术前放疗联合手术治疗Ⅱ期宫颈癌临床分析  

Clinical analysis on preoperative radiotherapy plus surgery in treating stage Ⅱ cervical cancer

作　　者：马代远[1] 杜国波[1] 谭榜宪[1] 柳弥[1] 周业琴[1] 廖碧霞[1] 

机构地区：[1]川北医学院附属医院肿瘤科,四川南充637000

出　　处：《重庆医学》2012年第17期1693-1695,共3页Chongqing medicine

摘　　要：目的探讨术前放疗联合手术治疗Ⅱ期宫颈癌的疗效、晚期不良反应及预后因素。方法 82例病理确诊的初治Ⅱ期宫颈癌患者,采用术前放疗联合手术治疗模式。放疗:外照射采用6mV X线全盆腔照射,总剂量20～40Gy,中位剂量40Gy;192Ir高剂量率后装治疗,每周1次,每次A点剂量6～8Gy,共照射2～4次。手术:术式为60例行子宫广泛切除及盆腔淋巴结清扫,22例行子宫次广泛切除和盆腔淋巴结部分清扫。放疗后3周行手术。结果 5年局部控制率为85.4%,总生存率为78.0%,无瘤生存率为75.6%;Ⅱ级及以上晚期反应发生率,膀胱为8.5%、直肠为12.2%,下肢水肿发生率为8.5%;单因素分析血红蛋白(Hb)≥110g/L(χ2=6.736,P=0.009)、术后无残留(χ2=5.818,P=0.016)、术后病检阴性(χ2=12.177,P=0.000)及无盆腔淋巴转移(χ2=8.924,P=0.004)的患者预后较好。结论术前放疗联合手术是Ⅱ期宫颈癌临床可行的治疗模式,晚期不良反应可耐受,Hb水平、有无术后残留、术后病检情况是独立预后因素。Objective To investigate the effect, late adverse reactions and prognostic factors of simple preoperative radiotherapy plus surgery in treating stage Ⅱ cervical cancer. Methods 82 cases of pathologically diagnosed stage Ⅱ cervical cancer were performed preoperative radiotherapy plus surgery. Radioetherapy： the total dose of extraorgan radiation to whole pelvic cavity was 20 -40 Gy with 6MV X-ray and the median dose was 40Gy, simultaneously, the 192 Ir afterloading treatment was enforcing once a week （the dose at A point was 6-8Gy every time,2-4 times）. Operation：60 cases were performed radical hysterectomy and pelvic cavity lymph nodes dissection and 22 cases were performed suhradical hysterectomy and pelvic cavity lymph nodes dissection. The surgery was followed in 3 weeks after radiotherapy. Results The 5- year control rate was 85.4%, the total survival rate was 78.0% and the survival rate without tumor was 75.6%. The incidence rate of late reactions grade]] was 8.5% for bladder and 12.2% for rectum. The incidence rate of lower extremity edema was 8.5%. The univariate analysis showed that the patients with HGB〉 110g/L（z2 =6. 736,P=0. 009）,without operation residual （X2 =5. 818,P=0. 016）,without pelvic cavity lymph nodes metastasis （x2 =8. 924,P=0. 004）and with negative postoperative pathologic results（x2= 12. 177,P=0. 000） had favorable prognosis. Conclusion Preoperative radiotherapy plus surgery is a feasible treatment mode to stage cervical carcinoma. The late adverse reactions are tolerable. The HGB level,operation residual and postoperative pathologic results are independent prognosis factors.

关 键 词：宫颈癌 术前放射治疗 手术 预后分析 

分 类 号：R737.33[医药卫生—肿瘤]