子宫内膜癌术前动脉插管化疗临床研究

目的:观察子宫动脉插管化疗 栓塞对子宫内膜癌的疗效,以期进一步提高子宫内膜癌患者的生存率.方法:选择2005年3月至2006年4月我院收治的、经诊刮病理证实为子宫内膜癌、经检查无介入化疗禁忌证的患者13例,术前1周经股动脉双侧子宫动脉插管化疗 栓塞,两侧分别单次注射单药顺铂(DDP)30 mg,总量60 mg,同时双侧子宫动脉予以栓塞.化疗1周后常规手术.术后病理与术前诊刮病理作对照.结果:13例中,12例双侧子宫动脉插管成功,注药后8例栓塞,4例未栓塞;1例插管仅达双侧髂内动脉,双侧注药后未行栓塞.术后子宫内膜癌灶标本组织检查发现:8例癌巢消失,细胞呈变性、坏死样变化,盆腔淋巴无转移;2例有癌细胞残存,癌细胞与诊刮标本对比,细胞分级降低,且有增生的纤维组织包裹及淋巴细胞增生;3例无效.1例患者伴输卵管、宫颈及髂总淋巴转移,术后继续全身化疗后予以放疗.结论:子宫动脉插管介入化疗后双侧栓塞,对不同组织学类型子宫内膜癌短期疗效显著,有利于彻底手术,并降低术后放疗率,但远期疗效尚待进一步观察,能否成为根治子宫内膜癌的化疗方法有待更多的研究.

Clinical study of preoperative chemotherapeutic infusion by artery catheterization for endometrium cancer

Objective To investigate for endometrium cancer and to evaluate its certified by pathology after diagnostic cure clinical efficiency of transcatheter uterine arterial chemotherapy and embolism effects on survival rate. Methods Thirteen cases with endometrium cancer, ttage were studied from March, 2004 to April, 2005. All of the cases had no contraindications to interventional treatment, and underwent catheterization of bilateral uterine arteries ria unilateral femoral artery and was injected 30 mg of platinum, into each side of uterine arteries individually in order to embolize arteries of tumors one week in advance of operations. The results of postoperative pathology were compared with those of preoperative. Results Twelve of thirteen cases were successfully infused and embolized by bilateral uterine arteries catheterization. Bilateral injections of chemotherapeutic drug were successfully performed resulting in embolism in 8 cases out of 13 cases. Only one case was failed to be embolized because catheter was merely introduced into the bilateral internal iliac arteries. Postoperative results of pathology showed that the cancer cell nests of the tissues of cancerous focus were disappeared and cancer cells appeared degeneration and necrosis without metastasis of pelvic lymph nodes in 8 cases. Cancer cells in cancerous focus remained, but the cytology grade decreased with the encapsulation of the proliferated fibrotic tissue and proliferation of lymph cells comparing with the cells in the tissues from diagnostic curettage in 2 cases. Three cases showed no effects. Only one case needed further treatment of chemotherapy and radiotherapy after the operation because of the metastasis of tubal, cervix and loft internal iliac artery. Conclusion For patients with endometrium cancer of various tissue types,interventional treatment with pelvic arterial infusion can achieve short term good result and benefit the overall operation to decrease the rate of radiotherapy because of the decrease of clinical stage. However, the long-term results need more studies.