中晚期宫颈癌动脉灌注化疗临床疗效分析

The Clinical Effect Analysis on Bilateral Internal Iliac Arterial Infusion Chemotherapy for Advanced Cervical Carcinoma

目的探讨动脉灌注化疗在中、晚期宫颈癌患者治疗中的临床疗效。方法回顾性分析2008年1月~2013年12月我科治疗的47例Ⅱb~Ⅲb期宫颈癌患者的临床资料,按FIGO分期:Ⅱb期36例,Ⅲa期1例,Ⅲb期10例;其中鳞状细胞癌46例,腺癌1例;病理分级:低分化8例,中分化21例,高分化18例。均行双侧髂内动脉灌注化疗,其中22例化疗后行广泛子宫切除+盆腔淋巴结清扫术。观察临床疗效、化疗后手术率、化疗前后患者的骨髓抑制、肝肾功能损害及其他并发症。结果 47例患者临床有效率为76.6%,化疗后手术率为46.8%。Ⅱb期患者临床有效率高于Ⅲ期患者,差异有统计学意义(χ2=12.241,P=0.001)。Ⅱb期患者手术率明显高于Ⅲa、Ⅲb期患者(χ2=15.032,χ2=13.843,P均<0.01)。宫颈癌患者肿瘤组织学分化程度与临床化疗缓解率无相关性(r=0.012,P=0.081);临床分期与临床化疗缓解率呈正相关(r=0.585,P=0.000)。化疗后患者白细胞(WBC)、血小板(PLT)较化疗前降低,丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转氨酶(AST)、肌酐值(Cr)及尿胆原(Ur)较化疗前升高(P<0.05)。均未发生严重不良反应。结论动脉灌注化疗对中晚期宫颈癌患者有较好的临床疗效及手术率,不良反应少,是一种有效的治疗方法。

Objective To investigate the clinical effect of bilateral internal iliac arterial infusion chemotherapy for treatment of advanced cervical carcinoma. Methods The clinical data of 47 cervical carcinoma cases were reviewed,including 36 of Ⅱb,1 of Ⅲa and 10 of Ⅲb according to FIGO staging. There were 46 cases of squamous-celled carcinoma and 1 case of adenocarcinoma. The pathological exam revealed poorly differentiated in 8 cases,moderately differentiated in 21 cases and well differentiated in 18 cases. Bilateral internal iliac arterial infusion chemotherapy was performed in all 47 cases,and radical hysterectomy and pelvic lymph node dissection was carried out in 22 cases after chemotherapy. The short-term clinical effect,operation rate were observed. The bone marrow suppression and liver and kidney function damage were observed before and after chemotherapy. Results The total remission rate was 76. 6%,and the operative rate after chemotherapy was 46. 8%. The effective rate was higher in stage Ⅱb than that in stage Ⅲ（χ2= 12. 241,P = 0. 001）,and the operative rate of stage Ⅱb patients was significantly higher than that of stage Ⅲa and Ⅲb patients（χ2= 15. 032,χ2= 13. 843,P〈0.01）. No correlation was found between tumor histological differentiation and clinical chemotherapy remission rate in cervical cancer patients（r = 0. 012,P = 0. 081）. There was a positive correlation between clinical stage and clinical chemotherapy remission rate（r = 0. 585,P = 0. 000）. The leu kocyte（WBC）and platelet（PLT）were decrease,while alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,urobilinogen（Ur）and creatinine（Cr）were increased after the chemotherapy（P〈0.05）.There was no serious adverse reaction after the operation.Conclusion The bilateral internal iliac arterial infusion chemotherapy can achieve a better clinical effect,high operation rate and less adverse reaction for advanced cervical carcinoma patients,and it is a kind of effective comprehensive therapy.