术前动脉灌注联合栓塞新辅助化疗治疗宫颈癌临床研究

目的 评价经子宫动脉灌注化疗和经周围静脉化疗2种术前新辅助化疗方法对宫颈癌的疗效.方法 将63例Ⅰb2期～Ⅱb期宫颈癌患者术前随机分为经子宫动脉灌注化疗（动脉组）和经周围静脉化疗（静脉组）2组,其中动脉组30例;静脉组33例.均分别治疗2个疗程,患者于第2疗程结束后10～ 14天行宫颈癌根治术.对2种方法的显效率、有效率和切缘、淋巴结病理阳性率进行比较.结果 动脉组显效率为63.33％,有效率为93.33％,静脉组显效率为54.55％,有效率为84.85％;动脉组高于静脉组,2组近期疗效的组间比较无统计学意义（x2 =2.58,P＞0.05）.2组平均手术时间无明显差异;术中平均出血量动脉组高于静脉组,2组比较有差异（U=20.69,P＜0.05）.动脉组和静脉组的切缘（宫旁、阴道）及盆腔淋巴结病理阳性率分别为3.33％ （1/30）和21.21％ （7/33）;动脉组显著低于静脉组,2组间比较差异有统计学意义（x2=4.53,P＜0.05）.结论 2种新辅助化疗方法均能有效的控制宫颈局部病灶,而经子宫动脉灌注化疗优于静脉化疗,应作为新辅助化疗的首选.

Clinical study of two pre-operation neoadjuvant chemotherapies for cervical cancer

Objective To compare the effects of neoadjuvant trans -uterine arterial chemotherapy and neoadjuvant chemotherpy via peripheral vein on cervical cancer prior to operation. Methods Sixty - three patients with cervical cancer at phase I b2 to IIb were randomly divided to an intra -artery group （30 cases） and a peripheral vein group （33 cases） before operation. The patients were performed radical hysterectomy 10 to 14 days after the end of the second chemotherapy course to compare their obvious effective rates, effective rates and lymph node positive rates. Results The obvious effective rate and effective rate were 54.55% and 84.85% in the intraartery group, in contrast with 63.33% and 93.33% in the peripheral vein group. There was no statistical significance in short - term efficacy between the two groups （χ2 =2.58 ,P 〉0.05 ）. No significant difference was found in the average operation time between the two groups （ u = 1.78, P 〉 0.05 ）. The average amount of bleeding was higher significantly in intra - artery group than in the peripheral vein group （ u = 20. 69, P 〈 0.05 ）. The positive rate of surgical margins （ parametrium and/or vagina） and the pelvic lymph nodes was 3.33% （1/30） in the intra - artery group which was significantly lower than 21.21% （7/33） in the peripheral vein group （χ2 = 4.53, P 〈 0. 05）. Conclusion Both neoadjuvant trans -uterine arterial chemotherapy and neoadjuvant chemotherpy via peripheral vein could control the local lesions of cervical cancer. Neoadjuvant trans - u- terine arterial chemotherapy should be the first choice for its superiority over neoadjuvant chemotherpy via peripheral vein.