子宫内膜癌盆腔及腹主动脉旁淋巴结转移的临床病理特征分析

发布时间：2018-05-14 05:10

本文选题：子宫内膜癌 + 腹主动脉旁淋巴结　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:子宫内膜癌是一组来源子宫内膜的上皮性的恶性肿瘤,是女性生殖系统三大恶性肿瘤之一,占女性全部生殖系统恶性肿瘤的20%~30%,并且其发病率逐年升高,在许多西方发达国家,子宫内膜癌的发病率高居生殖道恶性肿瘤的首位。淋巴结的转移是影响子宫内膜癌患者预后的非常重要的因素,而盆腔淋巴结转移与腹主动脉旁淋巴结转移对预后有着不同的提示作用。本研究通过回顾性分析子宫内膜癌患者的临床病理资料探讨盆腔及腹主动脉旁淋巴结转移的子宫内膜癌的临床病理特征及其相关因素。方法:选取自2008年1月至2014年12月于河北医科大学第四医院妇科住院并经手术病理组织学证实为子宫内膜癌的患者1445例,且所有患者均行全子宫、双附件及盆腔±腹主动脉旁淋巴结的切除,对该组所有患者临床、病理及随访资料进行详细查阅记录,并建立临床随访资料Excel数据库,应用SPSS16.0统计软件对这些病例与临床资料进行统计学分析,单因素分析采用卡方检验及Fisher确切概率法,多因素分析采用二元Logistic回归模型,P0.05为差异有统计学意义。结果:1本研究共纳入子宫内膜癌患者1445例,其中该组患者的年龄分布范围为28~77岁,平均发病年龄53.76±8.375岁,中位数年龄为55岁,其中55岁者720例(49.8%),≥55岁者725例(50.2%)。绝经后诊断为子宫内膜癌患者有884例,占61.2%,未绝经者561例,占38.8%;绝经患者的平均年龄57.54岁,年龄分布为57.54±6.757岁。体重指数BMI25Kg/m2者454例,占31.4%,BMI≥25 Kg/m2者991例,占68.6%。最小体重指数15 Kg/m2,最大49 Kg/m2,平均体重指数为26.28±4.0311 Kg/m2。绝经后阴道出血为首要症状者1052例,占72.8%,阴道排液者103例,占7.1%,月经异常者124例,占8.6%,其他症状包括腹痛、腹胀、体检发现者166例,占11.5%。直系亲属癌症病史者共194例,占13.4%,其中子宫内膜癌患者4例,卵巢癌2例,宫颈癌2例,食道癌48例,贲门癌10例,胃癌40例,肺癌39例,乳腺癌6例,肝癌20例,直肠癌10例,胰腺癌6例,甲状腺癌1例,肾癌1例,牙龈癌1例,胆囊癌1例,喉癌1例,血液系统疾病2例。合并高血压者461例,占31.9%,合并糖尿病者111例,占7.7%,同时合并高血压和糖尿病61例,占4.2%,合并不孕者69例,占4.8%。2本组1445例子宫内膜癌患者中行开腹子宫内膜癌根治术者手术770例,占53.3%,行腹腔镜下手术者675例,占46.7%。高分化G1者79例,占5.5%,中分化G2者1097例,占75.9%,低分化G3者269例,占18.6%。无肌层浸润者147例,占10.2%,浅肌层浸润者1002例,占69.3%,深肌层浸润者296例,占20.5%。存在脉管瘤栓者95例,占6.6%,无脉管瘤栓者1350例,占93.4%。同时存在宫颈间质受侵者277例,占19.2%,无宫颈间质受侵者1168例,占80.8%。同时伴附件转移者76例,占5.3%。术前CA125≥35U/ml者341例,占23.6%。Ⅰ期1047例,占72.5%,Ⅱ期211例,占14.6%,Ⅲ期176例,占12.2%,Ⅳ期11例,占0.7%。子宫内膜样腺癌1366例占94.5%,非宫内膜样癌79例,其中包括混合癌7例,浆乳癌35例,透明细胞癌23例,小细胞癌5例,粘液腺癌9例。3本组1445例子宫内膜癌患者中,共109例子宫内膜癌发生淋巴结转移,其中盆腔淋巴结转移而腹主动脉旁淋巴结未转移者77例,占70.6%,腹主动脉旁淋巴结转移而盆腔淋巴结未转移者13例,占11.9%,盆腔及腹主动脉旁淋巴结同时转移者19例,占17.4%。结论:1体重指数BMI、血清CA125、组织分级、肌层浸润、脉管瘤栓、宫颈间质受侵、附件转移、病理类型、手术方式是子宫内膜癌盆腔及腹主动脉旁淋巴结转移的相关危险因素。2深肌层浸润、脉管瘤栓、附件转移是子宫内膜癌盆腔及腹主动脉旁淋巴结转移的独立危险因素。3子宫内膜癌盆腔淋巴结转移的发生率高于腹主动脉旁淋巴结转移的发生率。
[Abstract]:Objective: endometrial carcinoma is a group of epithelial malignant tumors that come from the endometrium. It is one of the three major malignant tumors of the female reproductive system, which accounts for the 20%~30% of all female malignant tumors of the reproductive system, and its incidence is increasing year by year. In many western developed countries, the incidence of endometrium cancer is the highest in the malignant tumor of the reproductive tract. The metastasis of the pelvic lymph nodes and the lymph node metastasis of the abdominal aorta have different prognostic effects on the prognosis of the patients with endometrial carcinoma. This study is a retrospective analysis of the intrauterine and intrauterine lymph node metastases of the pelvic and abdominal aorta by a retrospective analysis of the clinicopathological data of endometrial cancer patients. The clinicopathological features and related factors of membrane cancer. Methods: from January 2008 to December 2014, 1445 patients with endometrial cancer confirmed by gynaecology in fourth hospital of Hebei Medical University were confirmed by surgical histopathology, and all patients were treated with total uterus, double appendage and pelvic abdominal aorta paraaortic lymph node resection. The patients' clinical, pathological and follow-up data were recorded in detail, and the Excel database of clinical follow-up data was established. The statistical analysis of these cases and clinical data was carried out with SPSS16.0 statistical software. The single factor analysis adopted chi square test and the exact probability of Fisher, and the multifactor analysis adopted the two yuan Logistic regression model, and the P0.05 was poor. Results: 1, 1445 cases of endometrial cancer were included in this study. The age distribution of the patients was 28~77 years old, the average age of onset was 53.76 + 8.375 years, the median age was 55 years, 720 (49.8%) in 55 years old, 725 cases (50.2%) in those aged over 55 years, and 884 cases of endometrial cancer in the postmenopausal patients, accounting for 61.2%. There were 561 cases without menopause, accounting for 38.8%, the average age of menopause was 57.54 years old and the age distribution was 57.54 + 6.757 years. The body mass index BMI25Kg/m2 was 454 cases, 31.4%, and BMI > 25 Kg/m2, accounting for 68.6%. minimum body mass index 15 Kg/m2 and maximum 49 Kg/m2. The average body mass index was 26.28 + 4.0311 Kg/m2. postmenopausal vaginal bleeding as the primary symptom. 72.8%, 103 cases of vaginal discharge, 7.1%, 124 cases of abnormal menstruation, 8.6%, other symptoms including abdominal pain, abdominal distention, 166 cases of physical examination, accounting for 194 cases of 11.5%. direct relatives cancer history, accounting for 13.4%, including 4 cases of endometrial cancer, 2 cases of ovarian cancer, 2 cases of cervical cancer, esophagus carcinoma 48 cases, gastric cardia 10 cases, gastric cancer 40 cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancer cases, breast cancers There were 6 cases of cancer, 20 cases of liver cancer, 10 cases of rectal cancer, 6 cases of pancreatic cancer, 1 cases of thyroid cancer, 1 cases of renal carcinoma, 1 cases of gingiva cancer, 1 cases of gall bladder cancer, 1 cases of larynx, 2 cases of blood system diseases, 461 cases of hypertension, 31.9%, and 111 cases with diabetes, combined with hypertension and diabetes, accounting for 4.8%.2 cases. In patients with endometrial carcinoma, 770 cases were operated on radical resection of endometrial carcinoma, accounting for 53.3% and 675 cases of laparoscopic surgery, accounting for 79 cases of 46.7%. highly differentiated G1, 5.5% in G2, 1097 in G2, 269 in low differentiated G3, 147 in 18.6%. without myometrium infiltration, 10.2%, 1002 in superficial myometrium infiltration, 69.3%, 296 in deep myometrium infiltration. In 20.5%., there were 95 cases of vascular tumor embolus, 6.6% and 1350 cases without vascular tumor thrombus, 277 cases of cervical interstitial invasion and 1168 cases of cervical interstitial invasion, 1168 cases of 80.8%. and 76 cases of CA125 more than 35U/ml before 5.3%., accounting for 1047 cases in 23.6%. I stage 1047, 72.5%, 211 cases in stage II, 14.6%, III There were 176 cases, 12.2% and 11 cases, 1366 cases of 0.7%. endometrioid adenocarcinoma, 94.5% non endometrioid carcinoma, 79 cases of non endometrioid carcinoma, including 7 cases of mixed carcinoma, 35 cases of plasma breast cancer, 23 cases of clear cell carcinoma, 5 cases of small cell carcinoma, 9 cases of mucous adenocarcinoma and 1445 cases of endometrial carcinoma, including lymph node metastasis in endometrial carcinoma, including pelvic lymphatic lymph node metastasis. There were 77 cases of metastasis and non metastasis of abdominal aorta lymph node, accounting for 70.6%, 13 cases of abdominal lymph node metastasis and non metastasis of pelvic lymph node, 11.9%, 19 cases of pelvic and abdominal lymph node metastases, accounting for 17.4%.: 1 body weight index BMI, serum CA125, tissue classification, myometrium infiltration, vascular tumor thrombus, cervical interstitial invasion, attached to the cervix, attached to the cervix of the cervix. The risk factors of pelvic and Pararal lymph node metastasis in endometrial carcinoma.2 deep muscular layer infiltration, vascular tumor thrombus, accessory metastasis is an independent risk factor for pelvic and abdominal aortic lymph node metastasis in endometrial carcinoma.3, the incidence of pelvic lymph node metastasis in endometrium carcinoma is higher than that of abdominal initiative. The incidence of para - pulse lymph node metastasis.

【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】：R737.33

【参考文献】