本文選題：大腸癌肝轉(zhuǎn)移 + 影響因素��； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的 通過對曾在湖北省中醫(yī)院腫瘤科住院及門診治療的54例大腸癌根治術(shù)后患者進行臨床研究,運用統(tǒng)計學(xué)方法歸納探討年齡、性別、中醫(yī)證型、治療方式等多個方面與這些患者術(shù)后肝轉(zhuǎn)移之間是否存在統(tǒng)計學(xué)差異。對影響大腸癌肝轉(zhuǎn)移的部分可能因素進行探討研究,為中西醫(yī)結(jié)合預(yù)防及治療大腸癌肝轉(zhuǎn)移提供理論依據(jù),尤其是中醫(yī)藥在防治肝轉(zhuǎn)移上的作用,以期將來在臨床上能合理運用中西醫(yī)結(jié)合治療方法達到延緩甚至防止大腸癌肝轉(zhuǎn)移的目的。方法 本研究采用回顧性分析方法,根據(jù)制定的相關(guān)納入及排除標(biāo)準(zhǔn)篩選出的2015年1月-2017年1月在湖北省中醫(yī)院花園山及光谷院區(qū)腫瘤科病房住院及門診治療的原發(fā)性大腸癌術(shù)后患者54例,運用X2檢驗及Logistic回歸分析,統(tǒng)計分析及歸納可能影響大腸癌肝轉(zhuǎn)移的多項相關(guān)因素。結(jié)果 54例患者中已出現(xiàn)肝轉(zhuǎn)移的34例,未出現(xiàn)的肝轉(zhuǎn)移患者20例。男性24人,占比44.4%,女性30人,占比55.6%。先行單因素分析:(1)所有患者,年齡最大的有75歲,最小的有29歲,分為60歲組和≥60歲組,其中60歲組共29人,14人出現(xiàn)肝轉(zhuǎn)移,占比48.3%,15人未見肝轉(zhuǎn)移,≥60歲組共25人,20人肝轉(zhuǎn)移,占比80%,5人未見肝轉(zhuǎn)移,兩組比較具有統(tǒng)計學(xué)差異(P0.05),年齡可能是影響肝轉(zhuǎn)移的因素之一,年長的病人相較年輕人更易出現(xiàn)肝轉(zhuǎn)移。(2)按腫瘤原發(fā)部位分為結(jié)腸組和直腸組,原發(fā)于結(jié)腸的29人,原發(fā)于直腸的25人。根據(jù)X2檢驗統(tǒng)計得出,兩組無明顯統(tǒng)計學(xué)差異,大腸癌肝轉(zhuǎn)移與否與腫瘤原發(fā)部位無關(guān)。根據(jù)大腸癌手術(shù)同時有無淋巴結(jié)轉(zhuǎn)移,可分為淋巴結(jié)轉(zhuǎn)移組及無淋巴結(jié)轉(zhuǎn)移組,有淋巴結(jié)轉(zhuǎn)移的患者39人(72.2%)所占比例明顯大于無淋巴結(jié)轉(zhuǎn)移患者15人(27.8%),可能因為多數(shù)病人發(fā)現(xiàn)腫瘤時已發(fā)生淋巴結(jié)轉(zhuǎn)移,且與肝轉(zhuǎn)移之間具有統(tǒng)計學(xué)差異(P0.05),表明手術(shù)同時即發(fā)現(xiàn)有淋巴結(jié)轉(zhuǎn)移是導(dǎo)致大腸癌肝轉(zhuǎn)移的不利因素。(3)大腸癌肝轉(zhuǎn)移與否與原發(fā)腫瘤的病理學(xué)分型有統(tǒng)計學(xué)差異(p0.05),本文研究所分的四種病理學(xué)分型中屬于低及未分化腺癌肝轉(zhuǎn)移人數(shù)最多,13人,占38.2%,表明組織分型為低及未分化腺癌的患者最易發(fā)生肝轉(zhuǎn)移。(4)術(shù)前腫瘤標(biāo)志物水平也與大腸癌肝轉(zhuǎn)移相關(guān),與大腸癌相關(guān)的腫瘤標(biāo)志物cea、afp和ca-199中,cea及ca-199術(shù)前升高可能導(dǎo)致大腸癌肝轉(zhuǎn)移,apf統(tǒng)計學(xué)無明顯意義。(5)中醫(yī)證型區(qū)別也與大腸癌肝轉(zhuǎn)移相關(guān)(p0.05),脾腎兩虛證發(fā)生肝轉(zhuǎn)移概率最大(47%),且具有統(tǒng)計學(xué)意義(p0.05);肝脾不和證也是較易導(dǎo)致肝轉(zhuǎn)移發(fā)生的證型(38.2%),與其他證型比較具有統(tǒng)計學(xué)意義(p0.05);肝腎陰虛證(11.8%),與大腸癌肝轉(zhuǎn)移關(guān)系不大(p0.05),濕濁內(nèi)蘊證(2.9%),導(dǎo)致肝轉(zhuǎn)移幾率最低。(6)在治療方式上,未完成或未行術(shù)后輔助化療的患者肝轉(zhuǎn)移率較高(70.6%)及未服用或不規(guī)律服用中藥的患者肝轉(zhuǎn)移人數(shù)相較非肝轉(zhuǎn)移者多,占比(91.7%),均具有統(tǒng)計學(xué)差異(p0.05),規(guī)律服用中藥的人中服藥長達1年的患者肝轉(zhuǎn)移率較低(21.7%),具有統(tǒng)計學(xué)差異(p0.05)。(7)在本文中討論的因素中患者性別和腫瘤原發(fā)部位與大腸癌肝轉(zhuǎn)移與否無明顯相關(guān)性,根據(jù)肝轉(zhuǎn)移與非肝轉(zhuǎn)移之間的比較統(tǒng)計顯示這兩組均無統(tǒng)計學(xué)差異(p0.05)。運用logistic回歸分析對單因素分析中具有統(tǒng)計學(xué)意義的幾項因素再行多因素分析,結(jié)果表明年齡、淋巴結(jié)、化療完成情況、中藥服藥時間及術(shù)前cea水平為影響大腸癌肝轉(zhuǎn)移的獨立影響因素(p0.05),其中年齡、淋巴結(jié)和術(shù)前cea水平的or值1,表明這三個指標(biāo)為導(dǎo)致大腸癌肝轉(zhuǎn)移的危險因素�；熗瓿汕闆r及服用中藥時間or值1,表明完成化療的患者肝轉(zhuǎn)移幾率較低,中藥服用時間越長肝轉(zhuǎn)移可能性越小。結(jié)論 通過對文中10個因素的單因素及多因素分析,得出年齡、腫瘤的組織分型、術(shù)前cea及ca-199水平、手術(shù)時是否有淋巴結(jié)轉(zhuǎn)移、化療完成情況、中醫(yī)證型及中藥的治療時間都與結(jié)直腸癌肝轉(zhuǎn)移相關(guān)。年齡大于60歲易發(fā)生肝轉(zhuǎn)移;低及未分化腺癌是最易導(dǎo)致肝轉(zhuǎn)移的腫瘤病理類型;術(shù)前cea及ca-199有升高易導(dǎo)致肝轉(zhuǎn)移的發(fā)生;中醫(yī)證型中脾腎兩虛證最易發(fā)生肝轉(zhuǎn)移,肝脾不和證也有導(dǎo)致肝轉(zhuǎn)移的可能;未能或未行術(shù)后輔助化療或未規(guī)律服用中藥的患者易發(fā)生肝轉(zhuǎn)移,由此可見不規(guī)范的治療方式和不到位的治療會增加復(fù)發(fā)和轉(zhuǎn)移的危險性。按照NCCN指南的標(biāo)準(zhǔn)治療方案治療及長期中藥調(diào)理能降低結(jié)直腸癌肝轉(zhuǎn)移幾率,是防治肝轉(zhuǎn)移的有利因素。臨床上應(yīng)對這幾類危險因素引起重視,加以定期監(jiān)測及有效地預(yù)防治療。對于有效地治療方案也應(yīng)積極勸導(dǎo)病人配合治療,以此來降低大腸癌肝轉(zhuǎn)移的發(fā)生率。
[Abstract]:Objective through the clinical study of 54 patients after radical resection of colorectal cancer who were hospitalized in the oncology department of Hubei Provincial Traditional Chinese Medical Hospital and the outpatient clinic, statistical methods were used to investigate whether there were statistical differences between the patients' age, sex, TCM syndrome type and treatment methods and the postoperative liver metastases of these patients. In order to prevent and treat the liver metastasis of colorectal cancer, this study provides a theoretical basis for the combination of traditional Chinese and Western medicine to prevent and treat the liver metastasis of colorectal cancer, especially the role of traditional Chinese medicine in the prevention and treatment of liver metastasis. 54 cases of primary colorectal cancer treated in January -2017 January 2015, Hubei Provincial Traditional Chinese Medical Hospital, Optics Valley and the oncology ward of Hubei Provincial Traditional Chinese Medical Hospital, Hubei Provincial Traditional Chinese Medical Hospital were selected by retrospective analysis. The statistical analysis and induction could affect the large intestine by X2 test and Logistic return analysis. Results in 54 cases, there were 34 cases of liver metastases, 20 cases of liver metastases, 24 men, 44.4% and 30 women, accounting for 55.6%. single factor analysis: (1) all patients were 75 years old, and the youngest was 29 years old, divided into 60 years and 60 years of age, among which 60 group 29, 14, etc. People had liver metastasis, accounted for 48.3%, 15 people had no liver metastasis, more than 60 years old 25 people, 20 liver metastases, 80%, 5 people did not have liver metastases, two groups have statistical difference (P0.05), age may be one of the factors affecting liver metastasis, older patients are more prone to liver metastasis than young people. (2) the primary site of the tumor is divided into colon group and the primary site of the tumor. The rectal group, 29 of the primary colon and 25 people in the rectum, was found in the rectum. According to the X2 test statistics, there was no significant difference between the two groups. The metastasis of colorectal cancer was not related to the primary site of the tumor. According to the operation of colorectal cancer, lymph node metastasis was also divided into lymph node metastasis group and no lymph node metastasis group, and 39 patients with lymph node metastasis were found. The proportion of people (72.2%) was significantly greater than that of 15 patients without lymph node metastasis (27.8%). It may be because most patients found lymph node metastasis when they found tumor, and there was a statistical difference from liver metastasis (P0.05). It was found that lymph node metastasis was an unfavorable factor in the liver metastasis of colorectal cancer. (3) liver metastasis of colorectal cancer. There was a statistically significant difference in the pathological type of primary tumor (P0.05). In this study, the number of liver metastases of low and undifferentiated adenocarcinoma was the most in the four types of pathological classification, and 13 people, accounting for 38.2%. (4) the level of tumor markers in the patients with low and undifferentiated adenocarcinoma was the most likely to occur. (4) the level of preoperative tumor markers was also associated with the liver metastasis of colorectal cancer. Related to colorectal cancer related tumor markers CEA, AFP and CA-199, the elevation of CEA and CA-199 may lead to liver metastasis of colorectal cancer, and APF statistics have no significant significance. (5) the difference of TCM syndrome type is also associated with liver metastasis of colorectal cancer (P0.05), the largest probability of liver metastasis in the two deficiency syndrome of spleen and kidney (47%), and statistically significant (P0.05); liver splenic disharmony Syndrome is also more likely to lead to the occurrence of liver metastasis (38.2%), compared with other syndrome types (P0.05); liver kidney yin deficiency syndrome (11.8%), and liver metastasis of large intestine cancer (P0.05), damp turbidity syndrome (2.9%), and the lowest risk of liver metastasis. (6) in the treatment, patients who have not completed or did not perform postoperative adjuvant chemotherapy The number of liver metastases in patients with high (70.6%) and non taking or irregular use of traditional Chinese medicine was more than those of non liver metastases (91.7%), and had statistical differences (P0.05). The rate of liver metastasis was lower (21.7%) in the patients who took traditional Chinese medicine for 1 years (21.7%), and (7) in the factors discussed in this article, the sex and swelling of the patients were discussed. There was no significant correlation between the primary site of the tumor and the liver metastasis of colorectal cancer. According to the comparison of liver metastases and non hepatic metastases, there was no statistical difference between the two groups (P0.05). Multiple factors were analyzed by logistic regression analysis on several factors of statistical significance in single factor analysis. The results showed that age, lymph nodes, chemotherapy were finished. The time of taking medicine and the level of CEA before operation were the independent factors affecting the liver metastasis of colorectal cancer (P0.05), of which the or value of age, lymph node and preoperative CEA level was 1, indicating that these three indexes were the risk factors leading to the liver metastasis of colorectal cancer. The completion of chemotherapy and the or value of traditional Chinese medicine were 1, indicating the liver metastasis of patients undergoing chemotherapy. The probability is low, the longer the possibility of the longer Chinese medicine, the less possibility of liver metastasis. Conclusion through the analysis of the single factor and multiple factors of the 10 factors in the article, the age, the histological classification of the tumor, the level of CEA and CA-199 before operation, the lymph node metastasis, the completion of chemotherapy, the treatment time of Chinese medicine and Chinese medicine are all with the liver transfer of colorectal cancer. Shift related. Liver metastasis is easy to occur at age 60 years of age; low and undifferentiated adenocarcinoma is the most likely pathological type of liver metastases; CEA and CA-199 before operation may lead to liver metastasis; the spleen and kidney of TCM syndrome is the most likely to occur liver metastasis, liver and spleen syndrome also may lead to liver metastasis; no or no postoperative adjuvant chemotherapy Patients with or without regular use of traditional Chinese medicine are prone to liver metastasis. This shows that nonstandard treatment and poor treatment will increase the risk of recurrence and metastasis. The standard treatment plan treatment and long-term Chinese medicine conditioning according to the NCCN guide can reduce the risk of liver metastasis in colorectal cancer. It is a favorable factor in the prevention and treatment of liver metastasis. Several types of risk factors are paid attention to, regular monitoring and effective prevention and treatment. For effective treatment programs, patients should also be actively persuaded to cooperate with treatment in order to reduce the incidence of liver metastasis in colorectal cancer.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.34
，

本文編號：2003479