前列腺癌根治术病人临床资料库的建立及数据分析

发布时间：2018-11-03 19:47

【摘要】：背景：前列腺癌在欧美国家较为多见，在美国是因肿瘤引发男性死亡的第二大原因，其发病率在男性恶性肿瘤中排名第一。【1】近年来，中国前列腺癌的发病率明显上升，据上海市恶性肿瘤发病率统计，，至2007年为止，前列腺癌的发病率已上升至男性恶性肿瘤的第六位。【2-3】。前列腺癌根治术是治疗早期前列腺癌的重要方法之一，前列腺癌具有临床表现差异较大、辅助检查手段较多，术前治疗方法多样等特点。为了进行大规模数据的收集、整理、分析，以及根据数据分析进行前瞻性的研究，需要有较为完善的前列腺癌数据库管理系统。可以方便对所统计的数据进行更深入的研究。目的：探索、建立便于对前列腺癌病人资料进行收集、管理以及查询的前列腺癌数据库。对统计到的病人进行术后随访，了解术后尿控及性功能恢复情况。对前列腺癌术前相关资料结合术后随访情况进行分析，希望找出更多的与前列腺癌手术及术后恢复有关的因素，并进一步应用与临床。方法：根据实际情况需要，使用联众科研工作站，对2009年2月至2012年10月在本科行耻骨后前列腺癌根治术病人的临床资料进行统计。统计病人共135例，并对纳入的病人进行术后电话随访，随访内容主要为术后肿瘤复发情况及尿控、勃起功能情况。将得到的临床资料以及术后随访资料进行回顾性分析，以找出更多的与前列腺癌手术及术后恢复有关的因素。结果：1）可获得可靠术后病理者共134例，切缘阳性及精囊腺或闭孔淋巴结阳性共29例。29例中：Gleason评分7分21例（22.6%）、8分4例（40%）、9分4例（57.1%）。相比较下，切缘阴性中6分24例，7分72例，8分6例，9分3例。2）单纯尿道残端阳性8例，单纯周切缘阳性5例，单纯精囊腺侵犯4例，单纯淋巴结侵犯2例，尿道残端+周切缘阳性4例，尿道残端+精囊腺阳性2例，周切缘+精囊腺阳性1例，精囊腺+淋巴结阳性2例，尿道残端+周切缘+精囊腺阳性1例。尿道残端阳性共15例（51.7%），周切缘阳性共11例（37.9%），精囊腺阳性共10例（34.4%），淋巴结阳性共4例（13.8%）。3）术前术后均有Gleason评分者共132例，评分不一致60例，其中评分相差2分10例，相差1分50例。4）术前穿刺标本描述阳性针数者共89例，阳性针数比例未超过33.3%有36例，阳性针数比例超过33.3%有53例。术后切缘：阳性针数未超过33.3%的切缘阳性3例（8.3%），阳性针数超过33.3%的切缘阳性有14例（26.4%）。5）前列腺癌根治术共随访到病人94例，截至随访时共死亡5例，分别为：乙状结肠癌伴肝转移、原发性肺癌、老年痴呆、肺部转移、死因不明各一例。6）根治术后尿控随访：随访到病人共有85人，现有尿失禁31人，主观评分3分以上者16人。该16人中，5人曾行放疗；1人术后出现淋巴瘘，引流34天，留置导尿48天；2人为术后4个月；1人术后出现尿瘘，引流22天，留置导尿21天；1人生化复发，行内分泌治疗；1人尿道残端阳性。结论：前列腺癌数据库的构建为前列腺癌临床及基础研究提供了良好的平台，经过进一步完善，可结合随访内容对前列腺癌的研究有更积极的意义。在前列腺癌的各项临床资料中，前列腺癌穿刺标本Gleason评分与术后病理切缘之间无相关性而穿刺针数的阳性比例与术后病理切缘之间有相关性。前列腺穿刺标本与根治标本的Gleason评分一致性较为一般，多数情况穿刺标本评分偏低，少数评分偏高。前列腺癌术前血清PSA值与Gleason评分呈正相关。术后尿失禁情况与病理切缘阳性之间无明确关系但可能与行放疗关系密切。
[Abstract]:Background: Prostate cancer is seen more in Europe, and in the United States is the second major cause of death for men in the United States, the incidence of which is ranked first among men's malignancies.[1] In recent years, the incidence of prostate cancer in China has increased significantly. According to the statistics of the incidence of malignant tumor in Shanghai, the incidence of prostate cancer has risen to the sixth place of male malignant tumor until 2007.[2-3]. Radical operation of prostate cancer is one of the most important methods for the treatment of early prostate cancer. In order to carry out large-scale data collection, collation, analysis and prospective research based on data analysis, there is a need for a more perfect database management system for prostate cancer. more in-depth study of the data being counted can be facilitated. Objective: To explore and establish the number of prostate cancers convenient for the collection, management and inquiry of prostate cancer patients. According to the database, postoperative follow-up was performed on patients with statistics for postoperative urine control and sexual function recovery. in ord to find out more relevant factors related to prostate cancer surgery and postoperative recovery, and to further their application to that follow-up of prostate cancer. Clinical and Methods: According to the actual situation, the clinical resources of the patients undergoing radical operation of pubic bone after suprapubic prostate cancer from February 2009 to October 2012 were studied by using the joint scientific research workstation. Materials were counted. 135 patients were counted, and postoperative telephone follow-up was performed on the patients included. The follow-up contents were mainly postoperative tumor recurrence and urine control. Functional status. Retrospective analysis of the clinical data and post-operative follow-up data to find out more for prostate cancer surgery and post-operative recovery Results: 1) There were 134 cases with reliable postoperative pathology, 29 cases were positive for resection margin and 29 cases of positive or closed-hole lymph nodes. Among 29 cases, Gleason score was 7 in 21 cases (22. 6%), 8 in 4 cases (40%), 9 points 4. (57. 1%). In contrast, there were 6 points, 24 cases, 72 cases in 7 points, 8 in 6 cases, 9 in 3 cases. 2) There were 8 positive cases of simple urethral stump, 5 cases of simple peripheral edge, 4 cases of simple salivary gland invasion, 2 cases of simple lymph node invasion, 6 cases of urethral stump. 4 cases of positive peripheral margin positive, 2 cases of urethral stump + salivary gland positive, 1 case of peripheral resection margin + salivary gland positive, 2 cases of salivary gland + lymph node positive, 2 cases of urethral stump + week resection. There were 15 cases (51. 7%) of positive urethral stump positive, 11 cases (37.9%) in peripheral resection margin, 10 cases (34. 4%) of salivary gland positive and 4 cases of lymph node positive (13. 8%). There were 132 cases with Gleason score before operation and 60 cases were not consistent. Among them, there were 132 cases with Gleason score before operation. The number of positive needles was not more than 33. 3% in 36 cases, and the number of positive needles was more than 3. 3. 3% had 53 cases. After operation, the number of positive needles was not more than 33. 3%, 3 cases (8.3%) were positive, and the number of positive needles exceeded 33. 3%, 14 cases (26. 4%) were positive. 5) Radical operation of prostate cancer was followed up to 94 cases, and 5 cases died as of follow-up. Postoperative urinary control follow-up: A total of 85 patients, 31 patients with urinary incontinence, and subjective scores were followed up. Among them, 16 were treated with radiotherapy, 5 had radiotherapy, 1 had lymphatic drainage, 34 days of drainage, 48 days for indwelling, 4 months after operation, 1 after the operation, urinary excretion, drainage for 22 days, indwelling for 21 days, biochemical relapse, and endocrine therapy. Conclusion: The construction of prostate cancer database provides a good platform for clinical and basic research of prostate cancer. The study of cancer has more positive significance. In the clinical data of prostate cancer, the Gleason score of prostate cancer puncture specimen has no correlation with the postoperative pathological margin, and the positive ratio of puncture needle number There was a correlation between the posterior pathological margins. The consistency of Gleason score between the prostate puncture specimen and the radical specimen was more common, and most cases were punctured. Low scoring, high scores of scores. Serum PSA values prior to prostate cancer and Gl There was no definite relationship between postoperative urinary incontinence and pathological margin.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.25

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