宫颈癌切除术后复发的动脉内化疗栓塞

Arterial chemoembolization for the recurrent cervical cancer following surgical resection

目的评估经导管动脉内选择性化疗栓塞治疗宫颈癌切除术后复发的可行性、安全性和短期疗效。方法回顾性分析37例宫颈癌切除术后复发的症状性患者资料,患者在接受栓塞治疗前伴有因肿瘤压迫而导致的症状:肾盂积水、下肢肿胀、盆腔疼痛。均接受了经导管动脉内选择性化疗栓塞,化疗药物采用顺铂,栓塞材料直径为360~510μm的明胶海绵颗粒。结果 37例患者的双侧髂内动脉造影显示:其中33例(89.2%,33/37)的肿瘤动脉发自单侧阴部内动脉,4例(10.8%,4/37)发自单侧副阴部内动脉;化疗栓塞后1个月的随访结果为:29例患者的肿瘤平均直径明显缩小(4.71±0.63)cm vs(4.37±0.73)cm,P<0.01;35例(94.6%,35/37)患者的临床症状明显或部分改善;无严重并发症发生。结论经导管动脉内选择性化疗栓塞治疗宫颈癌切除术后复发,具备技术可行性和安全性,能有效改善短期临床症状。

Objective To evaluate the feasibility, safety and short-term effectiveness of trans-catheter selective arterial chemoembolization for the recurrent cervical cancer following surgical resection. Methods Thirty-seven symptomatic patients with recurrent cervical cancer following resection were enrolled and underwent arterial injection chemotherapy using cisplatin combined with embolization using 350~500 μm sized gelatin sponge particles. The obstructive symptoms related to tumor included hydronephrosis, lower limb swelling, and pelvic pain. Results Angiographies at bilateral internal iliac arteries of 37 patients demonstrated that the tumor-feeding vessels originated from unilateral internal pudendal artery in 33（89.2%, 33/37） cases or accessory internal pudendal artery in 4 cases （10.8%, 4/37）. At 1 month follow-up, reduction in mean tumor size was significant （4.71±0.63） cm vs （4.37±0.73） cm, （P〈0.01） in 29 cases, and tumor-related symptoms were relieved significantly or partially in 35（94.6%, 35/37） cases. There were no major complications during the follow-up period. Conclusion Trans-catheter selective arterial chemoembolization for recurrent cervical cancer following surgical resection may be a safe and feasible procedure with good short-term effectiveness for relieving tumor-related symptoms.