术前介入治疗对ⅠB_2～ⅡB期宫颈癌的疗效分析

The Effects of Preoperative Interventional Therapy on Stage ⅠB_2-ⅡB Cervical Carcinoma

目的:探讨术前介入治疗(动脉灌注化疗栓塞)对ⅠB2～ⅡB期宫颈癌患者的近期与远期疗效。方法:将1997年1月至2002年1月期间,解放军第169中心医院143例ⅠB2～ⅡB期宫颈癌患者分为观察组与对照组。观察组86例,采用术前介入治疗、手术及放射综合治疗;对照组57例,手术及放射综合治疗。观察介入治疗后不良反应、治疗前后癌灶局部情况及病理检查变化;比较两组的术中情况及术后的生存率及复发率。结果:术前介入治疗不良反应少,ⅠB2～ⅡB期宫颈癌总有效率为93.0%,可缩小肿瘤的体积,使患者临床分期及癌细胞的分级逆转;对照组术中出血量为615.87±108.35ml,观察组术中的出血量为395.06±84.70m(lP<0.05);对照组手术时间为4.61±0.62h,观察组为3.82±0.53h(P<0.05);对照组与观察组2年生存率分别为87.7%和93.0%(P>0.05),而对照组与观察组5年生存率分别为63.2%和83.7%(P<0.05);对照组与观察组2、5年内复发率分别为24.6%、10.5%和43.9%、26.7%(P<0.05)。结论:术前介入治疗能为宫颈癌患者进行根治手术创造条件,降低术后复发,改善预后,是一种疗效显著的治疗方法。

Objective： To investigate the short-term and long-term clinical efficacy of preoperative interventional therapy （intraarterial chemoembolization） on stage ⅠB2～ⅡB cervical cancer. Methods： From January 1997 to January 2002, 143 patients with stage ⅠB2～ⅡB cervical cancer were enrolled and randomly divided into the study group and the control group. Patients in the study group （n=86） were treated with preoperative interventional therapy, surgical therapy and postoperative radiotherapy. Patients in the control group （n=57） received surgical therapy and postoperative radiotherapy. Local lesions, pathological features, patient conditions during surgery, and the postoperative survival and recurrence rates were compared between the two groups. Results： The overall effective rate of interventional therapy for stage ⅠB2～ⅡB cervical cancer was 93.02%. Interventional therapy reduced tumor size and decreased the clinical stage and grade of carcinoma. The average intraoperative blood loss was 615.87 ± 108.35 ml in the control group and 395.06 ± 84.70 ml in the study group （P〈0.05）. The duration of surgery was 4.61 ± 0.62 hours in the control group and 3.82±0.53 hours in the study group （P〈0.05）. The 2-year survival rate was 87.7% in the control group and 93% in the study group （P〉0.05）. The 5-year survival rate was 63.2% in the control group and 83.7% in the study group （P〈0.05）. The 2-and 5-year recurrence rates were 24.6% and 10.5% in the control group and 43.9% and 26.7% in the study group （P〈0.05）. Conclusion： For patients with ⅠB2～ⅡB stage cervical cancer, preoperative interventional therapy can help ensure successful radical surgery, reduce the postoperative recurrence rate, and improve prognosis.