单次大剂量顺铂术前不同给药途径在局部晚期子宫颈癌中的疗效分析

Analysis of clinical effect of single high dose cisplatin administration in different ways before operation for local advanced cervical cancer

目的探讨局部晚期子宫颈癌术前单次大剂量顺铂不同途径给药的临床疗效、手术率、化疗毒副反应以及术后生存率。方法分析丽水市中心医院2013年1月1日至2019年12月31日收治局部晚期子宫颈癌ⅠB2~ⅡA2期患者207例,根据化疗途径不同分为两组:超选择子宫动脉插管灌注单次大剂量顺铂+栓塞术(简称动脉化疗组)106例及同剂量顺铂静脉滴注化疗(简称静脉化疗组)101例,化疗结束后3周左右,对两组临床疗效、毒副反应、手术率及术后5年生存率进行分析。结果动脉化疗组近期有效率92.5%(98/106),静脉化疗组近期有效率87.1%(88/101),两组比较无统计学意义(P=0.205)。动脉化疗组手术率97.2%(103/106),静脉化疗组手术率93.1%(94/101),两组比较无统计学意义(P=0.169)。随访动脉化疗组5年生存率90.6%(96/106),静脉化疗组5年生存率86.1%(87/101),两组比较无统计学意义(P=0.962)。化疗期间未发现不能耐受的毒副反应,静脉化疗组的副反应如胃肠道反应、骨髓抑制、脉管炎化疗副反应大于动脉化疗组,两组比较差异有统计学意义(P<0.05)。结论局部晚期子宫颈癌术前单次大剂量顺铂超选择子宫动脉灌注+栓塞术,与静脉化疗组相比疗效类似,但妇科检查子宫颈局部病灶缩小、宫旁阴道旁条件改善比静脉化疗组明显,安全有效性更高。

Objective To investigate the clinical effect,operation rate,side effects of chemotherapy and postoperative survival rate of single high dose cisplatin administration in different ways before operation for locally advanced cervical cancer.Methods Analyze the data of 207 cases of stageⅠB2-ⅡA2 local advanced cervical cancer admitted to our hospital from January 1,2013 to December 31,2019,which were divided into two groups according to different chemotherapy routes:106 cases receviing superselective uterine artery catheterization and perfusion with single high dose cisplatin+embolization(referred to as artery chemotherapy group)and 101 cases receiving the same dose of cisplatin for intravenous drip chemotherapy(referred to as vein chemotherapy group).Three weeks after stopping chemotherapy,the clinical effect,side effects,operation rate and 5-year survival rate of the two groups were analyzed.Results The short-term effective rate of arterial chemotherapy group was 92.5%(98/106),the short-term effective rate of intravenous chemotherapy group was 87.1%(88/101),and there was no significant difference between the two groups(P=0.205).The operative rate of arterial chemotherapy group was 97.2%(103/106),while that of intravenous chemotherapy group was 93.1%(94/101),there was no significant difference between the two groups(P=0.169).The 5-year survival rate of the arterial chemotherapy group was 90.6%(96/106),and the 5-year survival rate of intravenous chemotherapy group was 86.1%(87/101),there being no significant difference between the two groups(P=0.962).No intolerable side effects were found during chemotherapy;the side effects of intravenous chemotherapy,such as gastrointestinal reaction,myelosuppression and vasculitis,were greater than those of arterial chemotherapy,the difference between the two groups being statistically significant(P<0.05).Conclusion The effect of single high-dose cisplatin superselective uterine artery perfusion plus embolization before operation for locally advanced cervical cancer is similar to that in the intravenous chemotherapy group,but the reduction in local cervical lesions and the improvement of paravaginal conditions in gynecological examination are more obvious than those in the intravenous chemotherapy group,and it is safer and more effective.