细胞减灭术联合腹腔热灌注治疗晚期卵巢癌的疗效分析

发布时间：2018-04-03 21:37

本文选题：晚期上皮性卵巢癌　切入点：肿瘤细胞减灭术　出处：《郑州大学》2017年硕士论文

【摘要】：背景及意义卵巢癌(Ovarian Cancer,OC)是妇科常见的恶性肿瘤之一,恶性程度高,预后差,其死亡率在妇科肿瘤中居于首位。据统计分析,全球每年约有20万人被确诊,死亡率高达60%。近年来,女性卵巢癌的发病率逐年上升。由于卵巢位于盆腔深处,发病隐匿,并且缺乏普查和早期诊断等有效措施,超过70-80%的女性发现时已是晚期(FIGO分期),且复发率高达50%。晚期上皮性卵巢癌的标准治疗为初治的细胞减灭术联合铂类为基础的综合治疗。晚期卵巢癌的疗效主要与手术满意度、化疗方案、化疗方式等因素相关。由于腹膜种植转移、细胞减灭术后微观/隐匿的残余病灶,即使达到满意的减灭术(残余病灶直径1cm),仍不能彻底清除腹膜表面肿瘤。临床上,对于晚期上皮性卵巢癌患者,目前多采用手术联合化疗。手术有细胞减灭术,包括初治的细胞减灭术和中间性细胞减灭术。化疗方式有全身化疗,其临床应用较为广泛,除此之外,尚有腹腔化疗、新辅助化疗、新辅助腹腔化疗/全身化疗,以及近年来研究越来越热的腹腔热灌注化疗,越来越引起临床医师的青睐。目的探讨分析细胞减灭术联合腹腔热灌注治疗在晚期上皮性卵巢癌中的临床疗效,为晚期上皮性卵巢癌患者的临床治疗提供相关依据。方法收集郑州大学第一附属医院2014年1月至2016年7月收入的84例初治III期、IV期上皮性卵巢癌患者,按照不同治疗方式将其分为两组:腹腔热灌注组:满意肿瘤细胞减灭术+腹腔热灌注共31例;对照组:仅行满意肿瘤细胞减灭术53例;所有治疗后均行PT方案化疗。比较两组CA125水平下降情况、腹水控制率、Karnofsky功能状态、化疗不良反应、低蛋白血症等治疗前后变化情况。结果两组患者不同治疗阶段CA125水平下降情况比较:术前与第一次化疗后比较(P=0.025);第一次与第二次化疗后比较(P=0.039);第二次与第三次化疗后比较(P=0.035);第三次与第四次化疗后比较(P=0.001),其中HIPEC(Hyperthermic Intraperitoneal chemotherapy)组CA125下降程度明显;HIPEC组腹水控制效果好于对照组(P=0.017);HIPEC组较对照组生活质量明显改善(P=0.018);化疗不良反应、低蛋白血症两组治疗前后变化无明显差异(P0.05)。结论腹腔热灌注治疗可显著降低晚期上皮性卵巢癌患者细胞减灭术后CA125水平,可有效控制腹水的产生,KPS评分显著增加,可明显改善患者生活质量;且不增加化疗副反应及并发症,如骨髓抑制、恶心、呕吐以及低蛋白血症的发生,值得在临床上推广应用。
[Abstract]:Background and significance Ovarian Cancer OCis is one of the most common malignant tumors in gynecology, with a high degree of malignancy and poor prognosis.According to statistical analysis, about 200000 people worldwide are diagnosed every year, and the mortality rate is as high as 60 percent.In recent years, the incidence of ovarian cancer in women has increased year by year.Because the ovary is located deep in the pelvic cavity, the disease is hidden, and lack of effective measures such as general survey and early diagnosis, more than 70-80% of the women found it was a late stage of Figo staging, and the recurrence rate was as high as 50%.The standard treatment for advanced epithelial ovarian cancer is the combination of primary cell reduction and platinum-based therapy.The curative effect of advanced ovarian cancer is mainly related to surgical satisfaction, chemotherapy regimen, chemotherapy mode and other factors.As a result of peritoneal implantation metastasis, microcosmic / concealed residual lesions, even if satisfactory deactivation was achieved (1 cm in diameter of residual lesions), could not completely clear the peritoneal surface tumor.Clinically, most patients with advanced epithelial ovarian cancer are treated with surgery combined with chemotherapy.Surgical procedures include primary cytoreductive surgery and intermediate cell reduction surgery.The chemotherapy methods include systemic chemotherapy, which is widely used in clinic. In addition, there are intraperitoneal chemotherapy, neoadjuvant chemotherapy, neoadjuvant intraperitoneal chemotherapy / systemic chemotherapy, as well as intraperitoneal hyperthermic chemotherapy, which is becoming hotter and hotter in recent years.More and more clinicians are getting more and more attention.Objective to investigate the clinical efficacy of cytoreductive surgery combined with intraperitoneal hyperthermic perfusion in the treatment of advanced epithelial ovarian cancer and to provide relevant evidence for the clinical treatment of advanced epithelial ovarian cancer.Methods 84 patients with primary III stage IV epithelial ovarian cancer were collected from the first affiliated Hospital of Zhengzhou University from January 2014 to July 2016.According to different treatment methods, they were divided into two groups: the abdominal hyperthermic perfusion group (31 cases) with satisfactory tumor cell reduction and the control group (53 cases) with satisfactory tumor cell reduction. All patients were treated with PT regimen chemotherapy.The changes of CA125 level, ascites control rate and Karnofsky function state, adverse reaction of chemotherapy and hypoproteinemia were compared between the two groups before and after treatment.The degree of decrease of CA125 in HIPEC(Hyperthermic Intraperitoneal chemotherapy group was significantly lower than that in control group. The ascites control effect of HIPEC group was better than that of control group, and the quality of life of HIPEC group was significantly better than that of control group.There was no significant difference between the two groups before and after treatment (P 0.05).Conclusion Peritoneal hyperthermic perfusion therapy can significantly reduce the level of CA125 after cell reduction in patients with advanced epithelial ovarian cancer, effectively control the increase of ascites and improve the quality of life of patients.No side effects and complications, such as bone marrow suppression, nausea, vomiting and hypoproteinemia, were increased.
【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】：R737.31

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