早期巨块型宫颈癌术前静脉化疗临床观察

An Analysis of Preoperative Adjuvent Chemotherapy in Patients with Early- stage Bulky Cervical Carcinoma

[目的]探讨辅助化疗对早期巨块型宫颈癌的疗效。[方法]对该院妇科自1998年3月至2002年8月收治的21例Ⅰb～Ⅱa期巨块型宫颈癌患者术前予以含顺铂的联合方案化疗1～2个疗程,后行广泛子宫切除和盆腔淋巴结清扫术,观察化疗后局部肿瘤体积的变化和盆腔淋巴转移、宫颈浸润深度及标本切缘肿瘤浸润情况,并与相同期别的57例直接行根治手术的巨块型宫颈癌和84例非巨块型者相比较。术后续予化疗1～2个疗程,随访治疗后生存状况。[结果]治疗组21例术前化疗后,宫颈局部肿瘤均有不同程度缩小,15例临床有效(71.43%)。且术中出血量(352.35±19.01)ml明显低于未行化疗的巨块型宫颈癌者[(619.05±35.58)ml,P<0.01]及84例非巨块型者[(568.07±45.23)ml,P<0.05]。78例巨块型宫颈癌的盆腔淋巴转移率(9/78)显著高于非巨块型者(3/84,P<0.05);宫颈深层浸润率(8/78)也高于后者(2/84),但无显著性差异(P>0.05)。3组病例术后标本病理均示无切缘浸润;78例巨块型宫颈癌患者中,术前化疗者宫颈深层浸润率(1/21)和盆腔淋巴阳性率(2/21)均低于直接手术者(7/57和7/57),但无显著差异(P>0.05)。[结论]早期巨块型宫颈癌术前辅助化疗可明显缩小原发灶以利手术,减少术中出血。

[Purpose]To investigate the effect of adjuvent chemotherapy on early stage cervical cancer with bulky tumor.Between Jan.1993and Aug.2002,162patients with cervical cancer in stageⅠ b ～Ⅱ a were investigated.Twenty-one patients with bulky tumors(≥4cm)were managed by cisplatin-based chemotherapy followed by radical hysterectomy and pelvic lymphadenectomy(Bulky-chemo group,BC group).The tumor size,depth of stromal invasion,lymph node metastasis and involvment of sur-gical specimens were assessed after operation and compared with those in57patients with bulky tu-mors(Bulky-nonchemo group,BN group)and84patients with the tumor size less than4cm(Small group,S group)Chemotherapy with the same regimen were offered for anther1～2cycles after operation and the survival situation was followed up.The tumor size in21patients of BC group decreased to various degrees after chemotherapy,15patients revealed clinical response(71.43%).The blood loss during operation[(352.35±19.01)ml]was significantly lower than that in BN group[(619.05±35.58)ml,P<0.01]and S group patients[(568.07±45.23)ml,P<0.05].The incidence of lymph node metastasis(9/78)in patients with bulky tumors was greatly higher than those with tumor size less than4cm(3/84,P<0.05);the rate of deep stromal inrision(8/78)was also higher than that of S group(2/84),on significant difference(P>0.05).Histology showed that there was no case with marginal involvment in all patients.The ratio of both deep stromal invasion(1/21)and positive lymph node(2/21)in BC group was lower than those in BN group(7/57,7/57respectively),while neither with statistical significance(P>0.05).[Conclusions]Pre-operative chemotherapy can decrease the primary tumor size and benefit to the following radical surgery.While the effect of adjuvent chemotherapy on lymph vascular involvment and in turn its long-term effect survival should be further testified.