局部晚期宫颈癌综合治疗方法探讨

目的 比较三种不同方法综合手术治疗局部晚期宫颈癌的优越性.方法 86例经病理证实的局部晚期宫颈癌,宫颈局部肿瘤直径>4 cm,Ⅰ b2期5例,Ⅱ a期39例,Ⅱb期39例,Ⅲa期3例.组织学分型:鳞状细胞癌72例,病理分级:高分化5例,中分化49例,低分化18例;腺癌14例.人院病人随机分为动脉化疗组(A)32例,根治性放疗组(B)27例,同步放化疗组(C)27例.结果 三种不同治疗方法术后淋巴结转移率分别是:A组:19.35%(6/31);B组:45%(9/20);C组:18.5%(5/27),经统计学处理,A组及C组相比无显著差异,C组与A组及B组相比,χ2值分别是3.86、4.61,P<0.05,差异有显著意义,手术切除率分别是96.9%、74%、100%,3年及5年生存率A组和C组相近,统计学上无显著差异,B组明显低于A组和C组,差异有显著意义.结论 动脉灌注化疗栓塞能明显提高局部晚期宫颈癌切除率,并不增加远期并发症,同步放化疗能明显提高近期疗效及5年生存率,年轻患者可优先选择动脉灌注化疗栓塞综合手术的治疗方案.

Investigation of combined therapies for locally advanced cervical cancer

Objective To evaluate the advantages of three different ways combining surgery in treating locally advanced cancer. Methods 86 patients with locally advanced cervical cancer confirmed by pathology ,and of which the diameter 〉 4 cm, are enrolled in the study. The number of the patients in FIG（9 stage Ⅰb2, Ⅱa, Ⅱb, Ⅲa are 5,39,39,3 respectively. Histological Type： Spuamous carcinoma-72cases, including： well-differentiated squamous carcinoma-Scases, moderately differentiated squamous carcinoma- 49cases and poorly differentiated squamous carcinoma-18cases,adenocarcinoma-14cases. Treatments consist of intra-arterial chemotherapy and embolization（Group A）,radical radiotherapy（Group B）, and concurrent radiotherapy plus chemotherapy（Group C）. Enrolled patients will be divided into the three groups at random. Results After the three treatments,the rates of lymphatic metastasis are： Group A 19.35% （6/31）, Group B 45% （9/20） and Group C 18.5% （5/27）. After statistical data processing,Group A and C have no significant difference. Group C , compared to A and B, the value of χ^2 is 3. 86 and 4. 61, respectively, P 〈 0.05,the differences are significant. The rates of resection are 96.9% .74% and 100% reapectively. The differences between Group A and C on 3-year and 5-year survival rate are significant. Conclusions The resuits suggest that intra-arterial chemotherapy and embolization can improve the operability of resection in patients with locally advanced cervical cancer without increasing long-term clinical complications. Concurrent radiotherapy plus chemotherapy can improve short-term effect and 5-year survival rate. As for young patients,the treatment of intra-arterial chemotherapy and embolization combining surgery is a priority selection.