探讨卵巢癌患者首诊的相关因素在早期诊断中的价值

发布时间：2018-05-29 03:54

本文选题：卵巢癌 + 首诊相关因素　；参考：《黑龙江中医药大学》2014年硕士论文

【摘要】：目的：通过回顾性分析卵巢癌患者的首诊相关因素,探讨卵巢癌诊断延误的因素,及诊断延误与卵巢肿瘤分期的对应关系；统计卵巢癌患者中医证型分布特点。从而为临床卵巢癌的早发现、早治疗提供参考意见。方法：对2012年5月-2013年10月在黑龙江中医药大学附属第一医院妇科门诊及其哈尔滨医科大学第三附属医院妇科病房的74例术后卵巢癌患者进行首诊相关因素的分析,及体质情况调查,对卵巢癌患者一般资料及首次发病的临床表现、病理特征、中医体质及影响其就诊的相关因素进行回顾性分析。结果： 1.从患者一般资料得出：本次研究中患者发病年龄在20-74岁,45-55岁发病率为41.9%；居住地中农村及非省会城市比例分别为28.4%、51.4%；文化程度为中学以下水平比例占62.1%；新农合和社会医保比例分别是52.7%、23%,而自费占2.7%；已婚占78.4%,未婚、离异或丧偶的占21.6%；就诊信息中家人推荐最高占25.6%；初诊医疗机构非省级综合医院占64%,其中年龄、医疗保障对就诊单位的选择p0.05,就诊费用来源、文化程度和婚况p0.05；误诊概率为44.6%；就诊时间最短为0天,最长达1825天,延迟诊断发生率为21.6%(16例)；对延误诊断的影响因素中年龄、居住地、就诊机构、文化程度、费用来源、医疗保障、婚况和就诊意愿有统计学意义(p0.05)。 2.从患者的疾病信息得出：卵巢癌患者首发症状出现概率由高到低依次为腹胀、下腹包块、下腹坠痛、阴道不规则流血、腹腔积液、膀胱刺激症状和胃肠道症状、淋巴结肿大、贫血、消瘦。首诊的病理类型卵巢上皮性癌66例(89.2%),性索间质瘤2例(2.7%)卵巢生殖细胞瘤6例(8.1%)。卵巢癌的发病部位双侧发病为41例占55.4%,左侧、右侧发病分别为25.7%、18.9%。临床分期较集中在Ⅲ期,调查中人数上Ⅲ期Ⅳ期Ⅱ期)Ⅰ期,Ⅲ期人数最多,Ⅰ期则最少。卵巢癌发病部位上看单侧发病多于早期,概率较高的为左侧Ⅰ期比例占12.2%,右侧Ⅱ期占6.8%,而双侧多晚期,双侧Ⅲ期占41.9%。 3.从影响分期情况得出：患者的诊断延迟情况分为就诊延迟和确诊延迟。16名(21.6%)病人发生诊断延迟现象,平均延迟378.18天。不同年龄文化程度、居住地、费用来源、医疗保障对卵巢癌病人就诊延迟差异均无统计学意义(P0.05)；婚姻状况差异有统计学意义(p0.05)。不同年龄、文化程度、婚姻状况对卵巢癌病人是否发生确诊延迟现象均无统计学意义(P0.05),误诊、医疗机构有统计学意义(P0.05)。诊断延迟与临床分期的调查中,卵巢癌早期患者的诊断延迟3例,晚期诊断延迟13例。卵巢癌主动就诊的患者27例(36.5%),被动就诊47例(63.5%)；卵巢癌早期患者中主动就诊20例,被动就诊9例；晚期患者主动就诊7例,被动就诊38例。 4.从中医证型的研究得出：发病较高的是气滞、血瘀型,发病人数分别为22人(占调查人数29.7%)、29人(占调查人数39.2%)；其次为热毒型有13人(占调查人数17.6%)、痰湿型有10人(占调查人数13.5%)。结论： 1.对卵巢癌患者就诊行为有统计学意义的影响因素包括年龄、文化程度、费用来源、婚况、家庭支持、就诊意愿等。 2.卵巢癌首诊年龄集中在45-55岁之间；首发症状以下腹痛、腹胀、下腹包块、阴道不规则流血为主；发病部位概率双侧左侧右侧；中医证型分布情况血瘀型气滞型热毒型痰湿型。 3.就诊延迟时间与卵巢癌临床分期呈正相关；卵巢癌发病部位单侧发病多早期,双侧多晚期。
[Abstract]:Purpose :

To investigate the factors of diagnosis delay of ovarian cancer and the correlation between diagnosis delay and ovarian tumor stage by retrospective analysis of the factors related to the first diagnosis of ovarian cancer .
In order to provide a reference for early detection and early treatment of ovarian cancer .

Method :

In May of 2012 to October 2013 , 74 cases of ovarian cancer patients in the First Affiliated Hospital of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine and the Third Affiliated Hospital of Harbin Medical University were analyzed , and the physical constitution investigation was carried out , and the general data of ovarian cancer patients and the clinical manifestation , pathological characteristics , the constitution of Chinese medicine and the related factors affecting them were analyzed retrospectively .

Results :

1 . From the general data of the patients , the age of the patients in this study was 20 - 74 years , and the incidence of 45 - 55 years was 41.9 % ;
The urban proportion of rural and non - provincial capitals in the place of residence is 28 . 4 % and 51 . 4 % , respectively .
The level of culture is 62.1 % in the middle school ;
The proportion of the new agricultural and social medical insurance was 52.7 % , 23 % , and the self - cost accounted for 2.7 % ;
78.4 % of married , unmarried , divorced or widows accounted for 21.6 % ;
The family recommended the highest rate of 25.6 % in the information of medical treatment ;
The non - provincial comprehensive hospitals in the first medical institution account for 64 % , among them the age , the choice of medical security to the treatment unit , the source of medical expenses , the degree of culture and the marital status p0.01 ;
The probability of misdiagnosis was 44.6 % .
The shortest time was 0 days , up to 1,825 days , and the rate of delayed diagnosis was 21.6 % ( 16 cases ) .
There was significant difference in age , place of residence , medical institution , degree of culture , source of cost , medical security , marriage status and willingness to visit in the influence factors of delay diagnosis ( p . 05 ) .

2 . From the patient ' s disease information , the probability of onset of initial symptoms in ovarian cancer patients was from high to low in order of abdominal distension , lower abdominal mass , lower abdomen falling pain , irregular vaginal bleeding , abdominal dropsy , bladder irritation symptoms and gastrointestinal symptoms , lymph node enlargement , anemia and wasting .

3 . The diagnosis delay of the patients was divided into the diagnosis delay and the diagnosis delay . The average delay was 378.18 days in 16 patients ( 21.6 % ) . There was no significant difference between the different ages and cultures , the place of residence , the source of cost and the medical security for ovarian cancer patients ( P0.05 ) .
There was a significant difference in the marital status ( P 0.05 ) . There was no statistical significance ( P0.05 ) in the diagnosis of ovarian cancer patients with different ages , cultures and marital status ( P0.05 ) . In the investigation of the diagnosis delay and clinical stage , the diagnosis delay of early stage patients was delayed in 3 cases , and the late diagnosis was delayed in 13 cases .
In the early stage of ovarian cancer , 20 cases were active and 9 cases were passively visited ;
In the advanced patients , 7 cases were actively visited and 38 cases were passively visited .

4 . From the study of syndrome type of TCM , the incidence of qi stagnation and blood stasis were 22 ( 29 . 7 % ) and 29 ( 39.2 % of the survey ) respectively .
There were 13 persons ( 17.6 % of the survey ) and 10 persons ( 13.5 % of the survey ) in the hot - toxin type .

Conclusion :

1 . The factors that affect the behavior of ovarian cancer patients include age , degree of culture , source of cost , marriage status , family support , doctor ' s willingness , etc .

2 . The first diagnosis of ovarian cancer was between 45 and 55 years old ;
The first symptoms were abdominal pain , abdominal distension , lower abdominal mass and irregular vaginal bleeding .
Two - sided left - hand right side of incidence part probability ;
Traditional Chinese medicine syndrome type distribution condition blood stasis type heat toxin type phlegm wet type .

3 . The delay time was positively correlated with the clinical stage of ovarian cancer .
In the pathogenesis of ovarian cancer , the onset of one - sided disease was early , bilateral and late .
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.31

【参考文献】