巨块型子宫颈癌介入性化疗中不同栓塞方式的分析

Evaluation of Different Methods of Embolization in Interventional Chemotherapy of Bulky Cervical Carcinoma

目的探讨介入性化疗不同栓塞方式对巨块型(直径≥4 cm)子宫颈癌的疗效及其副反应的比较。方法回顾分析能完成子宫动脉(单或双侧)超选择插管的52例巨块型子宫颈癌患者的临床病理资料,分为超液化碘油与丝裂霉素混悬剂栓塞肿瘤供血动脉后续化疗药物灌注组(A组)28例及灌注2/3量化疗药物后用携带有化疗药物(1/3量)的明胶海绵颗粒栓塞肿瘤供血动脉(B组)24例,并对两组的疗效和毒副反应进行比较。结果两组的化疗有效率和化疗后手术率比较差异统计学意义(P>0.05)。A组1次介入术后肿块缩小率为43.4%-62.7%。坏死率为78%-91%,均明显高于B组的31.1%-40.3%及54%-77%(P<0.05)。介入化疗期间两组均无不能耐受的毒副反应,但动脉栓塞并发症A组病例较B组严重。A组2年复发率为5.3%,明显低于B组的20%(P<0.05)。结论巨块型子宫颈癌介入栓塞化疗安全有效,而缩小肿瘤和降低术后复发率以应用超液化碘油等末梢栓塞剂较佳。

Objective To study the therapeutic effect and side reaction of different methods of embolization in interventional chemotherapy of bulky cervical carcinoma. Methods A retrospective study was carried out for 52 patients with cervical carcinoma that the superselective intubation of uterine artery （unilateral or bilateral） was successfully accomplished. All cases were divided into two groups. Group A （ n = 28 ） was performed the arterial ehcmoembolization with lipiodol - mitomycin C emulsion before the drug perfusion through the bilateral feeding arteries. Group B （ n = 24） was performed the arterial chemoembolization with gelfoam particles mixed with 1/3 total drug dose after 2/3 total drug dose perfusion through the bilateral feeding arteries. The therapeutic effect and side reaction of the two groups were analyzed and compared. Results The differences of the effective rate and the operative rate after chemotherapy between the two groups showed no significance （ P 〉 0.05 ）. The contractible and nec- rotic rate in group A （43.4% -62.7% and 78% -91% respectively） was evidently higher than that in group B （31.1% - 40.3% and 54% - 77% respectively,P 〈0.05 ）. No intolerant toxic and adverse effects were found in all patients during chemotherapy. But the complication of arterial embolization in group A was more serious than that in group B. The 2-year recurrent rate in group A （ 5.3 % ） was evidently lower than that in group B （ 20%, P 〈 0.05 ）. Conclusions Interventional chemoembolization is safe and effective for treating patients with bulky cervical carcinoma. It is better using distal embolism for dwindling the size of tumor and debasing the postoperative recurrent rate.