宫颈腺癌卵巢转移及保留卵巢可行性临床分析

发布时间：2018-03-20 09:21

  本文选题：宫颈腺癌　切入点：卵巢转移率　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景:在我国,宫颈癌是女性患者中发病率第五位的恶性肿瘤,是女性生殖系统发病率最高的恶性肿瘤,也是每年死亡人数最多的妇科恶性肿瘤。随着社会的发展和性观念的改变,宫颈癌的发病出现了年轻化的趋势。与此同时,宫颈腺癌的发病率相对于宫颈鳞状细胞癌发病率逐渐上升。传统的观点认为腺癌患者在手术的过程中要同时切除双侧附件,但是由于逐年增多的年轻患者对于卵巢功能的需求让我们不得不考虑保留卵巢功能的可行性。目的:分析宫颈腺癌发生卵巢转移的高危因素以及保留卵巢与切除卵巢的腺癌患者预后情况是否存在差异,探讨宫颈腺癌患者保留卵巢可行性。方法:通过山东大学齐鲁医院电子病历系统检索宫颈腺癌患者资料,收集自2005年1月至2016年12月之间的宫颈腺癌患者病历,筛选出初诊患者并于齐鲁医院接受手术治疗的宫颈腺癌患者233例。其中保留卵巢功能的患者44例,切除卵巢的患者189例,其中8例患者发现卵巢转移。将189例切除卵巢的患者按照卵巢转移和无卵巢转移分为两组,比较两组患者的年龄、肿瘤的组织分化程度及临床分期、肿瘤最大径、宫旁浸润、宫体浸润、阴道残端、输卵管转移、间质浸润深度、淋巴脉管间隙浸润(LVSI)及淋巴结转移情况,分析与卵巢转移相关的高危因素。通过log-rank检验的方法比较保留卵巢功能和切除卵巢的患者的生存曲线,分析术后生存时间是否存在显著差异。结果:(1)宫颈腺癌卵巢转移率为3.43%。(2)宫颈腺癌患者总体平均年龄为45.0±9.92岁,卵巢转移和无卵巢转移的患者平均年龄分别为45.5土7.9岁和45.0± 10.0岁,年龄因素与卵巢转移无明显相关性。(3)单因素分析结果:临床分期、组织分化程度、宫旁浸润、阴道残端、输卵管转移、宫颈间质浸润深度、宫体浸润、LVSI和淋巴结转移情况与卵巢转移有相关性。(4)多因素logistic回归分析结果:宫旁浸润(+)、阴道残端(+)、宫颈间质浸润深度1/2、LVSI(+)是卵巢转移的高危因素。(5)log-rank生存曲线分析结果:宫颈腺癌患者总体的5年生存率为91.73%;保留卵巢与切除卵巢的患者生存曲线没有显著的差异。结论:患者的年龄与卵巢转移无明显相关性,对于宫旁浸润(-)、阴道残端(-)、宫颈间质浸润深度≤1/2、LVSI(-)的年轻患者,可选择保留卵巢功能的治疗方案,结论还需大样本研究进一步证实。
[Abstract]:Background: in China, cervical cancer is a malignant tumor with the highest incidence in female reproductive system. It is also the most common gynecological malignancy with the highest number of deaths each year. With the development of society and the change of sexual attitudes, the incidence of cervical cancer is becoming younger. At the same time, The incidence of adenocarcinoma of the cervix is increasing relative to that of squamous cell carcinoma of the cervix. However, due to the increasing demand of young patients for ovarian function, we have to consider the feasibility of preserving ovarian function. Objective: to analyze the high risk factors of ovarian metastasis in cervical adenocarcinoma, and to analyze the risk factors of ovarian preservation and ovariectomy. Whether there is a difference in prognosis in patients with ovarian adenocarcinoma, Methods: the data of patients with cervical adenocarcinoma were searched by electronic medical record system in Qilu Hospital of Shandong University from January 2005 to December 2016. A total of 233 cases of cervical adenocarcinoma were selected and treated in Qilu Hospital. Among them, 44 were patients with ovarian function and 189 were ovariectomized. The patients were divided into two groups according to ovarian metastasis and no ovarian metastasis. The age, tumor tissue differentiation, clinical stage, tumor maximum diameter, para-uterine infiltration were compared between the two groups. Uterine body invasion, vaginal stump, fallopian tube metastasis, depth of interstitial infiltration, lymphatic vascular space infiltration, LVSIand lymph node metastasis. The high risk factors associated with ovarian metastasis were analyzed. The survival curves of patients with ovarian function and ovariectomized were compared by log-rank test. Results the average age of patients with cervical adenocarcinoma was 45.0 卤9.92 years old. The mean age of patients with ovarian metastasis and non-metastasis were 45.5 卤7.9 years and 45.0 卤10.0 years, respectively. There was no significant correlation between age factors and ovarian metastasis. The results of univariate analysis were as follows: clinical stage, degree of tissue differentiation, para-uterine invasion, vaginal stump, tubal metastasis, depth of cervical interstitial infiltration. Results of multivariate logistic regression analysis: para-uterine invasion (logistic), vaginal stump (P < 0.01), cervical interstitial invasion depth (1 / 2) LVSI () were high risk factors for ovarian metastasis. The overall 5-year survival rate of patients with cervical adenocarcinoma was 91.73. There was no significant difference in survival curve between patients with ovarian preservation and ovariectomized. Conclusion: there is no significant correlation between age and ovarian metastasis. For the young patients with periuterine invasion, vaginal stump and cervical interstitial infiltration 鈮，

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