巨块型宫颈癌术前静脉化疗的临床观察

Preoperative adjuvant chemotherapy in patients with bulky cervical carcinoma.

目的探讨术前静脉化疗对巨块型宫颈癌的疗效。方法选择我院2004年1月至2006年12月收治的23例Ⅰb期-Ⅱb期巨块型宫颈癌（局部肿块≥4cm）患者，术前予顺铂及氟尿嘧啶（5-Fu）联合化疗1～2疗程，化疗过程每周观察局部肿瘤体积的变化，化疗后2—3周行广泛子宫切除和盆腔淋巴结清扫术手术。术中记录出血量，术后病理检查盆腔淋巴结转移、宫颈浸润深度及标本切缘浸润情况，并与相同期别20例直接行根治术的巨型宫颈癌相比较。结果化疗组23例化疗后宫颈局部肿瘤均有不同程度缩小，有效率（100／％），显效率91、3／％，术中出血量（312．23±25．33）ml明显低于术前未行化疗的巨块型宫颈癌患者（414．59±38．16）ml（P〈0．01），盆腔淋巴转移率化疗组7／23，非化疗组6／20，无显著性差异（P〉0．05）。两组手术切缘均无肿瘤浸润，宫颈深肌层浸润率化疗组（5／23），非化疗组（6／20），无显著差异（P〉0．05）。结论巨型宫颈癌术前辅助化疗可明显缩小原发灶，降低分期，部分不能手术病人获得手术机会，增加手术切除率，减少术中出血。

Objective To investigate the effect of preoperative adjuvant chemotherapy on bulky cervical cancer. Methods 23 patients with bulky cervical cancer（ ≥4 cm） treated from Jan. 2004 to Dec. 2006 were enrolled in the study. Patients were initially treated with cisplatin and 5 -fu, followed by radical hysterectomy and pelvic lymph node dissection （Bc group）. The tumor size, invasive depth of cervical tumor, lymph node metastasis and incisional margin eendilions were compared with those of 20 patients with bulky tumors treated with radical hysterectomy alone （ Bn group）. Results Tumor size of Begroup patients decreased to a various degree after chemotherapy, the general effective rate being 100% , the significantly effective rate being 91.3%. Blood loss during operation （312.23±25.33ml） was significantly lower in Bc group patients than that in Bn group patients （414.59 ±38.16ml, P 〈0.05）. Metastatic rate of pelvic lymph nodes （7/23 in Bc group, 6/20 in Bn group, P 〉0. 05 ） and tumor infiltration rate of deep muscle （5/23 in Bc group, 6/20 in Bn group, P 〉0. 05 ） were not significantly different between the two groups. There was no tumor infiltration in incisional margin in the two groups. Conclusion Preoperative chemotherapy can decrease the primary tumor size and benefit the following radical surgery.