宫颈癌动脉灌注栓塞化疗中新鲜明胶海绵颗粒药物缓释作用的评估

目的:研究同等剂量卡铂不同动脉化疗方式后癌组织中铂浓度的药代动力学变化,探讨新鲜明胶海绵颗粒(GF)的作用。方法:选择经病理检查证实为宫颈癌、且癌灶较大易于取材的患者27例,随机分为3组:卡铂400mg/m~2双侧子宫动脉灌注后+新鲜GF颗粒栓塞(A组);卡铂300mg/m~2双侧子宫动脉灌注后+(卡铂100mg/m~2+新鲜GF颗粒混合)栓塞(B组);卡铂200mg/m~2双侧子宫动脉灌注后+(卡铂200mg/m~2+新鲜GF颗粒混合)栓塞(C组),卡铂总量按400mg/m~2一次性给药。于在灌注后0、0.17、0.33、0.5、1、7、13、25、49h钳取宫颈癌组织,采用原子吸收光谱法测定其铂浓度,计算其药代动力学参数。结果:(1)峰值及曲线形态:3组癌组织内铂平均药物浓度曲线均为双峰曲线,第一峰值均出现在灌注化疗后即刻,随着时间延长呈快速下降;第二峰值出现在栓塞化疗后即刻至6h,随着时间延长呈缓慢下降曲线。(2)卡铂在宫颈癌组织中的变化符合非房室模型,3组铂浓度参数C_(max)、AUC_((0-t))、MRT、CL/F、V_d/F比较,差异均无统计学意义。结论:在卡铂常规剂量下(400mg/m~2),新鲜明胶海绵颗粒在宫颈癌的动脉灌注/栓塞化疗中不具有药物缓释作用,仅具有单纯的栓塞作用。因此在宫颈癌动脉化疗中,新鲜明胶海绵颗粒的应用以灌注抗癌药物后即刻单纯栓塞为最合适。     

介入性化疗在宫颈癌手术前的应用

目的：探讨宫颈癌术前介入性化疗的临床疗效,病理学改变及癌组织内的药物浓度,对47例宫颈癌患者实施术前介入性化疗,抗癌药物选择卡铂、表阿霉素或阿霉素;部分病例在灌注化疗（2／3量抗癌药物）后用携带有抗癌药物（1／3量）的明胶海绵颗粒栓塞肿瘤供血动脉;7例患者检测了化疗后宫颈癌组织内铂离子浓度。结果：47例宫颈癌中32例（32／32）Ⅱ期、9例（9／11）Ⅲa期、2例（2／4）Ⅲb期经1－3次术前介入性化疗后可顺利手术切除;术后标本病理切片中可见大量坏死组织及淋巴细胞浸润,其中组织学完全缓解（HCR）9例;7例检测了宫颈癌组织内的铂离子浓度,发现动脉灌注后癌组织内铂离子浓度明显高于静脉灌注。结论：宫颈癌术前介入性化疗可有效提高癌组织内的抗癌药物浓度,缩小肿瘤体积,部分患者达到HCR的效果。     

宫颈小细胞神经内分泌癌1例报道及文献回顾

一、病例摘要 患者，女，49岁。主因“阴道不规则出血半年余，加重2个月”于2005年2月24日首次入院。病理活检示：宫颈小细胞型低分化癌，神经内分泌癌可能性大，临床分期IIBG3。于2005年3月2日髂内动脉给予顺铂120mg，静脉给予丝裂霉素20mg，表阿霉素70mg化疗，3月23日再次顺铂动脉化疗，无明显化疗副反应。遂于2005年4月1日于全麻联合硬膜外麻醉下行次广泛全子宫切除＋双附件切除＋盆腔淋巴结活检＋双侧髂内动脉顺铂化疗，术中髂内动脉给予顺铂80mg。     

卡铂腹腔化疗腹膜后淋巴结内的药物浓度

对２３例卵巢恶性肿瘤患者，分别于术前不同时间进行腹腔穿刺并灌注卡铂（３００ｍｇ／ｍ￣２），手术清扫腹膜后淋巴结，同时切取盆腔腹膜和髂外淋巴结周围脂肪结缔组织各１ｇ，用无火焰原子吸收光谱法分别测定上述３种组织的总铂浓度，并监测３例患者给药后２４小时内的血浆总铂浓度，以及观察化疗后腹膜后淋巴结的病理改变。结果显示，腹膜后淋巴结内总铂浓度在腹腔给药后１２小时达到高峰，峰值为１３．４±１．９～２１．６±７．８μｇ／ｇ。腹主动脉旁淋巴结、盆腔淋巴结、淋巴结周围脂肪结缔组织和盆腔腹膜总铂浓度的药时曲线下面积（ＡＵＣ＿（０～２４ｈ））分别为２１６．８±９．２、２４６．４±３２．９、１１５．６±４０．９和１３５１．３±６９６．５μｇ·ｈ／ｇ。血浆总铂浓度的峰值及ＡＵＣ＿（０～２４ｈ）分别为６．７±１．０μｇ／Ｌ和６１．５±２．４μｇ·ｈ／Ｌ。提示卡铂腹腔给药分布于腹膜后淋巴结组织中的药物浓度较血药浓度明显为高。病理检查可见化疗后的腹膜后淋巴结有变性改变。     

大鼠髂内动脉灌注甲氨蝶呤时肺及其他主要脏器药物浓度的变化

目的 研究甲氨蝶呤(MTX)髂内动脉灌注时大鼠肺及其他主要脏器药物浓度的变化.方法 选择50只雌性大鼠,随机分为2组,动脉组行股动脉插管、髂内动脉灌注药物,静脉组行股静脉插管、髂内静脉灌注药物.每组分别在5个时间点取血样及组织,利用建立的高效液相色谱方法 分析药物浓度.结果 动脉组大鼠肺、卵巢和子宫的药物浓度-时间曲线下面积(AUC)分别为(3.77±0.28)、(4.40±0.40)、(9.97±0.89)μg·h-1·g-1,静脉组分别为(2.31±0.25)、(3.91±0.19)、(7.65±1.54)μg·h-1·g-1,两组分别比较,差异均有统计学意义(P<0.05).动脉组大鼠血浆、心脏、肾、肝和脾的AUC分别为(6.13±0.53)、(1.90±0.11)、(5.32±0.89)、(14.16±1.96)、(0.76±0.20)μg·h-1·g-1,静脉组分别为(5.79±0.71)、(1.64±0.29)、(5.15±1.69)、(14.29±3.47)、(0.76±0.13)μg·h-1·g-1,两组分别比较,差异均无统计学意义(P>0.05).结论 相比较静脉给药,髂内动脉灌注给药后子宫、卵巢和肺有较高的药物浓度,髂内动脉灌注化疗町以有效地治疗妇科恶性肿瘤的肺转移.     

晚期宫颈癌放疗配合动脉栓塞化疗的应用

目的:探讨动脉栓塞化疗对晚期宫颈癌的放射治疗效果.方法:选择124例宫颈癌患者,并随机分为放疗配合动脉栓塞化疗(综合组)62例和单纯放射治疗(单放组)62例.综合组:先进行常规的放射治疗,在第5天开始配合动脉栓塞化疗,采取经子宫动脉灌注,每次双侧子宫动脉共灌注化疗药顺铂40mg,表柔比星40 mg,丝裂霉素12mg、注入约30粒1 mm×1mm明胶海绵颗粒栓塞双侧子宫动脉,共2次.放疗外照采用6MV X射线照射.全盆腔照射DT:30Gy.内照采用Ir192后装机照射7次,A点DT:42 Gy,A点总量:72Gy.盆腔四野照射DT:16Gy.单放组:只进行常规的放射治疗.结果:综合组局部完全缓解率为80.7%,单放组局部完全缓解率为54.8%,两组比较差异有高度统计学意义(P＜0.01).结论:放疗辅以动脉栓塞化疗治疗效果较好,为晚期宫颈癌的有效治疗方法.     

超选择骼内动脉插管化疗用于晚期妇科恶性肿瘤

应用Ｓｅｌｄｉｎｇｅｒ技术经双侧髂内动脉行超选择性动脉插管化疗及栓治疗妇科晚期恶性肿瘤２４例，共２９例次。其中宫颈鳞癌Ⅲ期３例，子宫内膜腺癌２例，绒毛癌１例，上皮型卵巢癌Ⅲ期１４例，Ⅳ期４例。结果：显效２例，有效１７例，总有效率７９．１７％。超选择技术直接向肿瘤供血动脉灌注化疗药物，浓度高，副反应小，提高介入治疗的疗效，为晚期妇癌病例进一步手术或放疗创造条件。     

宫颈癌介入化疗栓塞后合并肾盂积水一例

一、病例摘要患者42岁,主因＂阴道不规则出血6个月,宫颈癌介入化疗后3个月＂于2011年7月18日收入北京大学肿瘤医院。患者平素月经规律,6个月前（2011年1月）无明显诱因出现阴道不规则出血,淋漓不尽,量少于月经量,出血多时伴血块,伴下腹痛,无腹泻、腹胀,2011年3月13日在外院行阴道镜活检示（宫颈3、9点）中分化鳞癌,盆腔MRI示宫颈占位,腹部B超和胸片未见异常,瘤标：SCC3.3ng/ml,CA12525.32U/ml,妇科检查后诊为宫颈癌ⅡB期,于3月18日和4月21日分别在该院行“髂总动脉造影＋子宫动脉化疗栓塞”2次,化疗方案：长春新碱2mg,丝裂霉素16mg,卡铂500mg。介入化疗后患者乏力明显,消化道反应Ⅱ度,骨髓抑制Ⅲ度,低白蛋白血症。     

宫颈小细胞神经内分泌样癌术后放化疗后全身多部位转移

患者49岁，女，主因“阴道不规则流血半年余，加重2个月”于2005年2月24日首次入院。病理活检提示：宫颈小细胞型低分化癌，神经内分泌癌可能性大。临床分期ⅡBG3。于2005年3月2日髂内动脉顺铂120mg化疗，静脉给予丝裂霉素20mg，表阿霉素70mg化疗。于2005年3月23日再次顺铂动脉化疗，化疗副反应不明显。妇科检查：宫颈病灶缩小，双官旁组织有弹性，     

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

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。     

Blood loss and power Doppler ultrasound characteristics of uterine artery blood flow after 2 levels of bilateral internal iliac artery ligation before extensive myomectomies

OBJECTIVE: To compare the blood loss and power Doppler ultrasonographic characteristics of uterine artery blood flow after 2 different techniques of internal iliac artery ligation prior to extensive myomectomy. STUDY DESIGN: A randomized, double-blind study was conducted in a tertiary referral center. Either bilateral ligation of the anterior branch of the internal iliac artery (group I, n = 14) or ligation 2 cm proximal to its bifurcation (group II, n = 14) was performed. Intraoperative blood loss was calculated. Power Doppler ultrasonography and magnetic resonance angiography were used to evaluate blood flow in the uterine arteries. RESULTS: The mean number of leiomyomas excised was 9.5 +/- 3.4 in group I and 8.7 +/- 2.6 in group II (p = 0.5). The mean blood loss was similar in groups I and II (350 +/- 201 mL and 308 +/- 129 mL, respectively, p = 0.5). As compared to preoperative values, the decrease in the resistance index and mean arterial velocity was significant in both the right and left uterine arteries in group I. Only the decrease in mean arterial velocity in the right uterine artery was significant in group II. CONCLUSION: Ligation of the anterior branch of the internal iliac artery provides a greater decrease in uterine artery resistance and velocity without causing any difference in blood loss as compared to main trunk ligation.     

髂内动脉灌注新辅助化疗在子宫颈癌治疗中的价值

目的评价髂内动脉灌注新辅助化疗在宫颈癌治疗中的作用。方法对1997年3月—2002年1月间收治的186例巨块型(肿瘤直径≥4cm)宫颈癌随机分为2组,化疗加放疗组105例,经髂内动脉灌注化疗,采用Seldinger技术髂内动脉插管或腹壁下动脉插管2种方法注药,化疗以顺铂为主的联合方案,同时采用192Ir高剂量率腔内后装治疗,A点剂量为12~24Gy,分2~4次;放疗组81例,术前予腔内后装治疗,A点剂量同前。两组患者均于治疗后2周行子宫颈癌根治术。结果化疗加放疗组肿瘤消退总有效率为97 1%,明显高于放疗组的79 0% (P<0 01)。其中,临床Ⅰb期患者中,化疗加放疗组总有效率为100 0%,明显高于放疗组的78 3% (P<0 01 );Ⅱa期患者中,化疗加放疗组总有效率为93 2%、放疗组为79 3%,两组比较,差异无统计学意义(P>0 05);Ⅱb期患者中,化疗加放疗组总有效率为96 1%、放疗组为5 /6,两组比较,差异无统计学意义(P>0 05 )。术后病理检查,宫颈肿瘤残留、宫旁浸润、盆腔淋巴结转移发生率,化疗加放疗组(分别为51 4%、8 6%、7 6% )均明显低于放疗组(分别为79 0%、23 5%、21 0%, P<0 01);而2年内复发率放疗组为23 5%,明显高于化疗加放疗组的6 7% (P<0 01)。2年生存率化疗加放疗组为94 5%、放疗组为84 7%,两组比较,差异无统计学意义(P>0 05)。结论髂内     

髂内动脉造影解剖研究及对血管内介入操作的指导意义

目的:探讨髂内动脉及子宫动脉造影解剖及其最佳投照体位,指导超选择盆腔血管插管,提高介入插管的准确率及成功率。方法:(1)分析71例正常成人腹主动脉及髂总动脉造影资料。测量双侧髂总动脉间的夹角、双侧髂内动脉开口的高度和髂总动脉长度;(2)观察髂内动脉及其分支正位、对侧斜位及同侧斜位显示状况;(3)总结髂内动脉及其分支的血管造影表现及其解剖类型。结果:(1)正常成年男性双侧髂总动脉间夹角均数为57.22°±8.39,°正常成年女性双侧髂总动脉夹角均数为66.41°±7.99,°男女均值间差异有统计学意义;右侧髂内动脉开口高于左侧,左侧髂总动脉干长于右侧;(2)对侧斜位投照较正位和同侧斜位投照能更好地显示髂内动脉及其分支的开口和行程;(3)依据正常成人髂内动脉造影表现及其主要分支(臀上、臀下及阴部内动脉)走行及分布,正常成人髂内动脉可分为4种解剖类型;(4)子宫动脉大部分发自髂内动脉前干,2.9%的子宫动脉升支发出明显的卵巢支。结论:(1)女性髂总动脉间夹角较大,经皮股动脉穿刺对侧髂动脉插管时宜采用直接插管技术,男性患者宜取成袢技术,能提高手术成功率和缩短插管时间;(2)对侧斜位有助于超选插管至髂内动脉及其分支;(3)盆腔血管内介入治疗的患者应根据其髂内动脉及其分支的解剖类型实行个体化介入手术操作。     

Conservative treatment by angiographic artery embolization of an 11-week cervical pregnancy after a period of heavy bleeding

OBJECTIVE: To describe a rare case of conservative treatment of an 11-week cervical pregnancy after a period of heavy bleeding. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 33-year-old woman was admitted to our hospital for treatment of a cervical pregnancy. Two-and-a-half years thereafter, she gave birth to a healthy baby by vaginal delivery at 38 weeks of gestation. INTERVENTION(S): Systemic methotrexate treatment, ligation of descending branches of uterine arteries, cervical cerclage, and unilateral internal iliac artery embolization. MAIN OUTCOME MEASURE(S): Transvaginal ultrasound, magnetic resonance imaging, and arteriography findings. RESULT(S): The patient was successfully treated with unilateral internal iliac artery embolization on the same side as the pregnancy in the 11th gestational week. CONCLUSION(S): After failed methotrexate and vessel ligation in cervical pregnancy, unilateral internal iliac artery embolization is an effective and conservative treatment that allows preservation of reproduction potential.     

Neoadjuvant intraarterial infusion chemotherapy with a combination of mitomycin-C, vincristine, and cisplatin for locally advanced cervical cancer: a preliminary report.

Combination chemotherapy including cisplatin was administered intraarterially from the internal iliac artery as neoadjuvant chemotherapy to six patients with locally advanced uterine cervical cancer (stage higher than IIIB of FIGO). The drugs and doses were mitomycin-C 10 mg/m2, vincristine 1 mg/m2, and cisplatin 50 mg/m2. Two or three courses were repeated at intervals of 3 weeks. In three patients, dose reductions were undertaken for decreased renal function and thrombocytopenia. Partial response was, however, observed in all patients (response rate 100%), and five of six patients were able to undergo a radical hysterectomy. The major toxic effects were leukocytopenia, nausea, and vomiting. Our preliminary experience suggests that pelvic intraarterial infusion of combination chemotherapy is effective against primary and advanced uterine cervical cancer, and this preoperative treatment can lead to easier radical hysterectomy. However, further studies are warranted.     

Abdominal radical trachelectomy: two new surgical techniques for the conservation of uterine arteries

The objective of this study was to develop two new techniques for the conservation of uterine arteries in abdominal radical trachelectomy. Abdominal trachelectomy with conservation of uterine arteries was performed in two patients with cervical carcinoma. In the first case, the internal iliac artery was divided at 2.0 cm from the bifurcation of the common iliac artery. The internal iliac artery and uterine artery were skeletonized along their lengths to the lateral cervix. The dissected internal iliac artery was then reanastomosed following the radical trachelectomy. In the second case, the technique was similar to that of the first except that the internal iliac artery was not divided. Intraoperative observation and postoperative color Doppler ultrasound were used to confirm the patency of the uterine arteries. The operative time of the two patients was 390 min. and 350 min, respectively. Doppler flow studies demonstrated that the uterine arteries were patent in both cases. Resistance index of the left and the right uterine artery was 0.58 and 0.61, respectively, in the first case, and 0.60 and 0.63, respectively, in the second case. Reanastomosis of the internal iliac arteries or skeletonization of the internal iliac arteries are both feasible methods to conserve the uterine arteries during abdominal radical trachelectomy.     

Laparoscopic assessment of the sentinel lymph node in early stage cervical cancer

OBJECTIVE: The aim of this study was to describe a minimally invasive technique enabling us to identify the sentinel lymph node in patients affected by early stage cervical cancer and to report the preliminary data. METHOD: Patent Blue Violet was injected around the tumor. Laparoscopy was undertaken and the blue-dyed lymph nodes (BDLN) were sought. The evidenced BDLN were removed, and then the systematic dissection was carried out. Material. Thirty-five patients were submitted to surgery. A systematic dissection was performed on 69 pelvic sidewalls (no dissection was performed on the second side of the patient for whom we decided to renounce surgery after assessment of the first side). RESULTS: One or more BDLN was evidenced in 59 of 69 dissections. The rate of failure depends on the quantity of injected blue dye. Failure to identify a BDLN depended on the quantity of injected blue dye: 3 of 6 (50%) for 1.5 ml or less, 3 of 18 (17%) for 2 ml, and only 4 of 45 (10%) after injection of 4 ml (P = 0.05). Among the 63 BDLN (in 4 cases 2 BDLN were identified), 53 were located in contact with the external iliac vein, lateral to the inferior vesical artery, and ventral to the origin of the uterine artery, 7 were located close to the origin of one of the collaterals of the internal iliac artery, and 3 were adjacent to the left common iliac vein. One or more positive pelvic lymph nodes was found in 11 pelvic wall dissections done on 8 patients. The BDLN was the positive node or one of them in all cases. CONCLUSION: If the sensitivity of the assessment of the BDLN is confirmed to be 100%, this laparoscopic approach could transform the management of early cervical cancer.     

腹腔镜双侧髂内动脉临时阻断下子宫修补联合宫腔镜清宫术在Ⅲ型剖宫产瘢痕部位妊娠中的应用

目的 探讨腹腔镜下髂内动脉可逆性结扎及子宫修补联合宫腔镜下清宫术在Ⅲ型剖宫产瘢痕部位妊娠术中的疗效和安全性.方法 回顾性分析2017年11月～2020年11月广州医科大学附属广州市妇女儿童医疗中心收治的剖宫产瘢痕部位妊娠患者135例,其中Ⅲ型患者32例,根据术前处理措施不同,分为髂内动脉临时阻断组(21例)和子宫动脉栓...     

Effect of neoadjuvant chemotherapy on locally advanced cervical cancer by internal iliac arterial infusion

<正>Objective:To evaluate the effect of preoperative chemotherapy on locally advanced cervical cancer by internal iliac arterial infusion.Methods:Sixty two patients with bulky or locally advanced cervical cancer from 1999 to 2004 were underwent internal iliac arte- rial infusion chemotherapy by using Seldinger technique.Combined regimens were applied in- cluding cisplatin as the major drug.Two weeks later,all patients received radical hysterectomy. Results:The local tumor regression rate was 93.55%.Postoperative pathologic examination showed that no cervical tumor residue in stumps were found in 61 of 62 patients who underwent radical hysterectomy.Large quantity of necrotic tissue appeared on primary tumor.In 16 patients with positive lymph nodes,15 demonstrated necrotic lymph nodes.Conclusion:Internal iliac ar- terial infusion chemotherapy could effectively reduce tumor volume,increase surgical success rate and decrease lymph nodes and subclinical metastasis rates.     

Urinary tract fistulas following ligation of the internal iliac artery during radical hysterectomy

One hundred patients underwent radical hysterectomy at the University of South Florida over a 4 1/2-year period. In all patients the anterior division of the internal iliac artery was ligated on the left, and the uterine artery was ligated at its origin from the internal iliac artery on the right. One patient developed a left ureterovaginal fistula for a urinary tract fistula rate of 1%. Preservation of the distal branches of the anterior division of the internal iliac artery may help prevent urinary tract fistulas following radical hysterectomy. This study would suggest, however, that this of minimal importance.