巨块型宫颈癌术前组织间插植放疗的疗效观察

The Efficacy of Interstitial Implant Brachytherapy in Preoperative Management of Bulky Cervical Carcinoma

目的探讨巨块型宫颈癌术前组织间插植放疗的治疗效果。方法收集Ⅰb～Ⅱb期巨块型宫颈癌58例,其中术前放疗组(A组)30例,行术前Ir192后装腔内组织间插植放疗1～2次,总剂量10～20 Gy,每周1次,放疗结束后1～2周行宫颈癌根治术;直接手术组(B组)28例,直接行宫颈癌根治术。观察A组放疗前后宫颈肿瘤退缩情况,比较A、B组术中、术后情况,判断巨块型宫颈癌术前组织间插植放疗的疗效。结果A组放疗后肿瘤直径较放疗前明显缩小(P<0.05),临床有效率高达90%,近期随访无明显不良反应。A组的手术时间、术中出血量较B组明显减少(P<0.05)。2组在术后胃肠道功能恢复时间、膀胱功能恢复时间及术后高危病理因素发生率方面差别无统计学意义(P>0.05)。结论术前适当剂量的腔内组织间插植放疗可使宫颈肿瘤缩小,利于手术,不影响术后恢复,无高危病理因素出现。

Objective To investigate the efficacy of interstitial implant brachytherapy in preoperative management of bulky cervical carcinoma. Methods Fifty-eight cases with stage Ⅰ b～Ⅱb cervical carcinoma in our study were divided into two groups, with group A thirty cases and group B twenty-eight cases respectively. Patients of group A were treated by interstitial implant brachytherapy with Ir^192 , the total dose of radiation being 10～20 Gy（10 Gy/f, 1 f/w）, and radical hysterectomy of cervical carcinoma was performed 1～2 weeks after the radiation. The tumor volume was checked by gynecological examination before the radiation and one week after the radiation, and complications of radiation was observed at the same time. Patients of group B were given operations directly without radiation. Results Tumor volume was significantly reduced after irradiation, the clinical effective rate was up to 90% and the incidence of complications was quite low. The operation time and blood loss of group A were significantly lower than those of group B, but there were not significant differences between the two groups in light of gastrointestinal function restoring time, bladder function restoring time and the overall rate of parametrial invasion, vessel invasion and lymphatic metastasis. Conclusion Preoperative interstitial implant brachytherapy in proper dose administered before radical hysterectomy may reduce the tumor volume and help to guarantee a successful operation.