本文選題：結腸鏡　切入點：結腸癌　出處：《青島大學》2017年碩士論文

【摘要】：目的:通過對結腸癌患者進行根治術后定期結腸鏡檢查隨訪,利于早期發(fā)現(xiàn)術后的復發(fā)病灶以及結腸息肉等結腸病變,探討定期結腸鏡隨訪檢查和鏡下對癥治療對降低結腸癌復發(fā)率、提高術后生存率的臨床意義;并對所有患者的臨床病理特征及可能會影響結腸癌術后復發(fā)的多種因素進行分析,探討影響結腸癌患者術后生存預后的因素。方法:對濰坊市人民醫(yī)院2013年12月~2014年12月收治的共445例已行結腸癌根治術(包括結腸鏡手術和開腹手術患者)且有組織病理學診斷為結腸癌的患者進行定期結腸鏡隨訪檢查,包括升結腸癌130例,橫結腸癌70例,降結腸癌95例,乙狀結腸癌150例。收集所有患者住院期間的臨床病理資料,包括性別、年齡、原發(fā)腫瘤的部位、原發(fā)腫瘤的組織學類型及TNM分期、分化程度、淋巴結轉移情況、以及術前血清癌胚抗原(CEA)的水平。隨訪過程中,結腸鏡檢查對可疑結腸病變?nèi)』顧z標本送病理科做進一步檢查,抽血檢測CEA的水平,發(fā)現(xiàn)結腸息肉后及時行鏡下高頻電或圈套器套扎術治療。對發(fā)現(xiàn)可疑病變的復查者進一步做多普勒彩超和CT檢查,判斷術后有無復發(fā)。根據(jù)結腸鏡和影像檢查結果,以及病理檢查結果,進一步分析結腸癌患者的性別、年齡、淋巴結轉移、術前血清中CEA水平、腫瘤原發(fā)部位以及原發(fā)腫瘤的病理類型及TNM分期對結腸癌術后預后和復發(fā)的影響。結果:所有結腸癌患者術后兩年內(nèi)每6個月進行一次結腸鏡檢查,共檢出吻合口復發(fā)癌40例,多原發(fā)癌28例,吻合口炎45例,腺瘤性息肉51例,共105枚,均行結腸鏡下高頻電摘除或圈套器套扎術治療。隨訪結果顯示:結腸癌根治術后患者的復發(fā)情況與原發(fā)癌發(fā)病時患者的年齡、性別以及原發(fā)癌的部位關系并不大,無統(tǒng)計學意義;結腸癌的復發(fā)與原發(fā)腫瘤的病理類型、分化程度以及TNM分期密切相關,復發(fā)率分別為高分化腺癌(14.3%),中分化腺癌(18.3%),低分化腺癌(27.9%),乳頭狀腺癌(4.7%),以及粘液腺癌(15.3%),Ⅰ期患者(9.1%),Ⅱ期患者(11.7%),Ⅲ期患者(22%),Ⅳ期患者(33.9%);結腸癌患者術前血清中CEA水平以及是否已發(fā)生淋巴結轉移也是影響根治術后患者復發(fā)率和生存率的重要因素,其中原發(fā)癌患者血清中CEA水平越高,以及發(fā)生淋巴結轉移者,術后復發(fā)率顯著增高,復發(fā)率分別為CEA水平≥25 ng/ml的患者21.5%,CEA水平介于5~25ng/ml之間的患者16.8%,CEA水平≤5ng/ml患者5.7%。因此,CEA水平以及淋巴結轉移情況可以作為指導臨床治療方案實施的重要參考依據(jù)。結論:1.結腸癌患者術后定期隨訪是結腸癌手術治療后一個不可缺少的重要環(huán)節(jié),是目前根治術后隨訪最有效的檢查手段。2.通過結腸鏡能夠?qū)Y腸息肉直接行電凝切除,有效阻斷腺瘤性息肉等癌前病變向癌癥轉化,對降低結腸癌術后的再復發(fā)具有較大的臨床價值。3.結腸癌患者術后復發(fā)與患者發(fā)病時的年齡、性別以及原發(fā)腫瘤的位置相關性不大。4.結腸癌的復發(fā)與原發(fā)腫瘤的病理類型、分化程度以及TNM分期密切相關,其中原發(fā)癌病理類型分化程度越低,TNM分期等級越高,結腸癌術后的復發(fā)率越高。5.結腸癌患者術前血清中CEA水平以及是否已發(fā)生淋巴結轉移也是影響根治術后患者復發(fā)率和生存率的重要因素,其中原發(fā)癌患者血清中CEA水平越高,以及發(fā)生淋巴結轉移者,術后復發(fā)率顯著增高,因此,CEA水平以及淋巴結轉移情況可以作為指導臨床治療方案實施的重要參考依據(jù)。
[Abstract]:Objective: through regular follow-up colonoscopy after radical resection of colon cancer patients, to early detection of postoperative recurrence of colon polyps and colon lesions and lesions of regular colonoscopy and endoscopic follow-up examination, symptomatic treatment to reduce the recurrence rate of colon cancer, the clinical significance of improving survival rate; and the analysis of the will effect of postoperative colon cancer recurrence factors and clinical pathological features of all patients, the prognostic factors of survival of patients with colon cancer. Methods: the Weifang People's Hospital in December 2013 ~2014 year in December from a total of 445 patients with colon cancer resection (including colonoscopy surgery and open surgery patients) and tissue pathology the diagnosis of colon cancer patients with regular colonoscopy follow-up examination, including 130 cases of ascending colon cancer, 70 transverse colon, descending colon cancer in 95 cases, 150 cases of sigmoid colon. Collect all Hospitalized patients during the clinical and pathological data, including gender, age, primary tumor site, tumor histological type and TNM stage, degree of differentiation, lymph node metastasis and preoperative serum carcinoembryonic antigen (CEA) level. During the follow-up, colonoscopy check on suspected colonic lesions from biopsy specimens were sent to the pathology department for further examination, serum CEA level, the timely endoscopic electrosurgical snare or ligation in the treatment of colonic polyps. Further found after Doppler ultrasound and CT examination of suspicious lesions were judged, postoperative recurrence. According to colonoscopy and imaging results, and the results of pathological examination, further analysis of colorectal cancer patients with sex, age, lymph node metastasis, preoperative serum CEA level, pathological type and TNM primary tumor site and primary tumor staging of colorectal cancer recurrence and prognosis 褰卞搷.緇撴灉:鎵，

本文編號：1661412