卵巢子宫内膜异位症恶变的临床资料回顾性分析

发布时间：2018-03-02 13:42

  本文选题：卵巢子宫内膜异位症　切入点：恶变　出处：《天津医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:分析卵巢子宫内膜异位症(EMs)恶变患者的一般资料、临床表现、辅助检查、治疗方法及预后情况,总结卵巢EMs恶变的临床特征,探索影响卵巢EMs恶变及预后的相关因素。旨在发现卵巢EMs恶变的前瞻性和预后判断标志,以便早诊断、早治疗,延长患者生存时间,提高患者生活质量。方法:以2010年-2015年天津中心妇产科医院收治的564例卵巢EMs患者为研究对象,其中113例卵巢EMs恶变患者为研究组,451例卵巢EMs未恶变患者为对照组,回顾性分析两组患者的所有临床资料及术后随访情况,以多因素分析阐明EMs恶变的危险因素及预后的相关因素。结果:1、研究组患者平均年龄较对照组大、首次性生活平均年龄较对照组大、平均结婚年龄较对照组大、平均病程较对照组长、平均BMI指数较对照组大、脑力劳动者比例高于对照组、体力劳动者比例低于对照组。研究组绝经、痛经的患者比例均高于对照组。研究组患者流产次数较对照组多、剖宫产比例较对照组高、顺产比例较对照组低、生产次数较对照组少。两组患者以上指标均具有统计学差异(p0.05)。多因素非条件Logistic回归分析表明结婚年龄、生产次数、病程、BMI指数是影响卵巢EMs恶变的4个主要因素。2、研究组及对照组患者临床表现中腹部胀痛发生率最高,其他依次为腹部触及包块,性交痛,不孕,阴道不规律出血,无自觉症状。研究组患者腹部胀痛、腹部触及包块的发生率均高于对照组,且差异具有统计学意义(p0.05)。根据癌症临床分期,将Ⅰ、Ⅱ期作为轻度组(87例),Ⅲ、Ⅳ期作为重度组(26例)。重度组患者腹部胀痛、性交痛、不孕的发生率较轻度组高,差异均具有统计学意义(p0.05)。3、研究组患者包块以囊实混合性最多(40.7%),包块直径≥8cm者占34.5%,50.4%患者半年内包块迅速增大,所有标本均检出异位内膜腺上皮不典型或核异型性改变。对照组患者包块90%以上为囊性,包块直径≥8cm者占17.7%,14.4%患者半年内包块迅速增大,其中28例出现不典型或核异型性改变。4、研究组患者HE4、CA125、CA199水平均高于对照组,差异均有统计学意义(p0.05)。HE4、CA125、CA199在Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者血清中的表达水平均存在显著差异(所有p0.05),随着临床分期的增加,HE4、CA199、CA125的水平升高。而HE4、CA125及CA199在不同组织病理分型的患者间无统计学差异(p0.05)。5、研究组术后平均随访37.6个月(6-72个月)。术后1年内复发2例,3年内复发11例,5年内复发26例,死亡7例,其中5例死于术后复发。1年存活率99.4%,3年存活率96.8%,5年存活率92.8%。临床分期、组织学分型、化疗是影响恶变EMs患者术后预后的3个主要因素。结论:1、卵巢EMs患者以育龄妇女多见,恶变患者出现症状比例和症状复杂程度较未恶变患者高,且与临床分期有关,临床分期越高,症状越明显越复杂。2、结婚年龄晚、生产次数少、病程长、BMI指数大4个因素是卵巢EMs恶变的危险因素。3、综合临床症状、病史、病理检查、血清HE4、CA125、CA199和影像学检查等能有效提高卵巢EMs恶变的诊断和鉴别诊断。4、临床分期、组织学分型和化疗是影响恶变EMs患者预后的相关因素。
[Abstract]:Objective: to analyze ovarian endometriosis (EMs) patients with malignant general data, clinical manifestation, auxiliary examination, treatment and prognosis of ovarian malignant EMs, summarize the clinical features, explore the influence factors of ovarian malignancy and prognosis of EMs. In order to find ovarian malignant EMs and prospective prognosis sign to early diagnosis early treatment, prolong the survival time of patients, improve the quality of life of patients. Methods: 564 cases of ovarian EMs patients admitted to Tianjin Central Obstetrics and Gynecology Hospital from 2010 -2015 years as the research object, including 113 cases of ovarian malignant EMs patients for the study group, 451 patients with non malignant ovarian EMs as control group, retrospective analysis of all clinical data and two groups. The patients were followed up, with the multivariate analysis of factors related risk factors and prognosis of malignant transformation in the elucidation of EMs. Results: 1, the average age of patients in the study group than in the control group, for the first time of birth The average age of living compared with the control group, the average age of marriage was larger than the control group, the average duration than in the control group, the average BMI index compared with the control group, the proportion of mental workers was higher than the control group, the proportion of manual workers is lower than the control group. The study group menopause, the proportion of patients with dysmenorrhea were higher than the control group. The patients in the study group compared to the number of abortion the control group, the rate of cesarean section was higher than that in control group, delivery ratio is lower than the control group, the number of production is less than the control group. Two groups of patients with the above indexes were statistically significant (P0.05). Non conditional Logistic regression analysis showed that the age of marriage, the number of production factors, disease duration, BMI index is 4 main factors influencing EMs.2 of ovarian malignant transformation, the study group and the control group of patients with clinical manifestations of abdominal pain was the highest, followed by the palpable abdominal mass, sexual pain, infertility, irregular vaginal bleeding, no symptoms. Study group patients with abdominal Department of pain, the incidence of palpable abdominal mass were higher than the control group, and the difference was statistically significant (P0.05). According to the clinical stage of cancer, will I, II as mild group (87 cases), III, IV as severe group (26 cases). Patients with severe abdominal pain, dyspareunia and infertility the incidence of mild group, the differences were statistically significant (.3, P0.05) of patients in the study group with mass cystic mass (40.7%), the largest diameter was larger than 8cm accounted for 34.5%, 50.4% patients within six months of mass increases rapidly, all specimens were detected in ectopic endometrial epithelial cells or atypical nuclear atypia the changes of the patients in the control group. More than 90% of cystic mass, mass diameter was larger than 8cm accounted for 17.7%, 14.4% patients within six months of mass increases rapidly, including 28 cases of atypical nuclear atypia or changes in.4, CA125 HE4, CA199 of patients in the study group, the level is higher than the control group, the differences were statistically significant (P0.05).HE 4,CA125,CA199鍦ㄢ厾,鈪，

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