子宫内膜浆液性腺癌51例临床分析

发布时间：2018-05-14 10:45

  本文选题：子宫内膜浆液性腺癌 + 临床表现　； 参考：《大连医科大学》2017年硕士论文

【摘要】：目的:研究讨论子宫内膜浆液性腺癌的临床特点、诊断方法及治疗方案。方法:回顾性分析2011年6月至2016年6月大连市妇产医院收治的51例临床资料完整的UPSC(Uterine papillary serous carcinoma,子宫内膜浆液性腺癌)的临床表现、辅助检查结果、治疗方法、手术情况、术中及术后病理检查结果、术后恢复情况、后续治疗方法。结果:1.51例UPSC患者的平均发病年龄为61±6.43岁,平均绝经年龄51.60±2.88岁,4例患者未绝经(占7.84%);其余47例患者均已绝经(占92.16%),UPSC在绝经后的女性中发病率较高。2.50例患者有阳性症状,以阴道流血症状居多(占68.00%),阴道异常排液(血性分泌物或淘米水样分泌物)6例(占12.00%),3例为发现盆腔包块(占6.00%),下腹痛症状的有5例(占10.00%),2例表现为腹胀(占4.00%)。1例患者无明显不适。UPSC主要的临床表现是阴道异常的流血,无特异性的临床表现,如遇到绝经后女性出现异常阴道流血注意进一步检查进行鉴别。3.本课题中术前无合并症的患者有13例,有既往史的患者共有38例(占74.51%),其中既往合并高血压病史的患者最多,共有18例(占总患者人数的35.29%),15例合并糖尿病史(占29.41%),乳腺癌术后的有2例(占3.92%),子宫内膜息肉7例(占13.73%),宫颈息肉4例(占7.84%),子宫肌瘤26例(占50.98%),3例患者有家族史(占5.88%),分别是母亲肝癌去世,妹妹宫颈癌病史,母亲乳腺癌病史。BMI≥28 kg/m2有16例,占31.37%(16/51),至今该病的发病因素尚不明确。4.辅助检查缺乏特异性,影像学检查检查均对该疾病的诊断有提示作用,但均无确诊意义;51例患者中CA125值升高者(≥35.00U/ml)共有21例,占41.18%,CA125≥35.00U/ml的患者中手术病理分期为晚期占76.19%(16/21)。CA12535.00U/ml的患者中手术病理分期为晚期者占23.33%(7/30),两者相比较χ2=10.08,P0.01,差异有显著的统计学意义,CA125对于UPSC的诊断有提示价值。研究的病例中23例为宫腔镜下分段诊刮术,总阳性病理诊断率为37.26%(19/51),而其余28例患者行分段诊刮术,总阳性病理诊断率为11.77%(6/51)。比较而言,宫腔镜辅助直视下行诊刮术的病理结果准确率高于传统诊刮术,在术前的诊断检查中有意义。5.51例患者均行手术治疗,其中有16例术后行紫杉醇和卡铂联合治疗,对与该病目前的主要治疗方法仍以手术治疗为主,对于放化疗的效果尚无明确评价。结论:1.子宫内膜浆液性腺癌大多数发生于绝经后妇女,其临床症状缺乏特异性,以绝经后阴道流血最为常见。2.子宫内膜浆液性腺癌的诊断以病理学检查为金标准,宫腔镜下行分段诊刮术的准确率较经典分段诊刮术明显升高。3.子宫内膜浆液性腺癌辅助检查中CA125对于判断该病的分期有提示意义。4.子宫内膜浆液性腺癌治疗目前仍以手术治疗为主,手术方式应进行标准的外科分期手术,即肿瘤细胞减灭术(类似于卵巢浆液性乳头癌的肿瘤细胞减灭术)。
[Abstract]:Objective: to study the clinical features, diagnosis and treatment of endometrial serous adenocarcinoma. Methods: from June 2011 to June 2016, 51 cases of UPSC(Uterine papillary serous carcinoma, endometrial serous adenocarcinoma treated in Dalian Obstetrics and Gynecology Hospital were retrospectively analyzed. Intraoperative and postoperative pathological findings, postoperative recovery, follow-up treatment. Results the mean age of onset of UPSC was 61 卤6.43 years old, the mean menopausal age was 51.60 卤2.88 years old and the average menopausal age was 51.60 卤2.88 years old. The most common symptoms were vaginal bleeding (68.00%), abnormal vaginal discharge (6 cases) (blood secretion or water secretion from rice panning rice) in 6 cases (12.00%), pelvic mass (6.00%), abdominal pain in 5 cases (10.00%) and abdominal distension (4.00%) in 2 cases (4.00%). The main clinical manifestation of UPSC is abnormal vaginal bleeding. No specific clinical manifestations, such as postmenopausal women with abnormal vaginal bleeding attention to further examination to identify. 3. In this study, there were 13 patients without preoperative complications and 38 patients with previous history (74.51%). There were 18 cases (35.29% of the total patients) with diabetes history (29.41%), 2 cases (3.92%) with breast cancer, 7 cases (13.73%) with endometrial polyps, 4 cases (7.84%) with cervical polyps, 26 cases (50.98%) with myoma of uterus. Shi (5.88%) died of her mother's liver cancer. The history of cervical cancer in sister and breast cancer in mother (鈮，

本文编号：1887553