新辅助化疗后根治性手术与同步放化疗在局部晚期宫颈癌的远期疗效评价

目的本研究的目的是比较ⅠB2-ⅡB期局部晚期宫颈癌新辅助化疗后根治性手术与同步放化疗的远期生存情况。方法回顾性分析从2000年1月—2004年12月间ⅠB2-ⅡB期局部晚期宫颈癌共222例,将其分为二组：新辅助化疗＋根治性全子宫切除术＋盆腔淋巴结切除术共155例;同步放化疗组67例。所有患者最长随访时间为114个月,最短随访时间为54个月,中位随访时间为72．6个月。且对所有可能影响无瘤生存时间和总生存时间的高危因素进行评估。结果本研究中位随访时间为72．6个月,新辅助化疗后根治性手术组和同步放化疗组5年无瘤生存率分别是88．39％和70．94％,两组比较有统计学意义（P：0．006）;而5年总生存率分别为88．52％和72．91％,两组比较有统计学意义（P=0．0004）。在Cox风险回归模型中,调整宫颈癌患者的年龄、病理分型后,结果显示：接受新辅助化疗后根治性手术组和同步放化疗组治疗的宫颈癌患者5年无瘤生存时间有明显差异（HR：2．765,95％CI：1．446—5．288,P=0．0021）;在5年总生存时间上也有显著性差异（HR=3．516,95％CI：1．822—6．784,P=0．0002）。结论本研究ⅠB2-ⅡB期局部晚期宫颈癌新辅助化疗后根治性手术组在无瘤生存时间和总生存时间方面显著优于同步放化疗组。     

原发性肝癌超分割放射治疗辅以肝动脉化疗的临床研究

目的：分析比较Ⅱ期不能手术的原发性肝癌施行超分割放射治疗辅以肝动脉插管化疗、肝动脉结扎（A组65例）与常规分割放射治疗辅以肝动脉插管化疗、肝动脉结扎（B组65例）的疗效。方法：全组130例均经剖腹探查判定不能手术。分期为Ⅱ期，且经病理学诊断。分组系根据探查时间顺序采用单、双号的原则。2个组均先化疗后放射，且6d/周化疗，3d周超分割或5d周常规分割放射治疗交替夹心。肝动脉化疗采用顺铂10mg滴注。放射治疗采用6－8MV X射线或^60Coγ射线，超分割采用250cGy/次，2次／d。结果：A组的甲胎蛋白定量下降一半者占89．7％（35／39）,B组占67．6％（25／37）。A组1、3、5生存率为90．8％、63．1％、23．1％，B组分别为73．9％、41．5％、9．2％，A组高于B组（P＜0．05）。A组的PR率、Ⅱ步手术切除占总例数的比例分别为90．8％、35．4％，B组分别为70．8％、12．3％，A组高于B组（P＜0．01）。两组主要不良反应相近（P＞0．05）。结论：超分割放射治疗辅以肝动脉插管化疗、肝动脉结扎，系治疗不能手术肝癌有效、合理的治疗方案。该方案能有效地减轻症状、缩小瘤体，提高手术切除率、延长生存期，且操作较为简单易行。     

Ⅰb2Ⅱa期子宫颈癌腔内放疗加手术与单纯手术治疗的临床对比分析

目的：比较术前近距离腔内后装放疗和单纯手术治疗Ⅰb2、Ⅱa期宫颈癌的疗效，以探讨Ⅰb2、Ⅱa期宫颈癌术前适当剂量阴道腔内放疗的意义。方法：选取北京妇产医院1998年6月至2005年6月，Ⅰb2、Ⅱa期且宫颈肿块均〉4cm的宫颈癌患者78例。患者随机分为两组：术前放疗组38例行术前^192Ir近距离腔内放疗，阴道盒源旁1cm 2000～3000cGy，分2～3次，2～3周完成，放疗后10～14天行宫颈癌根治术即广泛子宫切除＋盆腔淋巴结清扫术；单纯手术组40例直接行宫颈癌根治术。评定两组的疗效和术前阴道腔内后装放疗对手术的影响及术后并发症的情况。结果：术前放疗组宫颈肿块均有不同程度的缩小，总有效率（CR＋PR）94．7％（36／38），术前放疗组和单纯手术组相比未增加手术难度和术后并发症，两组局部控制率分别为1年（89．5％和80．0％，P〉0．05）、3年（82．9％和61．3％，P〈0．05）、5年（76．9％和52．6％，P〈0．05）；两组1、3和5年生存率分别为（85．0％和92．1％，P〉0．05）、（83．9％和87．9％，P〉0．05）和（78.3％和80．0％，P〉0．05），差异无显著性。结论：术前近距离阴道腔内后装放疗可作为Ⅰb2、Ⅱa期宫颈癌综合治疗的一种有效的治疗方法，对Ⅰb2、Ⅱa期宫颈癌有满意的局部控制率。     

巨块型Ⅰb、Ⅱa宫颈癌的术前处理方式探讨

目的探讨术前处理巨块型Ⅰb、Ⅱa期宫颈癌和再行手术治疗最为恰当的方法。方法回顾性分析我院2003年1月至2007年12月间经手术治疗的巨块型Ⅰb、Ⅱa期宫颈癌288例。66例术前后装放疗;50例术前新辅助化疗;172例术前化疗同步后装放射治疗。比较术前不同方式处理后肿瘤退缩情况,肿瘤术后病理,手术时间,手术出血,并发症等情况。结果化疗同步后装放射治疗组局部控制率、病理缓解率均好于单独后装放疗或新辅助化疗组,差异有显著性（P〈0．05）。单独后装放疗组手术时间及术中出血少于新辅助化疗组和化疗同步后装放射治疗组,差异有显著性（P〈0．05）。化疗同步后装放射治疗组并发症发生率高于单独后装放疗或新辅助化疗组,但是无统计学差异（P〉0．05）。结论术前同步放化疗是治疗巨块型Ⅰb、Ⅱa期宫颈癌的有效治疗手段,但是应严密防止术中、术后并发症的发生。     

大肠癌介入化疗及栓塞治疗的临床研究

目的：探讨介入化疗及栓塞治疗对大肠癌疗效的影响。方法：选择术前经导管动脉内灌注化疗及明胶海绵栓塞治疗，２周后再手术切除的６０例ＤｕｋｅｓＣ期大肠腺癌（以下简称介入手术组）；与同期传统手术治疗的５２例ＤｕｋｅｓＣ期大肠腺癌患者（以下称传统手术组），就术中出血、手术根治性切除率、肿瘤细胞有效坏死率，进行对照研究。结果：手术根治性切除率：介入手术组为８３．３％（５０／６０），传统手术组为６２％（３２／５     

早期宫颈癌根治术后辅助治疗126例分析

目的：探讨早期宫颈癌术后辅助治疗方法的合理选择及临床价值。方法：回顾性分析了Ⅰb,Ⅱa期宫颈癌行根治术后加用放疗或化疗辅助治疗126例，其中单纯放疗64例，单纯化疗26例，放，化疗联合36例，对其治疗结果的预后因素进行分析。结果：126例总的五年生存率为73％（92／126），单纯放疗组，单纯化疗组，放，化疗联合组分别为76．6％（49／64），69．2％（18／26），69．4（25／36），临床分期及腹膜后淋巴结转移数目是最重要的预后因素。结论：早期宫颈癌根治术后辅助治疗的价值是有限的，但存在2个以上不良预后因素者，术后应加辅助治疗，同时应重视根治性手术彻底性。     

Ⅰ、ⅡA/ⅡB期睾丸精原细胞瘤远期疗效分析

目的：分析Ⅰ、Ⅱ、／Ⅱ。期单纯精原细胞瘤的远期治疗效果并探讨其治疗策略。方法：1986-2000年本院收治的Ⅰ、ⅡA／ⅡB期单纯精原细胞瘤107例，术后单纯放疗73例（68．2％），单纯化疗20例（18．7％），放、化疗联合10例（9．3％），未接受治疗4例（3．7％）。复发共7例，均予以化疗，残留者辅以放疗。结果：（1）Ⅰ期与ⅡA／ⅡB期单纯放疗的总生存率（OS）及10年无瘤生存率（DFS）分别为100％（61／61）、95．1％（58／61）、100％（12／12）、100％（12／12），而单纯化疗患者分别为100％（14／14）、100％（14／14）、66．7％（4／6）、66．7％（4／6）；（2）全组复发率为6．5％（7／107），再次治疗的治愈率为85．7％（6／7）；（3）远期并发症发生率为2．7％（2／73）。结论：（1）Ⅰ期及ⅡA／ⅡB期单纯精原细胞瘤术后可首选放疗；（2）为尽量避免放疗远期并发症，可选择部分病人行单独的腹主动脉旁野照射；（3）Ⅰ期也可单纯化疗；（4）复发病人经积极救治，仍可获较高的治愈率。     

116例宫颈癌综合治疗的临床观察

目的：探讨宫颈癌综合治疗的合理选择及临床价值。方法：采用综合治疗方案治疗116例宫颈癌，对其治疗结果进行临床对比观察。结果：1）单纯手术组Ⅰb、Ⅱa、Ⅱb期3年生存率分别为87．5％、60，0％、50．0％。手术＋术前放疗组Ⅰb、Ⅱa、Ⅱb期3牟生存率分别为87，5％、85．7％、81．8％。手术＋术后放疗组Ⅰb、Ⅱa、Ⅱb3牟生存率分别为100％、75．0％、75．0％。放疗＋化疗组Ⅲ、Ⅳ期患者的3年生存率分别为52，6％，0。各组生存率有显著性差异（P〈0．01）。2）临床分期和术后盆腔淋巴结转移是影响预后的重要因素．术后盆腔淋巴结无转移者3年生存率为95．7％，盆腔淋巴结转移1～2枚者3年生存率为75．0％，盆腔淋巴结转移〉2枚者3年生存率为563％。结论：宫颈癌综合治疗的近期疗效优于单纯手术，术前放疗能提高手术切除率，并不增加术后并发症．淋巴结转移枚数与宫颈癌的生存率相关，术后有不良预后因素者应加辅助治疗。     

手术治疗Ⅱb期宫颈癌29例临床分析

目的 探讨Ⅱb期宫颈癌手术治疗的效果。方法 手术组：年龄23～58岁,平均43岁,鳞癌17例,腺癌12例,行术前放疗和腹壁下动脉化疗后行宫颈癌根治术。放疗组：年龄24～60岁,平均45岁,鳞癌17例,腺癌1l例,行单纯根治量放疗。结果 手术组与放疗组3年生存率分别为79．3％,64.3％;5年生存率为72．4％,46．2％,3年内复发率为17．2％,53．6％;中心复发率为3．5％,32．1％。结论 对部分Ⅱb期宫颈癌患如腺癌,经术前放疗和化疗后有手术条件可行广泛子宫切除术及盆腔淋巴清扫术,对减少中心性复发,提高生存率,避免放射引起的并发症有一定意义。     

219例子宫颈癌根治术的并发症分析

目的分析子宫颈癌根治术后并发症及其相关因素,探讨其防治措施。方法1995年1月至2003年12月间,施行子宫颈癌根治术219例。其中ⅠA期26例（ⅠA1期17例,ⅠA2期9例）,ⅠB期142例（ⅠB1期78例,ⅠB2期64例）,ⅡA期40例,Ⅱb期3例,另外8例为外院治疗后无法分期。采用子宫颈癌根治术204例,改良子宫颈癌根治术15例。结果发生手术并发症49例,发生率为22．4％。手术并发症主要为尿潴留、淋巴囊肿、腹部伤口感染,其发生率分别为10．0％、7．8％和6．8％。子宫颈癌根治术并发症发生率高于改良子宫颈癌根治术。术前外院介入化疗、根治性放疗和既往有腹部手术史者的手术并发症发生率为分别为50．0％（2／4）、100％（1／1）和25．0％（13／52）,差异无统计学意义。87例术前辅助放疗的手术并发症发生率（25．3％）高于未辅助放疗者（19．4％）,但差异无统计学意义（P=0．239）。结论子宫颈癌根治术后并发症与术式有关,术前辅助腔内后装放疗不增加并发症,适当缩小手术范围可减少手术并发症。     

Analysis of Clinical Treatment Efficiency for 179 Geriatric Women with Stage I or II Cervical Carcinoma

OBJECTIVE To evaluate the efficiency of surgery plus radiotherapy and chemotherapy versus radiotherapy plus chemotherapy in the treatment of older patients with stage I or II cervical carcinoma and to seek suitable treatment for such patients. METHODS The clinical data of 179 elderly women with stage la or lib cervical cancer were analyzed retrospectively. One hundred and thirty-four cases underwent radical hysterectomy followed by adjuvant radiotherapy and/or chemotherapy (Group 1). Forty-five cases underwent radiation therapy plus adjuvant chemotherapy (Group 2). RESULTS The 5-year survival rates in group 1 and group 2 were 78.3% and 49.1%(P=0.04), respectively. The incidence of complications in group1 was 47.0%. Three patients died of complications after radical hysterectomy. The incidence of complications in group 2 was 75.6%. CONCLUSION Elderly patients with stage I or II cervical carcinoma should receive an operation if possible. In addition they should receive adjuvant treatments according to their personal conditions, and be treated with appropriate adjuvant chemo-and/or radiotherapy.     

Adjuvant oral 5-fluorouracil for cervical cancer: Japanese Gynecologic Oncology Group report

Japanese women with low-stage cervical cancer receiving radical hysterectomy and radiotherapy have a good 5-year survival rate. However, women with risk factors such as nodal metastasis may benefit from adjuvant chemotherapy, which was studied in women having surgery alone or surgery plus radiotherapy. Patients having surgery alone (S) (n=623) or surgery and radiotherapy (SR) (n=919) were randomly assigned to receive or not receive oral 5-fluorouracil (5-FU) for 1 year. The effect of various factors on survival was studied by multivariate analysis. Patients who received S obtained no benefit from 5-FU, whereas 5-FU-treated SR patients had significantly better 5-year survival than those not receiving chemotherapy (P=0.043). The SR patients without nodal metastases had a better survival rate if they received 5-FU (P<0.001), whereas those with nodal metastases did not. Oral 5-FU after radical hysterectomy with radiotherapy appears useful for patients with low-stage cervical cancer who have some risk factors but not for those with pelvic lymph node metastases.     

早期宫颈癌术后辅助治疗疗效分析

目的：研究宫颈癌术后辅助治疗的选择与疗效。方法：回顾性分析159例宫颈癌根治术后辅助放疗加或不加化疗的患者治疗效果,选取130例同期行宫颈癌根治术的Ⅰb期及Ⅱa期未作术后辅助治疗患者作为对照组,进一步分析宫颈癌预后因素。159例患者中有87例放疗化疗综合治疗,72例单纯放疗。结果：289例患者总的5年生存率为89.3%,（单纯放疗组5年生存率88.9%,放疗化疗综合治疗5年生存率为89.7%）,对照组5年生存率72.9%。两者差异有显著性（P〈0.05）。结论：宫颈癌术后辅助治疗尤其对于盆腔淋巴结转移者有意义,临床和术后病理分期是术后辅助治疗的选择与疗效最主要的影响因素,不同病理类型及分级的宫颈癌术后辅助治疗可有不同的选择。     

Prognosis and clinicopathological characteristics of Ib-IIb adenocarcinoma of the uterine cervix in patients who have had radical hysterectomy.

AIMS: The aim of the present study was to evaluate the outcome of patients with stage lb-IIb cervical adenocarcinoma treated with radical hysterectomy, and to determine the clinicopathological characteristics of those patients. METHODS: A total of 255 patients with cervical carcinoma stage Ib-IIb (57 adenocarcinoma and 198 squamous cell carcinoma) who had undergone radical hysterectomy were included in this study. Patient survival distribution was calculated using the Kaplan-Meier method. RESULTS: The estimated 5-year survival rate for patients with adenocarcinoma was significantly poorer than that for patients with squamous cell carcinoma (77.9% vs 91.7%). The survival rate in stage Ib patients did not differ between two groups (95.8% vs 94.4% respectively). The incidence of lymph node involvement was significantly higher in patients with adenocarcinoma than in those with squamous cell carcinoma (31.6% vs 14.8%). Among patients receiving post-operative radiotherapy, the survival rate for adenocarcinoma (71.1%) was significantly poorer than that for squamous cell carcinoma (90.0%). When patients underwent radical hysterectomy, the survival rate for stage II patients with adenocarcinoma was significantly poorer than that for patients with squamous cell carcinoma. CONCLUSIONS: The higher incidence of lymph node involvement and lower response to post-operative radiotherapy are considered to be factors of poorer prognosis in cervical adenocarcinoma.     

术前新辅助化疗治疗局部晚期宫颈癌临床疗效的观察

目的 探讨Ⅰb2～Ⅱb期局部晚期宫颈癌于根治术前给予新辅助化疗(NACT)的疗效.方法 回顾性分析48例Ⅰb2～Ⅱb期局部晚期宫颈癌NACT 1～2疗程后根治性手术者(NACT组)和38例直接根治性手术者(对照组)的临床资料,评价NACT在宫颈癌治疗中的作用及安全性.结果 术前NACT总有效率77.1%,化疗毒副反应轻...     

Clinical results of transcatheter arterial infusion for uterine cervical cancer

The effects of transcatheter intraarterial infusion of anticancer drugs on the prognosis of cervical cancer were retrospectively studied. Two or three sessions of transcatheter arterial infusion therapy were performed for 68 patients with primary uterine cervical cancer. The number of patients with stage I, II, III, or IV disease were 13, 22, 24, and 9, respectively. Patients with squamous cell carcinoma comprised 3, 17, 17, and 5 of the respective groups, and the patients with stage I and II disease had either adenocarcinoma or adenosquamous carcinoma, or bulky tumor (>4 cm). The drugs infused were cisplatin (60-70 mg/m2), doxorubicin hydrochloride (30-40 mg/m2), mitomycin (15 mg/m2), and 5-fluorouracil (500 mg/body). They were infused via the bilateral internal iliac arteries. Fifty-eight of the 68 patients (85%) received a radical hysterectomy after transcatheter arterial infusion: 12 of 13 with stage I disease, 21 of 22 with stage II disease, 20 of 24 with stage III disease, and five of nine with stage IV disease. Two patients with stage III disease received radical radiotherapy. The other eight patients (one with stage I disease, one with stage II disease, two with stage III disease, and four with stage IV disease) did not receive an operation after transcatheter arterial infusion because they had distant metastases at the time of operation. Thirty-two of 58 patients (56%) received postoperative radiotherapy. The complete histologic response rates (no active cancer cells) after transcatheter arterial infusion were: 2 of 12 patients with stage I disease, 3 of 21 patients with stage II disease, 5 of 20 patients with stage III disease, and one of five patients with stage IV disease. Tumors with squamous cell carcinoma disappeared at a significantly better rate (10/36, 28%) than did tumors with adenocarcinoma or adenosquamous cell carcinoma (1/22, 5%; p < 0.05). The overall 5-year survival rates of the patients with stages I, II, and III disease were 92.3%, 62.2%, and 71%, respectively. The 5-year survival rates of the patients who underwent surgery with stage I, II, and III disease were 100%, 66.3%, and 71.5%, respectively. Leukocytopenia and thrombocytopenia occurred as an acute complication in 75% and 79% of the patients, respectively. As a late complication, ileus occurred in 7%. Transcatheter arterial infusion may improve the prognosis of patients with cervical cancer without increasing the incidence of late complications.     

Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of Stage IB or II cervical carcinoma patients with or without pelvic lymph node metastases: an analysis of 891 cases

BACKGROUND: The purpose of this study was to investigate pretreatment variables that could predict prognosis and to evaluate the impact of postoperative adjuvant therapy on the outcomes of patients with Stage IB or II cervical carcinoma with or without pelvic lymph node metastases. METHODS: Eight hundred ninety-one patients with Stage IB or II cervical carcinoma who underwent radical hysterectomy and bilateral pelvic lymphadenectomy as primary treatment at a single institution were analyzed. Potential prognostic variables were studied. RESULTS: Among the variables that could be assessed before treatment, depth of cervical stromal invasion (determined by magnetic resonance imaging), clinical stage, tumor size, grade of differentiation, and DNA index (determined by flow cytometry) were independent predictors of outcome in multivariate analysis using a Cox regression model. Three distinct prognostic groups (low, intermediate, and high risk) were defined using these variables. Five-year recurrence free survival (RFS) rates for the low, intermediate, and high risk groups were 94.6%, 82.7%, and 62.3%, respectively (P = 0.0001), and overall survival (OS) rates were 98.4%, 84.5%, and 68.7%, respectively (P = 0.0001). Among patients with pelvic lymph node metastases who were free of parametrial extension, those who received postoperative chemotherapy or chemoradiotherapy had significantly better RFS (P = 0.017) and OS (P = 0.043) than those who received no adjuvant therapy. Among patients without pelvic lymph node metastases but at high risk of recurrence, those who received adjuvant radiotherapy had significantly better RFS (P = 0.015) and marginally improved OS (P = 0.087) compared with those who received no adjuvant therapy. CONCLUSIONS: A model containing assessable pretreatment variables for predicting the prognoses of patients with early stage cervical carcinoma was formulated. Subsets of patients for whom postoperative chemotherapy or radiotherapy might be beneficial were identified. The data from this retrospective review may be useful when future prospective trials of the treatment of early stage cervical carcinoma are designed.     

卵巢恶性生殖细胞肿瘤手术方式的探讨

目的　本文分析164例卵巢恶性生殖细胞肿瘤的手术疗效,探讨治疗该瘤更合理的手术方式。方法　回顾性分析164例卵巢恶性生殖细胞肿瘤患者的临床资料,其中5 7例采用保留生育功能的术式;10 7例采用不保留生育功能的传统术式。2组均根据个体状况辅以适当的化疗(和/或放疗)。结果　保留生育功能组和不保留生育功能组的5年生存率分别为69.0 1% (3 9/5 7)、5 4.94% (5 9/10 7) (P >0 .0 5 )。2组术后并发症发生率分别为3 .5 1% (2 /5 7)、3 .74% (4 /10 7) (P >0 .0 5 )。多因素分析显示临床分期、病理类型、残留肿瘤体积是影响预后的主要因素(P均<0 .0 5 )。结论　卵巢恶性生殖细胞肿瘤患者可根据需要采用保留生育功能的术式,并辅以适当的化疗和(或)放疗。     

同步放化疗与新辅助化疗联合手术加辅助放疗治疗Ⅱb期宫颈癌的对比分析

目的:分析比较根治性放疗联合双药同步化疗与新辅助化疗联合根治性子宫切除术加术后辅助放疗治疗FIGO Ⅱb宫颈癌的复发转移率,无进展生存期(PFS),总生存期(OS),不良反应及预后影响因素.方法:回顾性分析2008年9月至2013年12月期间中南大学湘雅二医院肿瘤中心及妇科收治的初治FIGO Ⅱb期宫颈癌患者,共计91例.按照治疗方式分为两组:①同步放化疗组49例:根治性放疗联合双药同步化疗,3周方案连续4至6周期;②新-术-放疗组42例:先予以2至3周期新辅助化疗,然后行根治性子宫切除及盆腔淋巴结清扫术加术后辅助放疗.比较两种治疗方式的疗效及不良反应有无差异,并通过Cox回归模型分析影响预后的因素.结果:同步放化疗组和新-术-放疗组5年无进展生存率分别为80.8%、74.6%,总生存分别为85.6%、81.8%,两组间5年无进展生存率及总生存差异均无统计学意义(分别为P=0.43和P=0.62).同步放化疗组随访期间6例患者(12.24%)出现死亡,新-术-放疗组7例(16.67%)患者死亡,两组之间差异无统计学意义(P=0.55).同步放化疗组2例(4.08%)患者出现复发和(或)转移,新-术-放疗组4例(9.52%)出现复发和(或)转移,两组之间差异无统计学意义(P=0.42).Ⅲ-Ⅳ级近期毒副反应同步放化疗组出现3例(6.12%),新-术-放疗组出现2例(4.76%),两组之间差异无统计学意义(P=1);远期毒副反应中,无Ⅲ级及以上的慢性放射性反应发生,同步放化疗组4例(8.16%)患者出现放射性肠炎,新-术-放疗组同样4例(9.52%)患者出现放射性肠炎,另外2例(4.76%)患者出现下肢水肿,两组之间差异无统计学意义(P=0.50).Cox回归比例风险模型分析肿瘤直径大于4 cm是无进展生存期和总生存期的预后不良因素(P均<0.05).结论:同步放化疗与新辅助化疗联合根治性手术加术后辅助放疗治疗FIGO Ⅱb期宫颈癌的复发转移率、无进展生存期及总生存期无统计学意义(P>0.05).同步放化疗与新辅助化疗联合根治性手术加术后辅助放疗治疗FIGO Ⅱb期宫颈癌的近期及远期毒性反应无统计学意义(P>0.05).