北疆地區(qū)肝血管瘤治療現(xiàn)狀的相關(guān)研究
發(fā)布時間：2018-11-10 21:47
【摘要】：目的:通過對新疆北疆地區(qū)肝血管瘤患者進行回顧性分析,了解肝血管瘤治療的現(xiàn)狀,對醫(yī)療干預(yù)情況進行分析,為新疆地區(qū)居民健康服務(wù)提供一定的幫助。并為進一步探索肝血管瘤治療的干預(yù)條件、干預(yù)時機和干預(yù)手段的臨床研究提供新的研究思路。方法:回顧性分析石河子大學(xué)醫(yī)學(xué)院第一附屬醫(yī)院、蘭州軍區(qū)烏魯木齊總醫(yī)院、新疆生產(chǎn)建設(shè)兵團總醫(yī)院、新疆伊犁州奎屯醫(yī)院、新疆生產(chǎn)建設(shè)兵團農(nóng)四師醫(yī)院、新疆生產(chǎn)建設(shè)兵團農(nóng)五師醫(yī)院、新疆生產(chǎn)建設(shè)兵團農(nóng)十師醫(yī)院、新疆生產(chǎn)建設(shè)兵團北屯醫(yī)院、哈密紅星醫(yī)院、新疆阿勒泰地區(qū)人民醫(yī)院、新疆生產(chǎn)建設(shè)兵團農(nóng)九師醫(yī)院、新疆石河子市人民醫(yī)院(新疆生產(chǎn)建設(shè)兵團農(nóng)八師醫(yī)院)、新疆烏蘇市人民醫(yī)院、新疆沙灣縣人民醫(yī)院等14所醫(yī)院2011年1月1日至2013年12月31日診斷為肝血管瘤并住院治療的病例,采用統(tǒng)一的調(diào)查表系統(tǒng)、全面的收集各種資料,包括患者基本信息(年齡、性別、民族、學(xué)歷、醫(yī)保狀況、經(jīng)濟情況、家族史等),診斷相關(guān)信息(診斷機構(gòu)、診斷方式、肝血管瘤大小、位置、形狀等),治療相關(guān)信息(治療方式、預(yù)后情況等),醫(yī)護人員肝血管瘤知識認知情況。結(jié)果:共納入415例肝血管瘤患者,其中男性159例(38.31%),女性256例(61.69%),男女比例為1∶1.61,肝血管瘤患者在41~60歲區(qū)間所占比例最高(286例,68.92%);職業(yè)分布以非農(nóng)戶產(chǎn)業(yè)工人98例(23.61%),農(nóng)業(yè)勞動者(從事農(nóng)林牧漁工作)82例(19.76%),離退休人員53例(12.77%),比例較大,占主要部分;2011年至2013年收治肝血管瘤病人構(gòu)成比是28.92%(120例),30.36%(146例),35.9%(149例),各年收治人數(shù)無明顯那增大趨勢。.本研究415例患者中,漢族352例(84.82%),少數(shù)民族患者63例(16.18%);本研究中腫瘤位置207例(49.8%)瘤體位于肝右葉,最為常見,同時不同性別患者的肝血管瘤瘤體位置分布不同(2=124.002,P=0,P0.05);瘤體病灶最大徑位于1.0—30cm之間,平均9.06±4.02 cm,腫瘤大小與患者性別無關(guān)(P0.05)。單發(fā)者226例(54.46%),多發(fā)者189例(45.54%)。單發(fā)或多發(fā)病灶在性別分布上的差異無統(tǒng)計學(xué)意義(P0.05),提示性別不是影響肝血管瘤個數(shù)的因素。本組病例病程3個月~12年,平均20.1±6.2個月;其中286例(68.02%)無任何臨床癥狀及體征,隨著直徑的增大患者出現(xiàn)癥狀體征的幾率增加(P0.05)。126例手術(shù)切除患者術(shù)后病檢發(fā)現(xiàn),肝海綿狀血管瘤121例96.03%),硬化性能肝血管瘤5例(3.97%),干預(yù)方式以經(jīng)腹腔瘤體切除除術(shù)110例(26.51%),肝動脈介入栓塞術(shù)90例(21.69%)最為常見,手術(shù)方式的選擇則受瘤體位置、大小、數(shù)量、癥狀體征、患者年齡、性別、就診機構(gòu)等的影響(P0.05)。262例(63.13%)患者行干預(yù)治療,符合上述指證一項或多項的患者有140例(53.44%),有122例(46.56%)患者者無任何干預(yù)指證,屬于過度干預(yù)治療,而且二級醫(yī)院過度干預(yù)情況較三級醫(yī)院嚴重。三級醫(yī)院醫(yī)護人員對肝血管瘤認知程度較二級醫(yī)院高。結(jié)論:1.北疆地區(qū)肝血管瘤患者在不同性別、年齡、職業(yè)、民族、文化程度等方面分部具有一定規(guī)律;肝血管瘤大小、位置、個數(shù)、癥狀及體征具有一點的特征性;2.北疆地區(qū)肝血管瘤干預(yù)方式多樣化,肝血管瘤切除術(shù)、TAE是最常用的干預(yù)手段,肝血管瘤患者瘤體位置、大小、數(shù)量、癥狀體征、患者年齡、性別、就診機構(gòu)的不同其治療方式不同;3.北疆地區(qū)肝血管瘤存在一定的過度干預(yù)情況,二級醫(yī)院就診的患者更容易出現(xiàn)過度干預(yù)治療,其原因可能有患者健康意識不足、經(jīng)濟利益驅(qū)使、基層醫(yī)生對疾病認識不足等多種原因。4.三級醫(yī)院醫(yī)護人員對肝血管瘤相關(guān)知識的認知度較二級醫(yī)院高。
[Abstract]:Objective: To study the status of the treatment of hepatic hemangioma and to provide some help to the health service of the residents in Xinjiang, through a retrospective analysis of the patients with hepatic hemangioma in the northern part of Xinjiang. In order to further explore the intervention conditions, the time of intervention and the means of intervention in the treatment of hepatic hemangioma, a new approach is provided. Methods: The first Affiliated Hospital of Shihezi University, Urumqi General Hospital of Lanzhou Military Region, General Hospital of Xinjiang Production and Construction Corps, Kuitun Hospital, Xinjiang Production and Construction Corps, the Fourth Division Hospital of Xinjiang Production and Construction Corps, and the Hospital of the 5th Division of the Xinjiang Production and Construction Corps were analyzed retrospectively. Xinjiang Production and Construction Corps, Nun Shishi Hospital, Xinjiang Production and Construction Corps, Beitun Hospital, Hami Hongxing Hospital, People's Hospital of Xinjiang Altai District, Xinjiang Production and Construction Corps, N9 Division Hospital, People's Hospital of Shihezi City, Xinjiang (Eighth Division of the Xinjiang Production and Construction Corps), From January 1, 2011 to December 31, 2013, the People's Hospital of the Wusu City of Xinjiang and the People's Hospital of Shawan County, Xinjiang, and the cases of hospitalization for the diagnosis of hepatic hemangioma on January 1, 2011 and December 31, 2013, the unified questionnaire system was adopted to collect various data comprehensively, including the basic information of the patient (age, sex, The knowledge of the knowledge of liver hemangioma of medical staff, such as national, educational background, medical insurance, economic situation, family history, etc.), diagnosis-related information (diagnosis, diagnosis, hepatic hemangioma size, position, shape, etc.), treatment-related information (treatment mode, prognosis, etc.), and knowledge of liver hemangioma of medical personnel. Results: A total of 415 cases of hepatic hemangioma were included, including 159 (38. 31%), 256 (61.69%) women, 1: 1.61, and the highest in the 41 ~ 60 years (286 cases, 68. 92%). The occupational distribution was 98 cases (23.61%) of non-farm workers. 82 cases (19. 76%) and 53 (12. 77%) of the retired workers (12. 77%) were the major part. The composition ratio of the patients with hepatic hemangioma from 2011 to 2013 was 28. 92% (120 cases), 30. 36% (146 cases), 35. 9% (149 cases), and there was no significant increase in the number of patients in each year. Among the 415 patients, there were 352 (84. 82%) of the Han and 63 (16. 18%) of the minority, and 207 (49. 8%) of the tumors in the study were located in the right lobe of the liver, most commonly, while the position distribution of the hepatic hemangioma in different sex patients was different (2 = 124. 002, P = 0, P <0.05). The maximum diameter of the tumor was located in the range of 1. 0 to 30 cm, with an average of 9.06 to 4.02 cm, and the size of the tumor was not related to the sex of the patient (P0.05). There were 226 cases (54. 46%) and 189 cases (45. 54%). There was no significant difference in the distribution of the single or multiple incidence (P0.05), and the suggestive value was not the factor that affected the number of the hepatic hemangioma. The course of this group was 3 months to 12 years, with an average of 20. 1 to 6. 2 months, of which 286 cases (62.02%) had no clinical symptoms and signs, and with the increase of the diameter, the incidence of symptoms and signs increased (P0.05). There were 5 cases (3.97%) of sclerosing hepatic hemangiomas, and 110 cases (26. 51%) and 90 (21. 69%) of hepatic artery interventional embolization were the most common in the treatment of hepatic hemangioma, and the choice of operation was controlled by the location, size, number, sign of symptoms, age and sex of the patient. There were 140 cases (55.3. 44%) of the patients with one or more of the above-mentioned indications, and 122 (46. 56%) of the patients had no intervention, and they were over-intervention. in addition, that level of excessive intervention of the second-level hospital is more serious than that of the third-level hospital. The level of cognition of hepatic hemangioma is higher in the third-level hospital. Conclusion: 1. The patients with hepatic hemangioma in northern Xinjiang have a certain rule in different sex, age, occupation, national and cultural degree, and the size, location, number, symptom and sign of hepatic hemangioma have a certain characteristic; 2. In Northern Xinjiang, the mode of hepatic hemangioma was diversified, and the resection of hepatic hemangioma and TAE were the most common methods of intervention. The location, size, number, sign of symptoms, age, sex and treatment of the patients with hepatic hemangioma were different. There are some over-intervention in the hepatic hemangioma in the northern part of Xinjiang, and the patients in the second-level hospital are more likely to be treated with excessive intervention. The reason may be that the patient's health consciousness is insufficient, the economic benefit is driven, and the basic doctor has many reasons for lack of knowledge of the disease. The cognition of the knowledge of the related knowledge of hepatic hemangioma is higher in the third-level hospital.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.7
本文編號：2323699
[Abstract]:Objective: To study the status of the treatment of hepatic hemangioma and to provide some help to the health service of the residents in Xinjiang, through a retrospective analysis of the patients with hepatic hemangioma in the northern part of Xinjiang. In order to further explore the intervention conditions, the time of intervention and the means of intervention in the treatment of hepatic hemangioma, a new approach is provided. Methods: The first Affiliated Hospital of Shihezi University, Urumqi General Hospital of Lanzhou Military Region, General Hospital of Xinjiang Production and Construction Corps, Kuitun Hospital, Xinjiang Production and Construction Corps, the Fourth Division Hospital of Xinjiang Production and Construction Corps, and the Hospital of the 5th Division of the Xinjiang Production and Construction Corps were analyzed retrospectively. Xinjiang Production and Construction Corps, Nun Shishi Hospital, Xinjiang Production and Construction Corps, Beitun Hospital, Hami Hongxing Hospital, People's Hospital of Xinjiang Altai District, Xinjiang Production and Construction Corps, N9 Division Hospital, People's Hospital of Shihezi City, Xinjiang (Eighth Division of the Xinjiang Production and Construction Corps), From January 1, 2011 to December 31, 2013, the People's Hospital of the Wusu City of Xinjiang and the People's Hospital of Shawan County, Xinjiang, and the cases of hospitalization for the diagnosis of hepatic hemangioma on January 1, 2011 and December 31, 2013, the unified questionnaire system was adopted to collect various data comprehensively, including the basic information of the patient (age, sex, The knowledge of the knowledge of liver hemangioma of medical staff, such as national, educational background, medical insurance, economic situation, family history, etc.), diagnosis-related information (diagnosis, diagnosis, hepatic hemangioma size, position, shape, etc.), treatment-related information (treatment mode, prognosis, etc.), and knowledge of liver hemangioma of medical personnel. Results: A total of 415 cases of hepatic hemangioma were included, including 159 (38. 31%), 256 (61.69%) women, 1: 1.61, and the highest in the 41 ~ 60 years (286 cases, 68. 92%). The occupational distribution was 98 cases (23.61%) of non-farm workers. 82 cases (19. 76%) and 53 (12. 77%) of the retired workers (12. 77%) were the major part. The composition ratio of the patients with hepatic hemangioma from 2011 to 2013 was 28. 92% (120 cases), 30. 36% (146 cases), 35. 9% (149 cases), and there was no significant increase in the number of patients in each year. Among the 415 patients, there were 352 (84. 82%) of the Han and 63 (16. 18%) of the minority, and 207 (49. 8%) of the tumors in the study were located in the right lobe of the liver, most commonly, while the position distribution of the hepatic hemangioma in different sex patients was different (2 = 124. 002, P = 0, P <0.05). The maximum diameter of the tumor was located in the range of 1. 0 to 30 cm, with an average of 9.06 to 4.02 cm, and the size of the tumor was not related to the sex of the patient (P0.05). There were 226 cases (54. 46%) and 189 cases (45. 54%). There was no significant difference in the distribution of the single or multiple incidence (P0.05), and the suggestive value was not the factor that affected the number of the hepatic hemangioma. The course of this group was 3 months to 12 years, with an average of 20. 1 to 6. 2 months, of which 286 cases (62.02%) had no clinical symptoms and signs, and with the increase of the diameter, the incidence of symptoms and signs increased (P0.05). There were 5 cases (3.97%) of sclerosing hepatic hemangiomas, and 110 cases (26. 51%) and 90 (21. 69%) of hepatic artery interventional embolization were the most common in the treatment of hepatic hemangioma, and the choice of operation was controlled by the location, size, number, sign of symptoms, age and sex of the patient. There were 140 cases (55.3. 44%) of the patients with one or more of the above-mentioned indications, and 122 (46. 56%) of the patients had no intervention, and they were over-intervention. in addition, that level of excessive intervention of the second-level hospital is more serious than that of the third-level hospital. The level of cognition of hepatic hemangioma is higher in the third-level hospital. Conclusion: 1. The patients with hepatic hemangioma in northern Xinjiang have a certain rule in different sex, age, occupation, national and cultural degree, and the size, location, number, symptom and sign of hepatic hemangioma have a certain characteristic; 2. In Northern Xinjiang, the mode of hepatic hemangioma was diversified, and the resection of hepatic hemangioma and TAE were the most common methods of intervention. The location, size, number, sign of symptoms, age, sex and treatment of the patients with hepatic hemangioma were different. There are some over-intervention in the hepatic hemangioma in the northern part of Xinjiang, and the patients in the second-level hospital are more likely to be treated with excessive intervention. The reason may be that the patient's health consciousness is insufficient, the economic benefit is driven, and the basic doctor has many reasons for lack of knowledge of the disease. The cognition of the knowledge of the related knowledge of hepatic hemangioma is higher in the third-level hospital.
【學(xué)位授予單位】：石河子大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R735.7
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