摘要
目的探讨瘦素(Leptin)、血管内皮生长因子(Vascular endothelial growth factor,VEGF)及不同麻醉方式对子宫内膜癌(Endometrial carcinoma,EC)预后生存的影响。方法回顾性分析本院在2012年1月—2013年11月期间接诊的345例有关子宫内膜的病历资料,分为正常子宫内膜组(63例)、不典型增生组(85例)和子宫内膜癌组(197例)。子宫内膜癌组以患者自愿选择的麻醉方式分类:连续硬膜外阻滞+静吸复合全身麻醉(方式A);静吸复合全身麻醉(方式B),术后随访观察两种麻醉方式对子宫内膜癌患者预后的影响。免疫组织化学SP法检测不同子宫内膜组织中Leptin、VEGF蛋白的表达,Kaplan-Meier法和Cox风险比例模型分析不同麻醉方式及Leptin、VEGF蛋白对子宫内膜癌患者预后的影响。结果 Leptin在正常子宫内膜组、不典型增生组和子宫内膜癌组阳性表达率分别为9. 52%、32. 94%、78. 68%,差异有统计学意义(χ2=105. 873,P <0. 05); VEGF在正常子宫内膜组、不典型增生组和子宫内膜癌组阳性表达率分别为4. 76%、21. 18%、68. 02%,差异亦有统计学意义(χ2=98. 976,P <0. 05)。Kaplan-Meier单因素分析显示,麻醉方式为A的EC患者1、3、5年生存率均高于方式B(P <0. 05),方式A预后生存显著优于方式B; Leptin、VEGF阳性表达患者的生存率低于二者阴性表达的患者(P<0. 05)。Cox模型分析子宫内膜癌患者预后各因素显示,手术病理分期、组织学分级、淋巴结转移和VEGF阳性表达是影响子宫内膜癌患者预后的显著因素。结论连续硬膜外阻滞+静吸复合全身麻醉方式在子宫内膜癌手术中效果好于静吸复合全身麻醉,预后好,生存时间较长,转移较晚。Leptin和VEGF在子宫内膜癌中的表达与正常组和不典型增生组差异有统计学意义,在子宫内膜癌中表达呈正向协同作用。
Objective The Objective of this study was to investigate effects of Leptin,vascular endothelial growth factor（VEGF）and different anesthetic Methods on prognosis of endometrial carcinoma（EC）.Methods A retrospective analysis of 345 cases of endometrial medical records from January 2012 to November 2013 were performed.The patients were divided into normal endometrial group（63 cases）,dysplasia group（85 cases）and EC group（197 cases）.The EC group was classified according to the patient＆apos;s voluntary choice of anesthesia：continuous epidural anesthesia ＋ static inhalation combined general anesthesia（mode A）and static inhalation combined general anesthesia（mode B）as well as postoperative follow-up observed two kinds of anesthesia for prognosis impact of EC.Immunohistochemical SP method was used to detect the expression of Leptin and VEGF protein in different endometrial tissues.Kaplan-Meier single factor and Cox risk ratio model were used to analyze the effects of different anesthetic Methods and Leptin,VEGF protein on prognosis of EC patients.Results The positive expression rates of Leptin in normal endometrium,atypical hyperplasia and EC groups were 9.52%,32.94% and 78.68%,respectively,and the differences was statistically significant（χ2=105.873,P〈0.05）.The positive expression rates of VEGF in normal endometrium,atypical hyperplasia and EC groups were 4.76%,21.18%,68.02%,respectively,and the differences was also statistically significant（χ2=98.976,P〈0.05）.Kaplan-Meier univariate analysis showed that 1-,3-and 5-year survival rates of EC patients with anesthesia of model A were higher than those of model B（P〈0.05）.The prognosis survival of mode A was significantly better than that of mode B.The survival rate of patients with positive expression of Leptin and VEGF were lower than that of patients with negative expression（P〈0.05）.Cox model analysis of EC patients with prognosis showed that surgical pathological staging,histological grade,lymph node metastasis,an
作者
李美艳
陈永学
侯俊德
LI Meiyan;CHEN Yongxue;HOU Junde(The First Department of Gynaecology,Handan Central Hospital,Handan 056008,China;Department of Anesthesiology,Handan Central Hospital.)
出处
《实用肿瘤学杂志》
CAS
2018年第5期426-431,共6页
Practical Oncology Journal
基金
邯郸市科学技术研究与发展计划项目(编号:1623208063-9)
关键词
子宫内膜癌
麻醉方式
瘦素
VEGF蛋白
预后
Endometrial neoplasms
Anesthesia method
Leptin VEGF protein Prognosis
