两种不同方案术前治疗宫颈癌Ib2期的疗效比较

Comparison of curative effects of two different preoperative therapy programs in treatment of phase Ib2 cervical cancer

目的：对比术前放疗和TP（紫杉醇＋顺铂）方案术前化疗对于宫颈癌Ib2期的临床疗效、手术影响、放化疗不良反应及远期复发率、生存率影响。方法：采取随机数字表法将2008年1月～2010年12月江南大学附属医院收治的宫颈癌Ib2期100例分为两组,实验组采取术前放疗,对照组采取TP方案术前化疗。对比两组患者治疗前后宫颈肿块体积,两组患者治疗后的骨髓抑制和胃肠道反应发生情况,两组患者手术时间、术中出血量,两组患者术后病理提示的宫旁浸润、阴道残端浸润、深肌层浸润、宫颈间质浸润发生率,两组患者的3年生存率及复发率。结果：两组患者在治疗后的宫颈肿块体积均显著下降（P〈0.01）,但实验组放疗后肿块体积显著小于对照组（P〈0.01）;对照组化疗后的不良反应与实验组放疗后无统计学差异（P〉0.05）;实验组的手术时间和术中出血量显著低于对照组（P〈0.05）;术后病理实验组的浸润转移程度显著低于对照组（P〈0.05）;实验组的术后3年生存率与对照组比较无统计学差异（P〉0.05）;实验组术后3年复发率与对照组比较,无统计学差异（P〉0.05）。结论：术前放疗优于化疗缩小局部肿瘤,两者均可减少术中出血,有利于手术切除宫旁及阴道旁组织,缩短手术时间,但术前放疗或化疗影响可能本身存在的亚临床微小转移灶的病理诊断,术前的放化疗并不提高3年生存率。

Objective： To compare the clinical effects,surgical effects,side effects and long- term recurrence rates and survival rates between preoperative radiotherapy and preoperative chemotherapy with TP regimen（ taxol combined with cis- platinum） in treatment of phase Ib2 cervical cancer. Methods： One hundred cases with phase Ib2 cervical cancer treated in the hospital from January 2008 to December 2010 were divided into two groups by random number table. The cases in experimental group were treated with preoperative radiotherapy,while the cases in control group were treated with preoperative chemotherapy with TP regimen. The volumes of cervical tumors before and after treatment,the incidence rates of myelosuppression and gastrointestinal reactions after treatment,the operation times,the amounts of blood loss during operation,the incidence rates of parauterine invasion,vaginal residual invasion,deep myometrial invasion and cervical interstitial invasion after treatment displayed by pathological examination,three- year survival rates and three- year recurrence rates in the two groups were compared. Results： The volumes of cervical tumors in the two groups decreased significantly（ P〈0. 01）,but the volume of cervical tumors in experimental group after treatment was statistically significantly less than that in control group（ P〈0. 01）; there was no statistically significant difference in the incidence rate of adverse reactions after treatment between the two groups（ P〈0. 05）; the operation time and the amount of blood loss during operation in experimental group were statistically significantly lower than those in control group（ P〈0. 05）;the degree of invasion and metastasis displayed by pathological examination after treatment in experimental group was statistically significantly lower than that in control group（ P〈0. 05）; there was no statistically significant difference in three- year survival rate and three- year recurrence rate between the two groups（ P〈0. 05）. Conclusion：Preoperative radiotherapy is superior to chemotherapy in reducing local tumor,both of which can reduce blood loss,be helpful to surgical removal of the pathological tissues adjacent to uterus and vagina,shorten operation time,but preoperative radiotherapy or chemotherapy may have impact on pathological diagnosis of cases with tiny subclinical metastasis,preoperative radiotherapy or chemotherapy can＇t improve three- year survival rate.