两种补救措施治疗意外发现的宫颈癌疗效分析

发布时间：2018-02-11 23:30

本文关键词： 意外发现的宫颈癌宫旁广泛切除术放射治疗生活质量　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景与目的宫颈癌是世界上女性常见的恶性肿瘤,发病率以及死亡率排在第四位。多数早期宫颈癌患者进行根治性手术治疗,5年生存率较高。然而,有时良性病变或宫颈上皮内瘤变仅行单纯性子宫切除术后会发现宫颈癌,即意外发现的宫颈癌。意外发现的宫颈癌临床上并不常见,主要归因于术前检查不充分或者术中快速冰冻病理不能确诊。目前对于意外发现的宫颈癌尚无完善的最佳治疗方法,单纯性子宫切除是不够的,复发率大约60%。根据2107年NCCN宫颈癌临床指南,如果切缘阴性并且影像学检查阴性且无高危因素及中危因素的患者,有两种补救治疗方案:宫旁广泛切除术或者放射治疗。然而,目前关于治疗的最佳方案的文献较少,国内尚无文献对两种方案疗效进行比较。经过这两种方案的治疗,意外发现的宫颈癌生存率较高。然而治疗存在的并发症,可不同程度的影响着患者的生活质量。随着现代生活水平的提高,人们由关注生存率,开始逐渐转移到关注患者的生活质量上来。生活质量是一个复杂的多维结构,通常使用生活治疗工具进行评估,即生活质量评定表。本研究应用宫颈癌患者生活质量的评估表为FACT-Cx,由共性模块及宫颈癌特异性模块构成。本研究旨在分析腹腔镜下宫旁广泛切除术和放射治疗两种补救措施治疗意外发现的宫颈癌的临床效果,以及分别评估两种治疗组患者的生活质量,为临床医师诊疗提供诊治思路。研究对象及方法回顾性分析郑州大学第一附属医院2011年1月至2015年3月收治的资料完整的32例意外发现的宫颈癌患者临床资料,17例患者接受腹腔镜下宫旁广泛切除术+阴道上段切除术+盆腔淋巴结清扫术(以下简称宫旁广泛切除术,手术组),15例患者行放射治疗及化疗同步疗法(放射治疗组),记录手术组手术时间、术中出血量、术中及术后并发症等,放射治疗组观察放疗早期及晚期并发症。统计两组年龄、体重指数、住院费用、住院天数。在全程治疗结束一年复查时进行对患者采用调查问卷形式评估生活质量。生活质量评估采取FACT-G共性模块及宫颈特异模块(CCS)对两组进行生活质量问卷调查并进行评分。对患者定期随访,随访时间截止到2017年3月。采用SPSS 17.0统计学软件进行数据处理。定量资料以((x|-)±s)表示,服从正态分布的定量资料间比较采用两独立样本t检验,定性资料采用Fisher确切概率法检验。以P0.05为差异有统计学意义。结果1.随访期间,手术组无复发,放射治疗组有1例复发,两组无复发率分别为100%及93.3%(P=0.47),差异无统计学意义。随访期间两组均无患者死亡。2.手术组及放射治疗组住院费用分别为21472.6±4179.1元及46102.1±3495.1元(P0.05),住院天数分别为14.3±4.1天及32.6±5.4天(P0.05)。差异均具有统计学意义。3.手术组生活质量评分FACT-Cx总分(P=0.006)、躯体情况得分(P=0.02)及宫颈癌特异模块(CCS)得分(P=0.001)均高于放射治疗组,差异具有统计学意义。社会情况、情绪情况及功能情况得分两组差异无统计学意义(P值分别为0.31、0.218及0.077)。4.手术组术后并发症3例(17.6%),放射治疗组早期并发症6例(40%),晚期并发症3例(20%),两组并发症发病率差异具有统计学意义(P=0.03)结论1.腹腔镜下宫旁广泛切除术及放射治疗均是意外发现的宫颈癌有效的补救治疗措施。2.在本研究中心,腹腔镜下宫旁广泛切除术是可行的,具有并发症少、便于术后恢复等优点,能够减轻患者经济负担及精神压力,增加患者治疗依从性,且能保留年轻患者卵巢功能、提高生活质量,尤其是对年轻患者值得临床推广。
[Abstract]:Background and objective: cervical cancer is a common malignant tumor in women in the world, the incidence and mortality ranked fourth. The majority of patients with early stage cervical cancer underwent radical surgery, 5 years survival rate is high. However, sometimes benign lesions or cervical intraepithelial neoplasia underwent simple hysterectomy will find cervical cancer. The unexpected discovery of cervical cancer. Cervical cancer is uncommon clinical discovered by accident, mainly due to inadequate preoperative examination or intraoperative frozen pathology could not be confirmed. The best treatment at present for cervical cancer found that there is no perfect method, simple hysterectomy is not enough, the recurrence rate is about 60%. according to clinical guidelines in 2107 NCCN cervical cancer, if the margin is negative and negative imaging and no risk factors and risk factors of the patients, there are two kinds of remedial treatment: Uterine resection or radiotherapy Treatment. However, the current literature on the treatment of the best scheme is less, there is no domestic literature to compare the effect of two kinds of schemes. After treatment of the two methods, found that cervical cancer survival rates are high. However, for the existence of complications, can influence the quality of life of patients. With the development of modern living standards to improve, people from the attention of the survival rate, begun to pay attention to the quality of life of patients. The quality of life is a complex multidimensional structure, usually are evaluated using life treatment tools, namely life quality evaluation table. The research on assessment of quality of life in patients with cervical cancer using the table for FACT-Cx, composed of general module and cervical cancer specific module. This study aims to analyze the clinical effect of laparoscopic parametrial resection and radiotherapy two remedial measures treat accident found in cervical cancer, and respectively. To evaluate the quality of life of two patients in the treatment group, to provide for clinical diagnosis. Diagnosis and treatment of cervical cancer patients were retrospectively analyzed in 32 cases of accidents in the First Affiliated Hospital of Zhengzhou University from January 2011 to March 2015 were complete data found in the object of study and methods, 17 patients underwent laparoscopic parametrial resection + vagina resection and pelvic lymph node dissection (hereinafter referred to as the parametrial resection, surgery group), 15 cases were treated by radiotherapy and chemotherapy therapy (synchronous radiotherapy group), operation group recorded the operation time, intraoperative blood loss, intraoperative and postoperative complications, radiotherapy for early and late complications of radiotherapy. Two statistical observation group age, body mass index, hospitalization expenses, hospitalization days. To evaluate the life quality of patients by questionnaire in the whole treatment over a year. The quality of life assessment review Take the FACT-G general module and cervical specific module (CCS) quality of life questionnaire survey of two groups of patients and score. Regular follow-up, follow-up time by the end of March 2017. The data were processed by SPSS 17 statistical software. The quantitative data ((x|-) + s) said to obey the normal distribution of quantitative data comparison using two independent samples t test, qualitative data using Fisher exact test. P0.05 the difference was statistically significant. The 1. group had no recurrence during follow-up, surgery, radiotherapy group had 1 cases of recurrence, two groups had no recurrence rate is respectively 100% and 93.3% (P=0.47), there was no significant difference in the follow-up period. The two groups had no death in patients with.2. surgery group and radiotherapy group hospitalization costs were 21472.6 + 46102.1 + 4179.1 yuan and 3495.1 yuan (P0.05), hospitalization days were 14.3 + 4.1 and 32.6 + 5.4 days (P0.05). The difference was statistically Learn the meaning of life quality group.3. Surgery score FACT-Cx score (P=0.006), body condition score (P=0.02) and cervical cancer specific module (CCS) score (P=0.001) were higher than the radiotherapy group, the difference was statistically significant. The social situation, no statistically significant difference between the two groups and the emotional function score (P = 0.31,0.218 0.077) and 3 cases of.4. surgery group, postoperative complications (17.6%), radiotherapy group of early complications in 6 cases (40%), 3 cases of late complications (20%), the incidence of complications of the two groups had significant difference (P=0.03) of 1. laparoscopic parametrial resection and radiotherapy were found in cervical cancer treatment effective remedial measures of.2. in the research center, laparoscopic parametrial resection is feasible, with less complications, postoperative recovery and other advantages, can reduce the patients economic burden and mental stress, increase patients Compliance, and can retain the ovarian function of young patients, improve the quality of life, especially for young patients worthy of clinical promotion.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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