局部晚期宫颈癌术前放化疗联合腹腔镜手术的预后分析  

Analysis on the prognosis of locally advanced cervical cancer patients treated by preoperative radiochemotherapy combined with laparoscopic surgery

作　　者：朱鹏峰[1] 许培箴[1] 欧阳俊[2] 董一善[1] 

机构地区：[1]南京医科大学附属常州妇幼保健院妇科,江苏常州213003 [2]南京医科大学附属常州妇幼保健院病理科

出　　处：《中国妇幼保健》2015年第28期4885-4889,共5页Maternal and Child Health Care of China

基　　金：南京医科大学科技发展基金项目〔2014NJ-MU021〕

摘　　要：目的探讨术前放化疗联合腹腔镜手术对局部晚期宫颈癌预后的影响。方法选取52例宫颈肿瘤最大径≥4cm且≤5cm的IB2、IIA2期宫颈癌患者，术前26例放化疗患者为观察组，26例直接手术患者为对照组。观察组术前采用静脉化疗1～2疗程＋阴道近距离放疗1～2疗程，治疗期间行临床评估，如无效改根治性放疗，如有效放化疗结束后2周手术。两组手术方式均采用腹腔镜宫颈癌根治术，年龄≤45岁鳞癌患者保留双侧卵巢。统计观察组术前放化疗疗效，比较两组患者腹腔镜手术相关质量因素、术中术后并发症、术后病理资料及术后补充放化疗及复发生存情况。结果观察组肿瘤病灶完全消失3例，部分缓解18例，1例无进展改根治性放疗，总临床有效率80．77％。观察组手术时间、切除宫颈阴道旁组织宽度优于对照组（P〈0．05），术中出血量、术后肛门排气时间及拔尿管时间两组差异无统计学意义（P〉0．05），两组1月内均无输尿管瘘、肠瘘。观察组与对照组的盆腔淋巴结转移率为24．00％和53．85％、淋巴脉管间隙浸润阳性率20．00％和46．15％、宫颈深间质浸润率40．00％和76．92％，差异均有统计学意义（P〈0．05）。根治性宫颈癌手术后接受补充放化疗的患者观察组17例，对照组22例。观察组与对照组的4年累积无疾病进展生存率分别为93．54％和75．20％，且与盆腔淋巴结转移、宫颈深间质浸润相关。结论局部晚期宫颈癌患者术前放化疗联合腹腔镜手术安全可行，能使部分患者达到病理治愈，免于术后追加补充放化疗，并有可能进一步提高患者的无进展生存期、远期生存率，有良好的临床应用前景。Objective To explore the effect of preoperative radiochemotherapy combined with laparoscopic surgery on prognosis of locally advanced cervical cancer patients. Methods Fifty-two cervical cancer patients （the maximum diameter ≥ 4 cm and ≤ 5 em） of stage I B2 and II A2 were selected and divided into observation group and control group; 26 patients in observation group were treated by preoperative radiochemotherapy, while 26 patients in control group were treated by surgery. In observation group, the patients were treated by venous chemotherapy for 1-2 courses of treatment and vaginal brachytherapy for 1-2 courses of treatment, during treatment period, clinical evaluation was carried out, if there was no clinical effect, radical radiotherapy was carried out ; if there was clinical effect, surgery was performed at two weeks after end of chemotherapy. Laparoseopic radical hysterectomy for cervical cancer was performed in the two groups, bilateral ovaries were preserved among cervical squamous cell carcinoma patients aged 45 years old or less than 45 years old. The curative effects of preoperative radiocbemotherapy in observation group was analyzed statistically ; the related quality factors of laparoscopic surgery, intraoperative and postoperative complications, data of postoperative pathology, postoperative supplementary radiotherapy and chemotherapy, recurrence, and survival in the two groups were compared. Results In observation group, tumor lesions of 3 patients completely disappeared, 18 patients partially relieved, one patient underwent radical radiotherapy, the total clinical effective rate was 80. 77% , the operation time and width of removed tissue adjacent to cervix and vagina were better than those in control group （ P〈0. 05 ） , there was no statistically significant difference in the amount of blood loss during operation, postoperative anal exhausting time, and the time of removing urinary catheter between the two groups （ P〉0. 05 ） ; in the two groups, no ureterostoma and intestinal fi

关 键 词：局部晚期宫颈癌 术前放化疗 腹腔镜手术 预后 

分 类 号：R737.33[医药卫生—肿瘤]