胰腺癌患者术后复发危险因素研究
点击此处>>查看其余5篇临床医学硕士范文第六篇临床医学硕士论文标题：胰腺癌患者术后复发危险因素研究本篇文章目录导航：[]胰腺癌患者术后复发危险因素研究[第一章-第二章]63名胰头部导管腺癌患者复发资料与方法[第三章]胰十二指肠切除术 更多精彩就在： 51免费论文网|www.hbsrm.com
后癌症复发研究结果[第四章-第五章]胰腺癌手术治疗复发影响因素讨论与结论[综述-参考文献]胰腺癌的综合治疗中文摘要胰头癌胰十二指肠切除术后复发危险因素分析目的：通过对吉林大学第一医院4年间收治的胰头部导管腺癌行胰十二指肠切除术(pancreaticoduodenectomy,PD)患者的临床资料进行总结,分析胰头癌行PD手术切除后与患者肿瘤复发和预后的相关危险因素,探讨预测患者术后生存期的因素,更好的指导临床诊治.方法：回顾性分析我院2013年1月至2016年12月收治的63例胰头部导管腺癌行胰十二指肠切除术(PD)患者的临床资料,包括一般资料(年龄.性别等).术前血清学检查.术后病理结果及术后是否行放化疗等.观察指标:(1)患者术前检查结果:血清总胆红素.白蛋白值.肿瘤标志物(主要包括CA19-9.CA125.CEA)等.(2)手术资料:术中出血量.术后并发症(胰瘘.胆瘘.胃排空延迟.腹腔感染.出血等).(3)病理学检查结果:肿瘤分化程度.淋巴结转移.血管侵犯.(4)患者随访结果:肿瘤复发情况.术后生存情况.采用随访门诊.电话方式随访.术后1年内每3个月随访1次,1年之后每6个月随访一次,随访以肿瘤出现复发或患者死亡为事件终点.随访内容包括病史采集.体格检查.实验室检查(包括CA19-9.CA125.CEA.肝功能.血常规等)及影像学检查(腹部超声.腹部CT或MRI等).若怀疑有复发转移可提前行该检查.复发的诊断主要依据影像学检查结果.肿瘤标志物和临床表现.数据使用Excel2007进行整理,采用SPSS22.0软件进行统计分析,计数资料采用频数或率表示,早期复发危险因素分析中单因素采用卡方检验,多因素分析采用二元非条件Logistic回归；术后无复发生存分析中单因素和多因素分析均采用COX比例回归；生存曲线绘制采用Kaplan-Meier法；以p<0.05判定为有统计学意义.结果:本研究共随访了63名胰头部导管腺癌患者,最长随访时间为38.0个月,中位随访时间为11.0个月,随访过程中共有3名患者失访,失访率为4.76%,随访中一年内共有37名患者发生复发,一年内复发率为58.73%,整个随访中共有53名患者发生复发,复发率为84.13%.术后无复发中位生存时间为11.00(9.47~12.53)个月.术后1年.2年.3年无复发生存率分别为41.27%.20.11%和8.94%.根据患者术后一年内是否发生复发将所有患者分为早期复发组和非早期复发组.单因素分析结果显示年龄.CA19-9.CA125.CEA.白蛋白.脉管转移.淋巴结转移.肿瘤分化程度和术后化疗是影响术后早期复发的危险因素.采用多因素Logistic回归分析上述因素,结果显示CA125.脉管转移.淋巴结转移.肿瘤分化程度以及术后是否行化疗是影响术后早期复发的独立危险因素.将患者一般资料.术前实验室检查资料.术中资料.术后病理学检查结果及术后是否行化疗进行单因素分析,结果显示年龄.CA19-9.CA125.CEA.白蛋白.脉管转移.淋巴结转移.肿瘤分化程度和术后是否行化疗是胰头部导管腺癌患者PD术后无复发生存的影响因素,(p<0.05).然后将这些因素使用COX比例风险回归模型进行分析,结果提示年龄.CA19-9.白蛋白.脉管转移.肿瘤分化程度.术后是否行化学治疗与无复发生存率有关,可被认为独立危险因素.结论:1．CA125.脉管转移.淋巴结转移.肿瘤分化程度和术后化疗为影响术后早期复发的独立危险因素.2.年龄.CA19-9.白蛋白.脉管转移.肿瘤分化程度.术后化疗是影响术后无复发生存率的独立危险因素.关键字:胰腺癌,胰十二指肠切除术,复发,治疗,预后AbstractObjective:Throughthefirsthospitalofjilinuniversityfouryearsofpancreaticductaladenocarcinomaoftheheadofpancreaticoduodenalresection(pancreaticoduodenectomy,PD)summarizedtheclinicaldataofpatients,analysislinePDaftersurgicalremovalofthepancreaticheadcarcinomaassociatedwithtumorrecurrenceandprognosisofpatientswithriskfactors,factorsonpatientswithpredictedpostoperativesurvivalandbetterguidetheclinicaldiagnosisandtreatment.Method:RetrospectiveanalysisinJanuary2013toDecember2016,63casesofpancreaticductaladenocarcinomaoftheheadofpancreaticoduodenalresection(PD)inpatientswithclinicaldata,includinggeneralinformation(age,gender,etc.),preoperative,postoperativepathologicresultsandserologictestingwhetherpostoperativeradiationandchemotherapy,etc.Observationindexes:(1)preoperativeexaminationresults:serumtotalbilirubin,albuminvalue,tumormarkers(mainlyCA19-9,CA125,CEA,etc).(2)surgicaldata:intraoperativehemorrhage,postoperativecomplications(pancreaticfistula,biliaryfistula,delayedgastricemptying,abdominalinfection,bleeding,etc.).(3)pathologicalexaminationresults:tumordifferentiationdegree,lymphnodemetastasis,andvascularinvasion.(4)follow-upresults:tumorrecurrenceandpostoperativesurvival.Follow-upoutpatientandtelephonefollow-upwereconducted.Thefollow-upwasperformedevery3monthsfor1year,followedby1yearafter1year,followedbyarecurrenceoftumorordeathofthepatient.Follow-upincludedmedicalhistory,physicalexamination,laboratoryexamination(includingCA19-9,CA125,CEA,liverfunction,bloodroutine,etc.)andimagingexamination(abdominalultrasound,abdominalCTorMRI,etc.).Ifarecurrenceissuspected,itcanbecheckedinadvance.Thediagnosisofrecurrencewasmainlybasedonimagingfindings,tumormarkersandclinicalmanifestations.DatausingExcel2007,adoptingSPSS22.0statisticalanalysissoftware,countdatausingfrequencyorrate,saidearlyrecurrenceriskfactorsanalysisofsinglefactorusingchi-square,multi-factoranalysisusingbinaryunconditionedLogisticregression;COXproportionalregressionwasusedintheanalysisofsinglefactorandmultifactorinpostoperativesurvivalanalysis.Thesurvivalcurvewasplottedusingkaplan-meiermethod;p<0.05wasconsideredasstatisticallysignificant.Result:Thisstudyfollowed63patientswithpancreaticductaladenocarcinomaofthehead,thelongestfollow-uptimewas38.0monthsandthemedianfollow-uptimeof11.0months,there'reatotalof3patientslosttofollow-upprocess,losttofollow-upratewas4.76%,followedupayearatotalof37casesofrecurrence,therecurrencerateof58.73%ayear,thefollow-upofthecommunistpartyofChinaa53patientshadarelapse,therecurrenceratewas84.13%.Thepostoperativesurvivaltimewas11.00(9.47~12.53).Therecurrenceratewas41.27%,20.11%and8.94%,respectively,1year,2yearsand3yearsaftersurgery.Allpatientsweredividedintoearlyrelapsegroupandnon-earlyrecurrencegroupaccordingtowhetherrecurrenceoccurredwithinoneyearaftersurgery.Theresultsofsinglefactoranalysisshowedthatage,CA19-9,CA125,CEA,albumin,vascularization,lymphnodemetastasis,tumordifferentiationandpostoperativechemotherapyweretheriskfactorsforearlypostoperativerecurrence.MultiariableLogisticregressionanalysistotheabovefactors,theresultsshowedthatCA125,vascularmetastasis,lymphnodemetastasis,tumordifferentiationdegreeandpostoperativechemotherapyareindependentriskfactorsforearlypostoperativerecurrence.Thepatients'generalinformation,preoperativelaboratorydata,intraoperativeandpostoperativepathology,checkwhethertheresultsandpostoperativechemotherapyforsinglefactoranalysis,theresultsshowedthatage,CA19-9,CA125,CEA,albumin,vascularmetastasis,lymphnodemetastasis,tumordifferentiationdegreeandpostoperativechemotherapywaspancreaticductaladenocarcinomaoftheheadtheinfluencefactorsofpostoperativerelapse-freesurvivalinpatientswithPD,(p<0.05).ThenthesefactorsusingCOXproportionalhazardsregressionmodelisanalyzed,theresultssuggestage,CA19-9,albumin,vascularmetastasis,tumordifferentiationdegree,whetherpostoperativechemotherapyassociatedwithrelapse-freesurvivalrate,canbeconsideredindependentriskfactors.Conclusion:1.CA125,vascularmetastasis,lymphnodemetastasis,tumordifferentiationandpostoperativechemotherapyareindependentriskfactorsforearlypostoperativerecurrence.2.Age,CA19-9,albumin,vascularmetastasis,degreeoftumordifferentiation,andpostoperativechemotherapyareindependentriskfactorsinfluencingpostoperativesurvivalwithoutrecurrence.Keywords:Pancreaticcancer,pancreaticoduodenectomy,recurrence,treatment,prognosis.目录第1章前言第2章资料与方法2.1研究对象2.2一般资料2.3统计学方法第3章结果3.1研究对象一般情况3.2研究对象术后随访的复发情况3.3术后早期复发危险因素分析3.3.1术后早期复发危险因素的单因素分析3.3.2术后早期复发危险因素的多因素分析3.4胰头癌胰十二指肠切除术后影响无复发生存的危险因素分析3.4.1影响胰头癌PD术后无复发生存的危险因素单因素分析3.4.2影响胰头癌PD术后无复发生存的危险因素多因素分析第4章讨论4.1血清肿瘤标志物检测的意义4.2病理因素对胰头癌术后早期复发及无复发生存的意义4.3术后化疗对胰头癌早期复发及无复发生存的意义4.4年龄.白蛋白值对胰头癌术后无复发生存率的意义第5章结论综述参考文献攻读硕士期间撰写及发表的论文作者简介致谢
后癌症复发研究结果[第四章-第五章]胰腺癌手术治疗复发影响因素讨论与结论[综述-参考文献]胰腺癌的综合治疗
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