexes such as vital signs, blood biochemistry and electrolyte fluctuation in the two groups were compared and analyzed, and the related factors affecting the perfusion times of HIPEC were analyzed. Results: 1, the study group had no bone marrow suppression during HIPEC. During the later period of intravenous chemotherapy, there were 12 cases of I-II toxic side effects and 13 cases of III-IV side effects, and 17 cases of I-II grade III-IV side effects after intravenous chemotherapy in the control group (n = 17). There was no significant difference between the two groups in the side effects of I-II grade III-IV and control group (n = 10). There was no significant difference between the two groups. No vaginal stump healing, intestinal fistula, infection were found in the two groups. One month after operation, the negative rate of CA125 in the study group was 45.7%, and that in the control group was 37. 2 / 43%. The negative rate of CA125 in the study group was 82.638 / 46. The negative rate of CA125 in the study group was higher than that in the control group. The negative rate in the study group was higher than that in the control group, and the negative rate in the study group was higher than that in the control group. However, there was no significant difference between the two groups (P 0.05). The median value of CA125 in all patients in the study group was 281.50 U / ml before operation and 50.75 U / ml 5.053U / ml after treatment (P 0.05). According to the completion of perfusion, 14 patients were treated with HIPEC only once, 6 patients were treated twice, and 26 patients completed three times of treatment. The median of CA125 was 230.10 U / ml 209.70 U / ml 324.45 U / ml HIPEC, and the median of CA125 was 52.65 U / ml / ml ~ (47.75) U / ml / ml ~ (43.852) U / ml / ml ~ (0.001) ~ 0.046 ~ 0.001 P _ (0.05), respectively. Therefore, the difference of CA125 in all three groups was significant in the treatment of HIPEC. Factors affecting the implementation of HIPEC: 46 cases were treated with HIPEC 104 times, monitoring vital signs, blood biochemical and electrolyte fluctuations (56.526 / 46) three times (13.0 / 46) twice 30.414 / 46) only once. During the treatment, the incidence of hypokalemia was 8.7% 10 / 10 4, and the incidence of hypoproteinemia was 28.8% or 30% / 104%, but most of them did not affect the successful implementation of abdominal hyperthermic perfusion .42.9% 6 / 14) because of economic reasons only one time perfusion of 7.14% (1 / 14) and 28.6% (4% 14) of hypokalemia and hypoproteinemia did not complete the treatment. Of the patients who completed two HIPEC treatments, 16.7B / 6 stopped the subsequent hyperthermic perfusion therapy because of hypoproteinemia (50% / 6). All patients were corrected after oral or intravenous potassium and albumin supplementation. No serious side effects were found in the course of treatment. Conclusion: it is safe and feasible to treat epithelial ovarian cancer with high precision continuous circulatory intraperitoneal hyperthermic infusion chemotherapy after operation, and the high precision continuous circulation peritoneal hyperthermic perfusion chemotherapy is effective in the treatment of epithelial ovarian cancer. The short-term curative effect is better than that of intravenous chemotherapy alone. Economic factors are one of the main factors that affect the successful implementation of high-precision continuous circulatory peritoneal hyperthermic perfusion therapy in Guizhou and other minority nationality areas.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.31

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