478例胃癌肝转移的临床分析

发布时间：2018-03-31 03:21

本文选题：胃癌　切入点：肝转移　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:通过回顾性分析胃癌肝转移的临床病理特征及可能影响患者预后的有关因素,进而分析胃癌原发灶与肝脏转移灶之间的内在联系,通过其内在的联系可能为获得治疗胃癌肝转移和预测胃癌肝转移预后带来新的方向。方法:回顾性分析河北医科大学第四医院病案室2000年1月至2014年1月归档的胃癌肝转移患者的病案资料。同时分别记录这些病例原发灶部分临床病理特征;其中包括:年龄、性别、肿瘤部位、肿瘤大小、肿瘤的大体类型、浆膜侵犯、分化程度、脉管癌栓、淋巴结转移、腹膜转移、手术性质、肝转移部位以及肝转移时机等情况,然后用EXCEL建立胃癌肝转移原发灶临床病理特征的数据库,翻阅部分病例,并对这些患者进行定期的随访。统计分析软件采用的是SPSS21.0软件包,使用卡方检验的方法将该资料同一因素的相关性进行统计学分析,然后采用logistic回归来分析胃癌肝转移的高危因素,将P0.05认为在有统计学方面具有意义。结果:1胃癌肝转移患者的男女比例为2.03:1;中老年人居多,其中患病平均年龄为58岁;原发病灶位于贲门部者有206例,占43.0%;原发病灶最大直径大于5cm者有287例,占60.2%;原发病灶侵及浆膜层者有317例(66.3%);低分化腺癌者有380例,占79.4%;中分化腺癌者有92例,占19.3%;高分化腺癌者有6例,占1.3%;脉管癌栓者有317例(66.3%);胃癌大体分型中Bormann I型者有72例(15.0%),Bormann II型者有87例(18.3%),Bormann III型者有299例(62.5%),Bormann IV型20例者有(4.2%);淋巴结转移者有436例(91.2%);腹膜转移者有103例(21.6%);行根治性手术者有104例(21.8%);胃癌转移至肝左叶者有95例(19.8%),转移至肝右叶163例有(34.2%),肝左右两叶均转移者有220例(46.0%);胃癌同时性肝转移者有141例(29.6%),胃癌异时性肝转移者有337例(70.4%)。胃癌术后肝上出现转移灶最短的时间为1.2个月,最长的时间为38月,术后出现转移的平均时间为9个月。其中血液检测发现AFP阳性8例,再次查阅2000-2014年期间共15704例胃癌归档病案资料,发现AFP阳性胃癌患者共有13例,表明AFP阳性的胃癌肝转移率非常高(61.53%)2通过将胃癌原发灶部位和肝转移灶经卡方检验后,P0.05,没有统计学意义,说明上述二者之间无明显相关性。结论:1胃癌原发灶组织中出现脉管癌栓、侵及浆膜、淋巴结转移、腹膜转移、肝转移时机都是影响肝转移患者预后的高危因素。其中的腹膜转移、浆膜受侵、肝转移时机三者在胃癌肝转移患者的预后是独立的危险因素。2胃癌肝转移的原发灶部位与转移灶部位无明显差异;
[Abstract]:Objective: to analyze the clinicopathological features of liver metastasis of gastric cancer and the related factors that may affect the prognosis of gastric cancer, and to analyze the relationship between the primary tumor of gastric cancer and the hepatic metastasis. It may bring a new direction to the treatment of liver metastasis of gastric cancer and predict the prognosis of hepatic metastasis of gastric cancer through its internal relationship. Methods: retrospective analysis of the medical records department of the fourth Hospital of Hebei Medical University from January 2000 to January 2014 was carried out. The medical records of patients with liver metastasis of gastric cancer were recorded, and some clinicopathological features of the primary lesions were recorded. These include: age, sex, tumor location, tumor size, gross type of tumor, serosal invasion, differentiation, vascular tumor embolus, lymph node metastasis, peritoneal metastasis, surgical nature, location of liver metastasis and timing of liver metastasis. Then EXCEL was used to establish a database of clinicopathological features of primary liver metastases of gastric cancer, and some cases were reviewed, and these patients were followed up regularly. SPSS21.0 software package was used for statistical analysis. The correlation of the same factor was statistically analyzed by chi-square test, and then logistic regression was used to analyze the high risk factors of liver metastasis of gastric cancer. Results the ratio of male to female was 2.03: 1 in patients with liver metastases from gastric cancer. The majority of middle-aged and elderly people, with an average age of 58 years, had 206 cases of primary lesions located in the cardia. The largest diameter of the primary lesion was larger than 5cm in 287 cases (60.2%); the primary lesion involved serous layer in 317 cases (66.3%); the poorly differentiated adenocarcinoma in 380 cases (79.4%); the moderately differentiated adenocarcinoma in 92 cases (19.3%); the highly differentiated adenocarcinoma in 6 cases. There were 317 cases with vessel tumor embolus, 72 cases with Bormann type I, 87 cases with type 18.3C, 87 cases with Bormann III type 18.3C, 20 cases with Bormann IV type, 436 cases with lymph node metastasis, 91.2i cases with lymph node metastasis, 103 cases with peritoneal metastasis and 21.6 cases with radical mastectomy. There were 104 cases of operation, 95 cases of gastric cancer metastasis to liver Zuo Ye, 163 cases to right lobe of liver, 220 cases to right lobe of liver, 220 cases to both sides of liver, 141 cases to simultaneous liver metastasis, 337 cases to abnormal liver metastasis and 70.4 cases to gastric cancer, respectively, to the patients with liver cancer and to the liver, and to the right lobe of the liver, to the right lobe of the liver, to the right lobe of the liver, to 220 cases to the right lobe of the liver and to the right lobe of the liver, to the right and to the right lobes of the liver. The shortest time of liver metastasis after operation was 1.2 months. The longest time was 38 months, and the average time of metastasis was 9 months. Among them, 8 cases were found to be positive for AFP by blood test, and 13 cases were found to be positive for AFP in the 15704 cases of gastric cancer archived from 2000 to 2014. The results showed that the liver metastasis rate of AFP positive gastric cancer was very high. There was no statistical significance by chi-square test on the location of primary gastric cancer and liver metastasis. Conclusion the vascular tumor embolus, involving serous membrane, lymph node metastasis and peritoneal metastasis were found in the primary tissues of gastric cancer. The timing of liver metastasis is a high risk factor for the prognosis of patients with liver metastasis. The prognosis of patients with liver metastasis is an independent risk factor .2 there is no significant difference between the primary and metastatic sites of liver metastasis of gastric cancer.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2

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