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。

Discussion on the Preoperative Treat Modes of Early Stage Bulky Cervical Cancer

Objective To discuss the effective preoperative methods in the local advanced early stage cervical cancer. Methods Retrospective Analydis of 288 local advanced cervical patients in our hospital during 2003 January to 2007 October. 172 patients underwent the surgery, of radical hysterectomy Mter synehro-radiochemotherapy, meanwhile 66 patients and 50 patients underwent the same operation after afterloading rdiaotherapy or NAC respectively. We compare the regress rate of tumor, pathologic change ; operation time, blood loss and complications of three groups. Results The local-control rate of the synchro-radiochemotherapy group were better than those of the other groups （P 〈0.05 ） ;The average operation time and blood lose of after afterloading rdiaotherapy group was more than those of the other groups （ P 〈 0. 05 ） ; The complication rate of synchro-radiochemotherapy group were more than those of the other groups hut there were no signifieience （ P 〉 0.05 ）. Conclusion Preoperative synchro-radiochemotherapy in the local advanced early stage cervical is a effective therapeutic means,but we shoud pay more attention to the complications.