Ⅰb2期巨块型宫颈癌术前不同治疗方法的疗效观察  

Analysis of the effects of different treatment methods in patients with stage Ⅰb2 bullky cervical cancer

作　　者：韩娜娜[1] 邵文裕[1] 刘开江[2] 马焱[1] 

机构地区：[1]新疆医科大学附属肿瘤医院妇外一科,新疆乌鲁木齐830011 [2]上海交通大学医学院附属仁济医院妇瘤科,上海200032

出　　处：《中国癌症杂志》2015年第1期56-62,共7页China Oncology

摘　　要：背景与目的:Ⅰb2期巨块型宫颈癌行手术治疗时,因肿瘤体积大,术前多采取多种辅助治疗措施缩小瘤体,哪种方案更为安全有效目前尚无统一意见。本研究比较术前新辅助化疗、新辅助放化疗及直接手术3种不同治疗方法的疗效,为Ⅰb2期巨块型宫颈癌术前辅助治疗方案选择提供依据。方法:回顾分析2006年4月—2010年10月新疆医科大学附属肿瘤医院收治的133例术前新辅助化疗(49例)、新辅助放化疗(40例)及直接手术(44例)的Ⅰb2期巨块型宫颈癌患者的临床资料。结果:新辅助化疗组、新辅助放化疗组近期有效率为91.8%、92.5%,差异无统计学意义(P>0.05)。2组治疗后肿瘤直径与治疗前比较,差异有统计学意义(P<0.05);手术标本病理有效率为95.56%、97.30%,差异无统计学意义(P>0.05);新辅助放化疗组出血量明显高于其它2组,差异有统计学意义(158.9±50.7 vs 116.8±45.5,123.1±30.2,P<0.05),直接手术组术后感染率明显高于其它2组,差异有统计学意义(P<0.05)。新辅助化疗组、新辅助放化疗组、直接手术组平均手术时间,两两比较,差异均无统计学意义(P>0.05),新辅助化疗组与直接手术组出血量比较、新辅助化疗组与新辅助放化疗组术后感染比较、3组术后临近脏器损伤及盆腔淋巴囊肿比较,差异均无统计学意义(P>0.05);术后病理组织学检查,直接手术组脉管受侵,与其它2组相比,差异有统计学意义(P<0.05)。比较3组阴道切缘、淋巴结转移情况、脉管受侵程度,差异均无统计学意义(P>0.05)。3组3年总生存率、无瘤生存率比较,差异也均无统计学意义(P>0.05)。结论:对Ⅰb2期宫颈癌患者术前行新辅助化疗能有效缩小肿块,在提高手术切除率、降低术后切缘阳性率及术后感染方面优于单一手术或术前放化疗。新辅助放化疗比单一术前新辅助化疗能提高病理完全缓解率,但不能降低复发率,因此,对于Ⅰb2期宫颈癌�Background and purpose：A variety of measures are taken preoperatively to reduce the tumor size of stageⅠb2 bulky cervical cancer before surgery. Which one is safer and more effective, currently, there is no consensus. This article compared the effect in 3 different treatment methods （neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and operation） on patients with stageⅠb2 bulky cervical cancer, and provided evidence for clinical decision. Methods：Retrospective analysis the clinical date of 133Ⅰb2 bulky cervical cancer patients, who received preoperative neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and direct operation from Apr. 2006 to Oct. 2010 in our hospital. Results： The effective rates of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy group were 91.8% and 92.5%, respectively, there was no statistical difference（P〉0.05）. The tumor size got smaller after treatment compared with the size before treatment （P〈0.05）;The pathological efifciency rates were 95.56% and 97.30%, respectively, the difference was not statistically significant （P〉0.05）. The bleeding volume of neoadjuvant chemo radio therapy group was significantly higher than those in the other 2 groups （158.9±50.7 vs 116.8±45.5, 123.1±30.2;P〈0.05）, the infection of immediate surgery group was more severe than the other 2 groups （P〈0.05）. The pairwise comparison of average operation time in neoadjuvant chemotherapy group, neoadjuvant chemoradiotherapy group, and the immediate surgery group, pairwise comparisons of neoadjuvant chemotherapy group and the immediate surgery group in bleeding, comparion of neoadjuvant chemotherapy group and neoadjuvant chemoradiotherapy group on postoperative infection, and the comparison of the 3 groups on pelvic organ injury and lymphocele, had no statistical difference（P〉0.05）;Pathological examination showed that vascular invasion in surgery group had statistical differences than other 2 groups （P〈0.05）, there was no patient with positive

关 键 词：Ⅰb2期 巨块型宫颈癌 疗效观察 新辅助化疗 新辅助放化疗 

分 类 号：R737.33[医药卫生—肿瘤]