术前盆腔外照射放疗与术前新辅助化疗联合手术治疗局部晚期ⅠB2～ⅡB期宫颈癌疗效对比

The Comparison of Efficacy between Preoperative Pelvic External Radiotherapy and Neoadjuvant Chemotherapy Followed by Surgery on Cervical Cancer of Local Advanced ⅠB2-IIB Stage

目的探讨术前不同辅助治疗方法对局部晚期ⅠB2~ⅡB期宫颈癌的疗效。方法选择2006年1月至2009年12月农垦中心医院收治的经盆腔检查和宫颈活检病理诊断为ⅠB2~ⅡB期的宫颈癌患者85例,根据术前辅助治疗情况分为两组：A组（43例）接受术前盆腔外照射放疗,放疗结束后2~3周在腰硬联合麻醉下行宫颈癌根治术;B组（42例）接受术前新辅助化疗,化疗结束后3~4周在腰硬联合麻醉下行宫颈癌根治术。评价两组患者的近期疗效。结果 A组总有效率高于B组（79.1%vs 61.9%）,差异有统计学意义（P〈0.05）。A组术中出血量、手术前后血红蛋白差值显著低于B组[（0.38±0.08）L vs（0.45±0.09）L]、[（19.49±5.45）g vs（29.91±8.67）g]（P〈0.05）。A组术后盆腔淋巴转移率低于B组[（9.30%、0、30.23%、6.98%）vs（21.43%、4.76%、50%、21.43%）]（P〈0.05）。A组术后1、3年复发率明显低于B组[（23.3%、48.8%）vs（38.1%、61.9%）]（P〈0.05）;A组3年生存率高于B组[（83.7%）vs（73.8%）]（P〈0.05）。结论术前盆腔外照射放疗的疗效确切,术中出血量少,且具有更低的复发率和更高的生存率,值得临床予以推广。

Objective To explore efficacy of different methods of preoperative adjuvant therapy for locally advanced Ⅰ B2- ⅡB cervical cancer. Methods A total of 85 cases of cervical cancer patients treated by pelvic examination and cervical biopsy forⅠ B2-ⅡB period admitted to Guangdong Agribusiness Center Hospital from Jan. 2006 to Dec. 2009 were included in the study, according to the preoperative adjuvant therapy they were divided into two groups,43 cases of ⅠB2- Ⅱ B were given preoperative pelvic external radiotherapy（ group A） for 2-3 weeks before the radical operation of cervical carcinoma under combined spinal epidural anesthesia;42 cases were given neoadjuvant chemotherapy （group B ） for 3-4 weeks before radical operation of cervical carcinoma under combined spinal epidural anesthesia. The short-term effect of the two groups were evaluated. Results The total effective rate of group A was higher than group B（79.1% vs 61.9% ）, with statistically significant difference （ P 〈 0.05 ）. Bleeding volume, hemoglobin value before and after operation of group A were lower than that in group B [ （0.38 ± 0.08 ） L vs （ 0. 45 ± 0.09 ） L ], [ （ 19.49 ± 5.45 ） g vs （29.91 ± 8.67 ） g ] （ P 〈 0. 05 ） ; postoperative pelvic lymph node metastasis rate, residual rate of vaginal, cervical deep myometrial invasion, parametrial infiltration rate of group A were lower than that of B group [ （9.30% ,0,30.23% ,6.98% ） vs（21.43% ,4.76% ,50% ,21.43% ） ] （ P 〈 0.05 ）. Group A 1,3-year recurrence rate were less than B[ （23.3% ,48.8% ） vs（38.1% ,61.9% ） ] （P 〈0.05）, 3-year survival rate was higher than group B[ （83.7%） vs（73.8% ） ] （P 〈0.05）. Conclusion Preopera- tive pelvic external radiotherapy has exact efficacy,less intraoperative blood loss, and has a lower recurrence rate and higher survival,thus deserves promotion in clinical,