本文選題：卵巢上皮癌 + 腫瘤細(xì)胞減滅術(shù)��； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的卵巢癌(ovarian cancer,OC)是女性生殖系統(tǒng)最常見(jiàn)的惡性腫瘤之一,其發(fā)病率僅次于宮頸癌、子宮內(nèi)膜癌,但死亡率居?jì)D科惡性腫瘤首位。卵巢上皮性腫瘤是最常見(jiàn)的卵巢腫瘤,占卵巢惡性腫瘤85%～90%,嚴(yán)重威脅女性健康。根據(jù)2015年NCCN指南指出晚期上皮性卵巢癌標(biāo)準(zhǔn)治療是滿意的腫瘤細(xì)胞減滅術(shù)(盡可能切除肉眼可見(jiàn)的所有病灶,使殘余癌灶1cm),獲得全面分期,術(shù)后給予足夠療程的化療、放療、生物治療等綜合治療。目前手術(shù)仍是卵巢癌的首要治療方法,但晚期卵巢癌已發(fā)生腹腔內(nèi)廣泛轉(zhuǎn)移和彌漫種植,滿意的腫瘤細(xì)胞減滅術(shù)后仍有較小的殘余病灶和癌細(xì)胞。雖然大多數(shù)卵巢癌患者對(duì)以鉑類(lèi)為主的化療藥物相對(duì)敏感,但由于血液-腹膜屏障的存在術(shù)后靜脈化療很難達(dá)到腹腔內(nèi)藥物濃度,疾病預(yù)后較差,復(fù)發(fā)率高。腹腔化療是將化療藥物直接放置腹腔內(nèi),增加藥物與惡性腫瘤的接觸面積,提高局部藥物濃度,顯著提高療效。腹腔熱灌注化療已在胃腸道腫瘤的治療中發(fā)揮了很好的療效,通過(guò)對(duì)腫瘤局部加溫,使之達(dá)到一定溫度持續(xù)一定時(shí)間,既能殺滅腫瘤細(xì)胞,又不損害正常組織,達(dá)到治療腫瘤的目的。近年來(lái),腹腔熱灌注化療聯(lián)合靜脈化療的臨床應(yīng)用逐漸增多,但關(guān)于灌注藥物及灌注時(shí)間尚無(wú)統(tǒng)一標(biāo)準(zhǔn),本研究對(duì)卵巢癌術(shù)后腹腔熱灌注聯(lián)合靜脈化療臨床療效及安全性進(jìn)一步研究,為晚期卵巢癌提供更多的治療方法。資料與方法1.資料來(lái)源:分析74例2011年01月～2015年06月就診于鄭州大學(xué)第二附屬醫(yī)院收治的臨床診斷III期～I(xiàn)V期的晚期上皮性卵巢癌患者,將74例晚期卵巢癌患者分為兩組:試驗(yàn)組35例(術(shù)后行腹腔熱灌注化療聯(lián)合靜脈化療);對(duì)照組39例(術(shù)后行靜脈化療)。觀察兩種治療方式的近期療效和化療毒副反應(yīng),并對(duì)兩組生存情況進(jìn)行對(duì)比,探討腹腔熱灌注化療在晚期上皮性卵巢癌中的臨床價(jià)值。2.統(tǒng)計(jì)學(xué)方法:采用SPSS17.0軟件分析,計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(?x±s)表示,采用t檢驗(yàn)分析;計(jì)數(shù)資料采用χ2檢驗(yàn)或Fisher確切概率法分析,化療毒副反應(yīng)采用秩和檢驗(yàn),用Kaplan-Meier法進(jìn)行生存曲線及單因素分析,多因素分析采用Cox比例風(fēng)險(xiǎn)回歸模型,Log-rank檢驗(yàn)生存差異,檢驗(yàn)水平a=0.05,P0.05時(shí)差異有統(tǒng)計(jì)學(xué)意義。結(jié)果1.在74例III～I(xiàn)V期的卵巢上皮性癌患者中,35例試驗(yàn)組患者接受腫瘤細(xì)胞減滅術(shù),術(shù)后給予腹腔熱灌注聯(lián)合靜脈化療,39例對(duì)照組患者接受腫瘤細(xì)胞減滅術(shù)聯(lián)合靜脈化療,兩組患者在年齡、病理類(lèi)型、臨床分期、殘余病灶等方面,差異無(wú)統(tǒng)計(jì)學(xué)意(P0.05)。2.試驗(yàn)組與對(duì)照組治療后CA125治療有效率分別是91.43%,79.49%,兩組對(duì)比差異有統(tǒng)計(jì)學(xué)意義(P0.05),腹水緩解率分別是97.14%,84.62%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組患者常見(jiàn)不良反應(yīng)為骨髓抑制、肝腎功能損害、胃腸道反應(yīng)、周?chē)窠?jīng)毒性、心血管損傷等方面,試驗(yàn)組骨髓抑制、胃腸道毒副反應(yīng)加重。4.試驗(yàn)組患者總生存期明顯延長(zhǎng),兩組對(duì)比差異有統(tǒng)計(jì)學(xué)意義,試驗(yàn)組和對(duì)照組5年生存率分別為42.86%、33.33%。結(jié)論1.腹腔熱灌注化療聯(lián)合靜脈化療的近期療效明顯,可有效控制腹水,提高臨床緩解率,優(yōu)于單純靜脈組。2.腹腔熱灌注化療聯(lián)合靜脈化療胃腸道反應(yīng)及骨髓抑制高于單純靜脈組,對(duì)癥治療后可緩解,未出現(xiàn)嚴(yán)重并發(fā)癥,安全可行。3.腹腔熱灌注化療聯(lián)合靜脈化療能夠延長(zhǎng)患者的中位總生存期,提高5年生存率。
[Abstract]:Background and objective ovarian cancer (OC) is one of the most common malignant tumors in the female reproductive system. Its incidence is second only to cervical cancer and endometrial cancer, but the mortality rate ranks first in gynecologic malignant tumors. Ovarian epithelial tumor is the most common ovarian tumor, accounting for 85% to 90% of ovarian malignant tumors, which is a serious threat to women's health. 2015 The NCCN guide points out that the standard treatment of advanced epithelial ovarian cancer is a satisfactory tumor cell reduction surgery (as far as possible all lesions visible to the naked eye, the residual cancer 1cm), comprehensive staging, sufficient chemotherapy, radiotherapy, and biological treatment after operation. Ovarian cancer has undergone extensive and diffuse implantation in the abdominal cavity, and there are still smaller residual foci and cancer cells after tumor cell subtraction. Although most ovarian cancer patients are relatively sensitive to platinum based chemotherapeutic drugs, it is difficult to achieve intraperitoneal drug concentration due to the presence of blood peritoneal barrier. The prognosis is poor and the recurrence rate is high. Intraperitoneal chemotherapy is to put chemotherapy drugs into the abdominal cavity directly, increase the contact area of the drug and malignant tumor, improve the local drug concentration and improve the curative effect. Peritoneal perfusion chemotherapy has played a very good effect in the treatment of gastrointestinal tumor. In recent years, the clinical application of intraperitoneal hyperthermia chemotherapy combined with intravenous chemotherapy has increased gradually in recent years. However, there is no unified standard about the perfusion and perfusion time. The clinical effect of intraperitoneal perfusion combined with intravenous chemotherapy after the operation of oval carcinoma is studied in this study. And further study of safety to provide more therapeutic methods for advanced ovarian cancer. Data and methods 1. sources: analysis of 74 cases of advanced epithelial ovarian cancer diagnosed in phase III to IV of the Second Affiliated Hospital of Zhengzhou University from 01 months to 06 months from 2011 to 06 months. 74 cases of advanced ovarian cancer were divided into two groups: Test Group 35 cases (intra-abdominal heat perfusion chemotherapy combined with intravenous chemotherapy), 39 cases in the control group (postoperative intravenous chemotherapy). Observe the short-term efficacy of the two treatments and the side effects of chemotherapy, and compare the survival of the two groups, to explore the clinical value of.2. in the clinical value of peritoneal perfusion chemotherapy in advanced epithelial ovarian cancer: the use of SPSS17. 0 software analysis, the measurement data were represented by mean number + standard deviation (? X + s), using t test analysis, the count data were analyzed by chi 2 test or Fisher exact probability method. The toxic and side effects of chemotherapy were tested by rank sum test, Kaplan-Meier method for survival curve and single factor analysis, multi factor analysis using Cox proportional risk regression model, Log-rank test student. The difference was statistically significant. Results 1. of the 74 cases of ovarian epithelial cancer in the III to IV stage, 35 of the 74 patients with III to IV were treated with tumor cell subtraction, postoperative intraperitoneal perfusion combined with intravenous chemotherapy, 39 cases of control group received tumor cell subtraction combined with intravenous chemotherapy, and the two group of patients were in the year. Age, pathological type, clinical stage and residual focus were not statistically significant (P0.05) in.2. test group and control group, the effective rate of CA125 treatment was 91.43%, 79.49%, and two groups were statistically significant (P0.05), and the remission rate of ascites was 97.14% and 84.62%, respectively. The difference was statistically significant (P0.05).3. two group patients common adverse reaction Bone marrow suppression, liver and kidney function damage, gastrointestinal reaction, peripheral neurotoxicity, cardiovascular damage, and other aspects, the total survival time of the test group was significantly prolonged in the.4. test group, the two groups were statistically significant, the 5 year survival rate of the experimental group and the control group was 42.86%, and the 33.33%. conclusion was 1. abdominal cavity. Hot perfusion chemotherapy combined with intravenous chemotherapy has obvious curative effect. It can effectively control ascites and improve clinical remission rate. It is superior to pure vein group.2. intraperitoneal hyperthermic chemotherapy combined with intravenous chemotherapy and gastrointestinal reaction and bone marrow suppression higher than that of pure vein group. It can be relieved after symptomatic treatment, without serious complications and safe and feasible.3. peritoneal perfusion. Chemotherapy combined with intravenous chemotherapy can prolong the median overall survival and increase the 5 year survival rate.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R737.31

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