局部晚期宫颈癌术前放化疗39例临床疗效观察

Clinical efficacy of preoperative radiotherapy and chemotherapy in 39 patients with locally advanced cervical cancer

目的：分析术前同步放化疗＋宫颈癌根治术治疗宫颈癌局部晚期患者的临床疗效。方法选取局部晚期（IB-IIB 期）宫颈癌患者80例，对所有病例进行编号，采用随机数字表法分为观察组（术前放化疗组）39例和对照组（根治性放疗组），比较两组近期疗效、并发症发生情况和随访资料。结果两组一般资料差异无统计学意义，具有可比性。近期疗效比较：两组有效率比较（87．2％比95．1％）差异无统计学意义（χ2＝1．579，P ＝0．209）。早期并发症中，两组相比发生胃肠道反应（χ2＝0．000，P ＝0．987）、直肠反应（χ2＝2．709，P ＝0．100）、膀胱反应（χ2＝1．343，P ＝0．247）和骨髓抑制（χ2＝1．898，P ＝0．168）差异均无统计学意义。晚期并发症中，观察组放射性直肠炎[4例（10．3％）比14例（34．1％）]，放射性膀胱炎发生率[3例（7.7％）比13例（31．7％）]与观察组差异均有统计学意义（χ2＝6．542，P ＝0．011；χ2＝7．205，P ＝0．007）。随访：观察组病例平均随访时间为38．6个月，对照组平均随访时间为44．8个月；两组生存率差异均无统计学意义（χ2＝0．075，P ＝0．784；χ2＝0．032，P ＝0．858）。结论对于宫颈癌局部晚期（IB-IIB 期）患者应用术前同步放化疗，使局部巨块瘤体缩小明显，有利于实施手术，与根治性放疗相比减少了远期并发症发生率，具有重要临床价值。

Objective To analyze the clinical efficacy of preoperative concurrent radiotherapy and chemo-therapy and radical operation in the treatment of cervical cancer patients with locally advanced cervical cancer （IB -IIB）.Methods 80 patients who were diagnosed locally advanced （stage IB -IIB）cervical cancer,were divided into observation group （preoperative radiotherapy and chemotherapy group）and control group （radical radio-therapy group）.The short -term efficacy,complications and follow -up data were compared between the two groups. Results The short -term efficacy of the observation group was 87.2%,which of the control group was 95.1%,and there was no significant difference （χ2 =1.579,P =0.209）.As to the early complications of the two groups,there were no significant differences in gastrointestinal tract reaction（χ2 =0.000,P =0.987）,rectal reaction（χ2 =2.709, P =0.100）,bladder reaction （χ2 =1.343,P =0.247）and bone marrow suppression（χ2 =1.898,P =0.168）.Late complications：in the observation group,the radiation proctitis[4 cases（10.3%）vs.14 cases（34.1%）]and the radiation cystitis[3 cases（7.7%）vs.13 cases（31.7%）]were less than those of the control group,the differences were statistically significant（χ2 =6.542,P =0.011＆χ2 =7.205,P =0.007）.The average follow -up time was 38.6 months in the observation group,which was 44.8 months in the control group.There was no significant difference in survival rate between the two groups（χ2 =0.075,P =0.784 ＆ χ2 =0.032,P =0.858）.Conclusion Locally advanced cervical cancer （IB -IIB）patients received preoperative concurrent radiotherapy and chemotherapy has important clinical value.The treatment makes the local giant block tumor shrink significantly,which is conducive to the implementation of surgery,and reduce the incidence of late complications compared with radical radiotherapy.