介入化疗栓塞治疗宫颈癌的临床应用

目的 评价经子宫动脉介入灌注化疗栓塞对宫颈癌的疗效及并发症。方法 对46例宫颈癌患者采用Seldinger技术，经右侧股动脉穿刺并分别插管至左，右子宫动脉行灌注化疗或栓塞，其中，19例行单侧子宫动脉栓塞，2例行双侧子宫动脉栓塞，介入治疗后，28例行根治术。结果 介入治疗后症状缓解率为100.0%,6例患者肿瘤大出血得以控制，28例手术患者中可观察到肿块体积明显缩小，总有效率为97.4%。栓塞后3例出现栓塞侧附件缺血，坏死，2例出现输尿管运动障碍及2例出现臀部瘀血。坏死等并发症。结论 经子宫动脉介入灌注化疗栓塞对宫颈癌患者有非常满意的近期疗效。     

进展型宫颈癌术前介入化疗栓塞疗效观察

目的 评价进展型宫颈癌术前子宫动脉化疗栓塞的疗效.方法 43例进展型宫颈癌患者术前采用Seldinger技术子宫动脉插管化疗加栓塞后行宫颈癌根治手术,观察其近期疗效.结果 介入后症状缓解率为100%,4例肿瘤大出血得以控制.术后病灶完全缓解24例(55.8%),部分缓解17例(39.5%),稳定2例(4.7%),总有效率为95.4%.43例均未发生与介入治疗相关的严重并发症.结论 进展型宫颈癌术前子宫动脉灌注化疗栓塞可缩小肿瘤病灶,提高手术治疗效果.     

鸦胆子油乳肝动脉灌注治疗转移性肝癌

[目的]探讨鸦胆子油乳联合化疗药物经药盒植入系统(PCS)肝动脉灌注对消化道肿瘤肝转移的临床疗效.[方法]经锁骨下动脉穿刺植入PCS至肝脏供血动脉,16例患者经PCS灌注或栓塞治疗,同时联合鸦胆子油乳肝脏供血动脉内灌注治疗(A组);14例患者单纯化疗灌注或栓塞(B组).每4周为1个疗程,连用6个疗程.[结果]A组16例患者生存期9～24个月,中位生存期17个月,有效率68.8%,1年生存率为81.3%,2年生存率为43.8%;B组14例患者生存期4～18个月,中位生存期14月,有效率57.1%,1年生存率42.9%,2年生存率28.6%.且A组较B组骨髓毒性轻,体力状况明显改善.[结论]鸦胆子油乳联合化疗药物肝动脉内灌注治疗能提高消化系统肿瘤肝转移的疗效;并可改善患者的体力状况及降低骨髓毒性.     

内引流加区域动脉灌注健择治疗晚期胰头癌

[目的]评价内引流加区域性动脉灌注健择(吉西他滨)治疗晚期胰头癌的可行性.[方法]对25例经病理确诊不能手术切除的晚期胰头癌病人行各种胆肠内引流术,术中、术后用健择作区域性动脉(如胃十二指肠动脉和/或胰十二指肠下动脉)灌注化疗.[结果]25例病人中可评价疗效者23例,其中PR3例,MR6例,SD11例和PD3例;临床受益反应评价有效率为65.2%(15/23).死亡9例,平均生存10.9月,另14例已存活1.5～21月.所有病人未发现明显的毒副作用.[结论]内引流加区域性动脉灌注健择化疗是治疗晚期胰头癌的一种较好的方法,可明显改善病人的生活质量、提高临床受益反应,病人耐受良好.     

子宫动脉灌注THP为主药物加栓塞与放疗治疗晚期宫颈癌

目的观察子宫动脉插管灌注THP为主的药物加栓塞与放疗联合应用治疗晚期宫颈癌的疗效.方法选择宫颈癌Ⅱb-Ⅳ期的患者共37例,在X线引导下做双侧髂内动脉插管并超选择插入双侧子宫动脉分别注入以THP为主的化疗药物并用碘油及明胶海绵栓塞双侧子宫动脉.3～4周重复治疗,2次后开始放射治疗,放疗采用腔内后装加外照射.同时复习本院以往采用全身化疗加放疗治疗的晚期宫颈癌40例作为对照组.结果治疗组37例患者,治疗后经B超及CT检查并与治疗前对照,CR和PR为有效.总有效率为94.7%,完全缓解率81%.结论以THP为主双侧子宫动脉灌注加栓塞与放疗联合应用治疗晚期宫颈癌近期疗效显著并适当延长中位生存期.     

拓扑替康在宫颈癌治疗中的抗癌效应

[目的]探讨DNA拓扑异构酶Ⅰ抑制剂--拓扑替康在宫颈癌治疗中的抗癌活性.[方法]将60例病理证实宫颈癌Ⅰb2期～Ⅳb期患者分为动脉化疗组和静脉化疗组,分别给予拓扑替康1.25mg/(m2·d),化疗15天后根据病理损伤程度进行疗效评定.[结果]60例病理总有效率为68%(41/60),动脉化疗组有效率为81%(26/32),静脉化疗组有效率为54%(15/28),两组间差异有显著性(P＜0.05).[结论]拓扑替康是治疗中、晚期宫颈癌有效的药物,动脉化疗疗效优于静脉化疗.     

区域性动脉灌注化疗22例不可切除胰腺癌插管途径分析

[目的]探讨不可切除胰腺癌区域性动脉灌注化疗的插管途径.[方法] 22例不可切除胰腺癌患者采用胰腺局部动脉插管区域灌注化疗,经胃十二指肠动脉插管并结扎胃网膜右动脉和胰十二指肠下动脉8例;经胃网膜右动脉插管并结扎胃十二指肠动脉根部10例;经胃左动脉逆行插管至腹腔干动脉4例.[结果]无手术死亡,无手术并发症.17例疼痛患者12例减轻,其中经胃网膜右动脉途经插管有7例(7/12).根据肿瘤客观疗效评定标准(VHO):部分缓解(PR)8例,其中经胃网膜右动脉途经插管4例(50%);无变化(NC)10例,恶化(PD)4例.平均生存12.4个月.[结论]区域性动脉灌注化疗短期内能有效抑制肿瘤生长、减轻疼痛,从而有助于生存质量的提高,是胰腺癌综合治疗的有效措施之一.经胃网膜右动脉途径插管加胃十二指肠动脉根部结扎,效果较好.     

宫颈癌术前子宫动脉化疗栓塞26例临床疗效观察

目的 探讨26例宫颈癌术前行子宫动脉化疗栓塞的方法 疗效。方法 对26例宫颈癌患者行超选择性子宫动脉化疗栓塞,观察其疗效和毒副反应。化疗栓塞后2-3周行子宫根治术及盆腔淋巴结清扫术。结果 26例患者阴道流血、流液、腰骶部疼痛等症状均明显缓解,化疗栓塞总有效率为92.3%,手术成功率为100.0%,26例各组淋巴结及切缘无癌残留。结论 宫颈癌术前行超选择性子宫动脉化疗栓塞有助于提高手术切除率,减少复发和转移;二次治疗的合适时机为化疗栓塞后2-3周。     

中晚期宫颈癌血管介入治疗61例应用

[目的]探讨超选择性髂内动脉插管化疗对中晚期宫颈癌的疗效.[方法]经皮股动脉穿刺插管.在数字减影血管造影下(DSA),对61例(81例次)中晚期宫颈癌进行超选择性髂内动脉及肿瘤供血动脉插管化疗,其中20例宫颈癌患者介入前后使用流式细胞仪进行DNA含量(DI)测定和S期细胞比率(SPF)以及细胞凋亡的检测,另30例宫颈癌患者介入前后取宫颈活检组织检测核仁组成区嗜银蛋白(AgNOR)、增殖细胞核抗原(PCNA)的表达.[结果]介入治疗近期有效率为78.7%,症状缓解有效率为88.5%,手术治疗46例,栓塞组术中出血量明显低于未栓塞组(P＜0.05);介入化疗后的DI、SPF均显著低于化疗前(P＜0.05);介入化疗后的AgNOR颗粒数目减少、直径增大(P＜0.05),介入化疗后PCNA的积分减少(P＜0.05).[结论]①中晚期宫颈癌经超选择性血管介入治疗获得根治手术机会明显增加;动脉化疗-栓塞治疗效果优于动脉化疗;提示未经治疗的宫颈癌患者为血管介入化疗最佳适应证.②介入化疗能降低其DNA含量和S期细胞比率,抑制宫颈癌细胞增殖,诱导细胞凋亡,抑制肿瘤的恶性进展.③超选择性髂内动脉插管化疗为一种微创、可重复进行、安全、有效的治疗措施.     

晚期非小细胞肺癌不同治疗方法疗效比较

[目的]评价3种不同方法治疗晚期非小细胞肺癌的疗效.[方法]85例经病理学诊断的晚期肺癌患者随机分为3组,A组(27例)经静脉给药化疗组,B组(30例)单纯支气管动脉灌注化疗组,C组(28例)超选择性支气管动脉栓塞化疗组.3组均采用吉西他滨联合顺铂进行治疗.[结果]近期疗效总有效率56.5%,其中A、B、C 3组分别为40.7%(11/27),56.7%(17/30),71.4%(20/28)(P《0.05).1、2年生存率3组分别为53.8%、30.0%;69.2%、48.2%;83.5%、65.7%,各组间差异有显著性(P《0.05).不良反应主要为骨髓抑制、胃肠道反应,未出现脊髓损伤等严重并发症.[结论]超选择性支气管动脉栓塞化疗是治疗晚期NSCLC的一种安全有效的方法,其疗效优于静脉注射和单纯支气管动脉灌注化疗.     

综合治疗宫颈癌106例临床分析

[目的]对中晚期子宫颈癌综合治疗的疗效进行观察。[方法]106例中晚期子宫颈癌病人，分为两组，一组78例，采用腹壁下动脉插管区域化疗2-3个疗程后，行广泛或次广泛子宫切除，二组28例，在区域化疗的同时加^192铱腔内放射治疗，然后行手术治疗，[结果]一组病人的5年存活率高于国内报道；区域化疗对淋巴结转移有治疗作用；二组病人的疗效明显高于一组。[结论]采用腹壁下动脉插管行区域性化疗结合腔内放疗再行手术治疗中晚期子宫颈癌较好的治疗方法，腹壁下动脉插管化疗具有技术条件低，费用低，方法简单等优点，适于基层医院开展。     

局部晚期子宫颈癌新辅助动脉化疗疗效的评价

目的　观察新辅助动脉化疗前后子宫颈癌组织中 p5 3、细胞增殖和凋亡的变化情况 ,探讨其生物学指标与化疗疗效关系 ,借以确定局部晚期子宫颈癌动脉化疗的适应证。方法　对 2 0例局部晚期子宫颈鳞癌患者进行B超选择子宫动脉灌注顺铂和阿霉素 ,分别取动脉化疗前及化疗后 3周时的子宫颈癌组织。用 TU NEL 结合形态学方法检测细胞凋亡 ,用 SABC法检测增殖细胞核抗原和 p5 3的表达。结果　局部晚期子宫颈癌 2 0例中部分缓解14例 (70 .0 % ) ,而 4例 (2 0 .0 % )患者无变化 ,2例 (10 .0 % )病灶进展。化疗前细胞增殖指数高者化疗疗效好 (P<0 .0 5 )。化疗后缓解者在化疗后细胞凋亡指数或细胞凋亡 /增殖指数均明显增高 (P<0 .0 1) ,且高于化疗后未缓解者水平。结论　新辅助动脉化疗前细胞增殖情况以及化疗后细胞凋亡或细胞凋亡 /增殖的水平可反映局部晚期子宫颈鳞癌患者化疗疗效     

Neoadjuvant chemotherapy with intra-arterial infusion in the treatment of advanced cervical cancer

Neoadjuvant chemotherapy (NAC) with intra-arterial infusion was performed in the treatment for 53 patients with advanced cervical squamous cell carcinoma. After NAC with intra-arterial infusion of the anticancer agents including cisplatin via internal iliac artery or uterine artery, 42 patients received radical hysterectomy. The response to therapy was observed in 45 of all patients (84.9%) clinically, and 36 of 42 patients (85.7%) pathologically. Cancer cells disappeared in 11.9% of patients with cervical invasion, 69.2% with vaginal wall invasion and 39.4% with parametrium invasion after NAG. Five-year survival rates were 100% in stage I, 71.5% in stage II, 52.2% in stage II and 0% in stage IV. The group of patients without cancer in the parametrium after NAC showed a significantly better 5-year survival rate than the group with residual cancer in the parametrium. According to the results, the elimination of cancer invasion to the parametrium by NAC is thought to be important for improvement of the prognosis in advanced cervical cancer.     

A clinical Comparison of Lobaplatin or Cisplatin with Mitomycine and Vincristine in Treating Patients with Cervical Squamous Carcinoma

Background: The research was to compare the efficacy and side effects of cisplatin or lobaplatin in combinationwith mitomycine (MMC) and vincristine in treating patients with cervical squamous carcinoma. Materials andMethods: Cervical squamous carcinoma patients who were pathologically diagnosed with stage Ib-IIb from April2012 to May 2013 in the general hospital of Chinese People’s Libration Amy were enrolled. All patients wereconfirmed without prior treatment and were randomly divided into two groups, Group A and B. Efficacy andside effects were evaluated after one cycle of chemotherapy. Results: Group A (n=42) were treated with Loubo®(Lobaplatin) 50mg/m2, MMC 16mg/m2 and Vincristine 2mg/m2 every 21 days. Group B (n=44) were treatedwith Cisplatin 100mg/m2, MMC 16mg/m2 and Vincristine 2mg/m2 every 21 days. All 86 patients completed onecycle of chemotherapy with cisplatin or lobaplatin in combination with MMC and vincristine. No difference wasobserved regardiing short-term effect between two groups. Main side effects were bone marrow suppression andgastrointestinal reactions including decrease of white blood cells, platelet and nausea/vomiting. Grade III-Ⅵliver and kidney impairment was not reported in two groups. In group A the incidence of uterine artery spasmin the process of drug delivery was significantly lower than the group B. Conclusions: Cisplatin or lobaplatinwith MMC and Vincristine in the interventional treatment of cervical squamous carcinoma were effective,especially after uterine artery perfusion chemotherapy at tumor reduction and tumor downstaging period. Theadverse reactions of concurrent chemotherapy are tolerable, and low physical and mental pressure even moreless stimulation of vascular in treatment with lobaplatin. However, the long-term effects of this treatment needfurther observation.     

同步放疗联合介入化疗治疗中晚期子宫颈癌的临床观察

 目的　比较吡柔比星（THP）、5-氟尿嘧啶（5-Fu）联合顺铂（DDP）介入化疗联合放疗与单纯放疗治疗中晚期子宫颈癌的疗效和不良反应。方法　将48例经病理确诊的ⅡB～Ⅳ期子宫颈癌患者按随机数字表法分为同步放疗及介入化疗组（25例）和单纯放疗组（23例）,两组放疗剂量相同,同步放化疗组在放疗前后予以髂内动脉局部介入灌注化疗,THP 30～40 mg、5-Fu 0.50～0.75 g、DDP 40～ 60 mg,28 d为1个周期,共 3～4个周期 。对比两组的治疗效果及相关不良反应。结果　同步放疗及介入化疗组有效率为92.0 %（23／25）,3年生存率80.0 %（20／25）。单纯放疗组有效率为69.6 %（16／23）, 3年生存率为52.2 %（12／23）,两组差异有统计学意义（均P＜0.05）。两组相关不良反应发生率之间差异无统计学意义（均P＞0.05）,经对症处理后可耐受,为可逆的。结论　同步放疗联合介入化疗治疗中、晚期子宫颈癌可显著提高患者有效率及生存率,不良反应与单纯放疗相比无明显增加。     

正常子宫颈和宫颈癌的弥散加权成像特点

背景与目的:磁共振成像(magnetic resonance imaging,MRI)是宫颈癌诊断和分期的重要检查方法.本研究对正常子宫颈和宫颈癌组织的弥散加权成像(diffusion-weighted imaging,DWI)特点进行分析,并探讨DWI在宫颈癌诊断以及放疗后疗效监测方面的价值.方法:对16例非宫颈肿瘤女性的子宫颈和20例宫颈癌患者的子宫颈进行常规MRI扫描和横断面DWI(b=800 s/mm2),比较正常宫颈和宫颈癌病灶的表观弥散系数(apparent diffusion coefficient,ADC)值.比较未行手术的7例宫颈癌患者放疗前后宫颈的ADC值.结果:正常子宫颈在DWI图上呈三层结构,其平均ADC值[(1.71±0.14)×10-3 mm2/s)]显著高于宫颈癌的ADC值[(0.97±0.13)×10-3 mm2/s)](P＜0.01).放疗后子宫颈的ADC值[(1.49±1.40)×10-3 mm2/s]较放疗前[(1.02±0.06)×10-3 mm2/s]升高,但仍低于正常子宫颈.结论:DWI能够区分正常子宫颈和宫颈癌组织,可用于宫颈癌治疗前侵犯范围的评价,并可显示放疗后宫颈组织的改变.     

选择性髂内动脉灌注化疗和栓塞治疗宫颈复发癌

本文报道３４例经根治性治疗愈合后盆腔复发的宫颈癌患者，经选择性髂内动脉灌注化疗和栓塞治疗６９次，治疗后１．９例肿瘤缩小，近期有效率５５．９％。结果表明：选择性髂内动脉灌注化疗和栓塞治疗在宫颈复发癌的治疗中是一种有效的、安全的方法。     

子宫颈癌放疗后子宫体恶性肿瘤47例临床分析

Objective  To study the characteristics and clinical features of uterine neoplasms developed after radiation therapy for cervical carcinoma. Methods  Clinical data of 47 cases of uterine neoplasms occurred following radiation therapy for cervical carcinoma were retrospectively reviewed. Results  The median age at uterine neoplasms diagnosis was 62 years (range: 38–77 years), and the median latency period from initial therapy to development of uterine neoplasms was 14 years (range: 5–35 years). Thirty of 47 cases were endometrial carcinoma, of which 3 were uterine papillary serous carcinoma (UPSC). Seventeen of 47 patients were uterine sarcoma, all of those were carcinosarcoma. The distribution by stage, grade, and histology of 30 cases of endometrial carcinoma was as follows: stage Ib, 1 case; stage Ic, 2 cases; stage II, 6; stage IIIa, 4; stage IIIb, 2; stage IIIc, 11; stage IV, 4 cases; grade 1, two cases; grade 2, nine; grade 3 (include 3 UPSC patients), seventeen; unknown grade, two; endometriod, 27; UPSC, 3 cases; 7 of 30 cases of endometrial carcinoma had recurrences (23.3%), at median time to recurrence was 24 months, and their median survival time was 26 months. The overall 3- and 5-year survival rates were 60% and 38%, respectively. Of the 17 cases of uterine sarcoma, the median survival was 10 months, 6 patients occurred recurrence (35.9%), at a median time to recurrence was 9 months, and their median survival was 6 months. The overall 3- and 5-year survival rates were 12% and 0, respectively. Conclusion  The main uterine neoplasms development after radiation therapy for cervical carcinoma is endometrial carcinomas, of which there is a preponderance of high-risk histological subtypes and a poor prognosis. Most of the uterine sarcomas occurred following radiation therapy for cervical carcinoma are carcinosarcomas and the prognosis is very poor.     

Chemotherapy against pulmonary metastasis from uterine cervical carcinoma

The eligibilities for chemotherapy, prognostic factors and effects of chemotherapy were evaluated in pulmonary metastasis from uterine cervical carcinoma. There was no difference in median survival between patients treated with surgery and those with chemotherapy. The mediastinal lymph node involvement and vascular invasion were demonstrated to be important prognostic factors in patients treated with surgery, and it was suggested that systemic chemotherapy should be given to the patients with mediastinal lymph node involvement. The median survivals of patients treated with chemotherapy were 12.3 months in patients with pulmonary metastasis alone and 5 months in those with both pulmonary and other visceral metastasis, respectively. Responders to chemotherapy survived longer than non-responders. Overall response rate was 42.7% (44/103), and the response rate of MDU (Mitomycin C+Dextran sulfate+Urokinase) (62.3%) was higher than other chemotherapeutic regimens, which suggested that appropriate chemotherapy would prolong the survival of patients with pulmonary metastasis from uterine carcinoma.     

新辅助放化疗联合手术治疗ⅠB2~ⅡA2期子宫颈癌临床预后因素分析

背景与目的：探讨Ⅰ_B2～Ⅱ_A2期子宫颈腺癌与腺鳞癌经新辅助放化疗联合手术治疗后的生存及复发情况,并分析其预后影响因素。方法：收集蚌埠医学院第一附属医院2005年4月—2011年10月50例Ⅰ_B2～Ⅱ_A2期患者的临床病理资料。患者均接受广泛全子宫切除+盆腔淋巴结清扫术,且术前均接受1次静脉化疗,宫颈肿瘤直径大于等于6 cm,给予阴道腔内放疗1次。回顾分析患者的生存及复发情况,探讨其预后影响因素。结果：50例Ⅰ_B2～Ⅱ_A2期子宫颈腺癌和腺鳞癌患者中,随访期内死亡15例,2年和5年无进展生存率分别是80.12%和72.24%,中位无进展生存时间为68个月;2年和5年累积总生存率分别是95.38%和73.56%,中位总生存时间为80个月。单因素分析显示,盆腔淋巴结转移、宫颈间质浸润、宫旁浸润和新辅助放化疗后肿瘤最大直径缩短小于3 cm的患者预后较差(P<0.05),而年龄、术后放化疗、淋巴管间隙受累分期、FIGO分期、是否保留卵巢和病理类型与预后无明显相关性(P>0.05)。多因素COX回归分析结果显示,盆腔淋巴结转移和放化疗后肿瘤直径缩小是宫颈腺癌和腺鳞癌的独立预后影响因素。结论：新辅助放化疗联合手术治疗提高了Ⅰ_B2～Ⅱ_A2期宫颈腺癌和腺鳞癌手术切除率,而盆腔淋巴结转移及放化疗后宫颈肿瘤最大径消退程度是宫颈腺癌和腺鳞癌的独立预后因素。