巨块型子宫颈癌治疗方法比较

目的 比较巨块型或局部晚期子宫颈癌几种治疗方法的疗效、并发症及经济性.方法 1991年1月至1993年12月收治的80例巨块型子宫颈癌随机分组(1组、2组)及1994年1月至1997年12月收治的96例巨块型子宫颈癌随机分组(3组、4组).1组40例接受动脉介入化疗+放射治疗;2组40例接受静脉化疗+放射治疗;3组48例接受激光+放射治疗;4组48例接受增加腔内治疗次数(消瘤量).结果 四组3年生存率分别为75.0%、72.5%、77.1%、75.0%,两两比较差异均无统计学意义(P＞0.05).5年生存率分别为65.0%、62.5%、66.7%、64.6%,两两比较差异均无统计学意义(P＞0.05).放射性直肠炎(便血)发生率分别为12.5%、10.0%、10.4%、27.1%,1组、2组、3组分别与4组比较,差异均有统计学意义(P＜0.05),其他各组间比较,差异均无统计学意义(P＞0.05).放射性膀胱炎(尿血)发生率为12.5%、15.0%、8.3%、22.9%.1组、2组、3组分别与4组比较,差异均有统计学意义(P＜0.05),其他各组间比较,差异均无统计学意义(P＞0.05).治疗费用(以人民币计算,常规放射治疗花费之外):1组平均14 000元,2组4000元,3组800元,4组1000元.结论 激光+放射治疗是治疗巨块型或局部晚期子宫颈癌的有效方法,患者不良反应发生率低,疗程较短,花费少.静脉化疗与动脉化疗远期疗效相近,但所需设备及费用较低,在没有激光设备时可以推广.

Comparison of the therapeutical effects on bulky cervical cancer treated with several different therapies

Objective　To evaluate the curative effects, complications and expense in bulky cervical cancer treated with several different therapies. Methods　A retrospective study was carried out on176 patients with bulky or locally advanced cervical cancers admitted to our hospital from 1991 to 1997. Among 176 patients, 80 treated from 1991 to 1993 were randomly divided into two groups:arterial interventional chemotherapy + radiotherapy (Group 1, n =40) and venous chemotherapy + radiotherapy (Group 2, n=40); 96 treated from 1994 to 1997 were randomly divided into other two groups. Laser therapy + radiotherapy (Group 3,n=48) and accessorial brachytherapy (eliminating tumor)+normal radiotherapy (Group 4,n=48). Results　The 3-year survival rates of four groups were 75.0 %, 72.5 %, 77.1 % and 75.0 % respectively, without significant difference (P >0.05). The 5-year survival rates of four groups were 65.0 %, 62.5 %, 66.7 % and 64.6 % respectively, without significant difference (P >0.05). Late complication rates in bladder and rectum in four groups:radioactive rectitis were 12.5 %, 10.0 %, 10.4 % and 27.1 % respectively; radioactive cystitis were 12.5 %, 15.0 %, 8.3 % and 22.9 % respectively, the group 4 was compared with other groups with significant difference(P <0.05), group1, group 2 and group 3 were compared with each other without significant difference (P>0.05). The expense of four groups were, 14 000 yuan, 4000 yuan, 800 yuan and 1000 yuan respectively. Conclusion　Laser therapy + radiotherapy is an effective mean for treating patients with bulky or locally advanced cervical cancer, and late complication rates in bladder and rectum are low, and it is easy and inexpensive. The effect on long-term survival between arterial chemotherapy and venous chemotherapy has no obvious difference. Venous chemotherapy has less demanding for special equipments and is inexpensive compared with arterial chemotherapy. Without laser therapy, venous chemotherapy shows promising prospect in clinical application.