超选择动脉栓塞灌注化疗加手术治疗中晚期宫颈癌29例疗效分析

目的:探讨中晚期宫颈癌经术前血管性介入动脉栓塞灌注化疗术后,分期逆转后获得行根治性手术的疗效。方法:选择活检确诊为宫颈癌临床分期Ⅱb、Ⅲa患者29例,术前行血管性介入动脉灌注化疗栓塞术,股动脉为穿刺点,采用Seldinger's技术超选择插管至双侧子宫动脉下行支或主干,灌注栓塞卡铂300 mg/m2,2/3量灌注,1/3量混合于明胶海绵中进行栓塞,然后将导管退至髂内动脉前干,再灌注化疗药:鳞癌采用博来霉素45 mg/疗程,腺癌采用吡柔吡星60 mg/m2加生理盐水100 ml分双侧灌注。介入术后15~20天给予根治性手术,随访5年,通过介入术后观察宫颈肿瘤的反应性、根治性手术的情况,淋巴结转移、复发、生存时间的长短来评价疗效。结果:29例患者经介入治疗后15~20天肿瘤体积明显缩小或消除,近期效果显著,出现临床分期逆转后行根治性手术,术后病理检查显示4例患者癌细胞变性,坏死,7例宫旁浸润消失或显著减轻,6例脉管内癌栓,6例淋巴结转移。介入治疗加手术后至今无复发或转移12例。结论:根治性术前超选择动脉灌注化疗栓塞具有较好的缩减肿瘤,粘连松动的效果,不增加手术难度及术后并发症,可使原来无法手术的患者获得切除病灶的机会,术中出血少,手术时间缩短,组织分离容易,手术彻底,不增加手术风险。

Analysis of 29 cases with middle and advanced cervical cancer treated by ultraselection arterial embolism infusion chemo -therapy plus surgery

Objective:To explore the therapeutic effect of radical surgery with preoperation interventional arterial embolism infusion chemo-therapy of middle and advanced cervical cancer.Methods:29 patients with Ⅱb and Ⅲa cervical cancer diagnosed by biopsy received preoperation interventional arterial embolism infusion chemo-therapy,femoral artery as puncture site,intubation was placed to bilateral uterine artery remus descendens or bole,infused with carboplatin 300 mg/m2 accounted for two thirds,embolised accouted for one third in gelatin sponge,then intubation was drawed to anterior trunk of internal iliac artery to infuse with bleomycin 45 mg/therapy time in squamous carcinoma,pirarubicin 60 mg/ m2 plus normal saline 100 ml in adenocarcinoma.Radical surgery was done 15~20 days after intervention.Following-up lasted 5 years.Therapeutic effect was evaluated by reaction of cervical cancer,surgery condition,lymph node metastasis,relapse and survival time.Results:Gross tumor volume of 29 cases obviously decreased or eliminated 15~20 days after intervention,having significant effect in the near future.Radical surgery was conducted after clinical stage reversion.Postoperational pathological examination showed 4 cases of carcinoma cell degeneration and necrosis,7 infiltrations or significant alleviations,6 intraductal carcinomas,and 6 lymph node metastasis.12 cases had no relapse or metastasis after intervention plus surgery to this day.Conclusion:Ultraselection arterial embolism infusion chemo-therapy before radical surgery has better effect of decreasing cancer volume and adhering cinch,does not increase surgery difficulty and postopertaional complications,which could give the chance to cut focal for the patients without surgery possibility,having advantages such as less perioperation bleeding,shortened surgery time,easier to separate tissue,and less surgery risks.