子宫内膜癌卵巢转移的危险因素分析及保留卵巢的可行性探讨

发布时间：2018-02-27 09:11

  本文关键词： 子宫内膜癌 卵巢转移 保留卵巢 影响因素　出处：《广西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：研究子宫内膜癌患者卵巢转移的临床病理特点、影响因素及其意义，探讨子宫内膜癌保留卵巢的适应证及可行性。 资料与方法：本文收集2007年1月至2013年12月在广西医科大学第四附属医院妇科就诊且临床资料完整的子宫内膜癌患者206例，所有患者均行手术治疗，并按照国际妇产科联盟（International Federation ofGynecology and Obstetrics，，FIGO）2009年修订的子宫内膜癌手术-病理分期标准分期或再分期。回顾性分析206例子宫内膜癌患者的年龄、临床表现、孕产史、术前CA-125检查、确诊途径、术前临床分期、手术方式、手术范围、手术-病理分期、病理类型、组织分级、卵巢转移等情况；单因素及多因素分析子宫内膜癌卵巢转移的影响因素。应用SPSS17.0软件进行统计学分析，单因素分析采用χ2检验，多因素分析采用Logistic回归模型分析。 结果：1、子宫内膜癌平均发病年龄52.43±8.48岁，206例患者中已绝经者100例，占48.54%。2、子宫内膜癌以不规则阴道流血或流液为主要症状者有192例，占93.20%。其中绝经后阴道流血88例。3、卵巢转移者15例，占7.28%，其中双侧卵巢转移8例，占卵巢转移的53.33%。所有卵巢转移者术中卵巢大小正常，外观无异常者10例。4、单因素分析结果提示低分化、肌层浸润深度≥1/2、宫颈受累、盆腔淋巴结阳性、肿瘤标记物CA125阳性、脉管癌栓阳性、术前临床分期高的患者的卵巢转移率显著升高（p0.05），是子宫内膜癌卵巢转移的影响因素。年龄、病理类型、组织中/高分化以及腹主动脉旁淋巴结阳性对子宫内膜癌卵巢转移无显著影响（p0.05）。5、多因素分析结果提示低分化、肿瘤标志物CA-125阳性是子宫内膜癌卵巢转移的独立影响因素(p0.05)，OR值依次为2.095、4.170。 结论： 1、子宫内膜癌卵巢转移率为7.28%（15/206），双侧卵巢转移率为3.88%（8/206）。 2、低分化、肌层浸润深度≥1/2、宫颈受累、盆腔淋巴结阳性、肿瘤标记物CA-125阳性、脉管癌栓阳性、术前临床分期高为子宫内膜癌卵巢转移的影响因素。 3、肿瘤标志物CA-125阳性、低分化是子宫内膜癌卵巢转移的重要独立影响因素。 4、子宫内膜癌卵巢转移多为存在高危因素者，若为高分化子宫内膜样腺癌、无深肌层浸润、无宫颈受累及脉管癌栓、无淋巴结转移，且肿瘤标志物CA125正常的临床Ⅰ期患者，经严格术前评估及术中广泛探查，可考虑保留一侧或双侧卵巢，术后需严密随访。但此研究为回顾性研究，仍需要多中心、大样本的前瞻性随机对照试验来论证。
[Abstract]:Objective: to study the clinicopathological features, influencing factors and significance of ovarian metastasis in endometrial carcinoma, and to explore the indications and feasibility of ovarian preservation in endometrial carcinoma. Materials and methods: from January 2007 to December 2013, 206 cases of endometrial carcinoma with complete clinical data were collected from 4th affiliated Hospital of Guangxi Medical University. According to the standard staging or re-staging of endometrial carcinoma, which was revised by International Federation ofGynecology and Obstetrics Figo on 2009, the age, clinical manifestation, history of pregnancy and childbirth and preoperative CA-125 examination of 206 patients with endometrial carcinoma were retrospectively analyzed. The way of diagnosis, preoperative clinical stage, operation mode, operation range, operation-pathological stage, pathological type, histological grade, ovarian metastasis and so on; Univariate and multivariate analysis was used to analyze the influencing factors of ovarian metastasis of endometrial carcinoma. SPSS17.0 software was used for statistical analysis, 蠂 2 test for univariate analysis and Logistic regression model for multivariate analysis. Results the mean age of onset of endometrial carcinoma was 52.43 卤8.48 years old. 100 cases were menopausal, accounting for 48.54.2.192 cases of endometrial carcinoma were characterized by irregular vaginal bleeding or fluid flow. There were 88 cases of postmenopausal vaginal bleeding, 15 cases of ovarian metastasis (7.28%), and 8 cases of bilateral ovarian metastasis, accounting for 53.33% of ovarian metastasis. The results of univariate analysis showed that the myometrial invasion depth 鈮

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