子宫颈癌根治性放疗中不同体外照射技术联合三维近距离放疗的剂量学研究及临床观察  

Clinical study of intensity modulated radiotherapy and three-dimensional conformal radiotherapy with three-dimensional brachytherapy and concurrent chemotherapy for patients with advanced cervical cancer

作　　者：杜欣欣[1] 杨昊 张慧娟[3] 李立安[1] 范文生[1] 孟元光[1] Du Xinxin Yang Hao Zhang Huijuan Li Lian Fan Wensheng Meng Yuanguang(Department of Obstetrics and Gynecology, Chinese PLA General Hospital, Beifing 100853, China)

机构地区：[1]解放军总医院妇产科,北京100853 [2]内蒙古自治区肿瘤医院放疗科 [3]解放军总医院放疗科,北京100853

出　　处：《中华妇产科杂志》2017年第10期679-686,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金（81571411）;内蒙古自治区自然科学基金（2015MS0896）

摘　　要：目的 探讨宫腔镜手术终止Ⅱ型剖宫产术后子宫瘢痕妊娠（CSP）的疗效、安全性以及预防性子宫动脉栓塞术（UAE）的临床价值。方法 回顾性分析2009年1月至2016年6月浙江大学医学院附属妇产科医院收治的、采用宫腔镜手术终止妊娠的早期Ⅱ型CSP患者104例，均由专人进行完成宫腔镜手术，分为联合UAE（UAE组，67例）和不联合UAE（非UAE组，37例），同步采用腹腔镜或腹部超声监护。比较两组的初始治愈率、宫腔填塞率、子宫穿孔率、手术前后血红蛋白含量变化值、妊娠包块消退时间和血β-hCG水平恢复正常时间、住院时间、住院费用以及并发症情况。结果 UAE组和非UAE组患者的中位孕周、中位妊娠包块直径、中位子宫瘢痕处子宫肌层厚度和中位术前血β-hCG水平分别为47和47 d、30和30 mm、2和2 mm、36 524和32 226 U/L，分别比较，差异均无统计学意义（P均〉0.05）。104例患者中100例顺利完成宫腔镜手术，4例改为腹式手术。UAE组和非UAE组分别有94%（63/67）和92%（34/37）经初次宫腔镜手术治愈，宫腔镜手术的初始治愈率两组比较，差异无统计学意义（P=0.944）。两组子宫穿孔率、宫腔填塞率、手术前后血红蛋白含量变化值、血β-hCG恢复正常时间和妊娠包块消退时间分别比较，差异均无统计学意义（P均〉0.05）。两组住院时间中位数分别为5、7 d，住院费用中位数分别为9 108、13 654元，分别比较，差异均有统计学意义（P均〈0.01）。两组分别有4例（6%，4/67）和2例（5%，2/37）发生严重并发症，两组比较，差异无统计学意义（P=0.906）。结论 对于宫腔镜手术经验丰富的术者，宫腔镜手术可安全有效终止妊娠包块直径≤30 mm、孕周〈7周的Ⅱ型CSP；预防性UAE的作用不确定。Objective To investigate the safety and efficacy of hysterosopic management of type Ⅱ cesarean scar pregnancy （CSP） and the value of prophylactic uterine artery embolization （UAE）.Methods Totally 104 patients with type Ⅱ CSP treated with hysteroscopic surgery at the Women′s Hospital, School of Medicine, Zhejiang University, during Jan. 2009 to Jun. 2016 were analyzed retrospectively, 67 patients combined with UAE （UAE group） and 37 patients without combined with UAE （non-UAE group）. Laparoscopy or sonography guidance was conducted simultaneously. The following clinical parameters were compared, including： primary cure rate, uterine packing rate, uterine perforation rate, hemoglobin level change, the time for the mass absorption and the return of β-hCG to normal, complications, hospital days and hospital stay cost. Results Median gestational age, size of mass, thickness of the anterior myometrium and β-hCG level in UAE group versus non-UAE group were 47 versus 47 days, 30 versus 30 mm,2 versus 2 mm, 36 524 versus 32 226 U/L （all P〉0.05）. Out of 104, 100 patients were managed successfully with hysteroscopic surgery, and 4 patients transformed to laparoscopic or laparotomy surgery. Hysteroscopic surgery was effective in 63 out of 67 patients （94%） in UAE group and 34 out of 37 patients （92%） in non-UAE group （P〉0.05）. There was no significant differences regarding uterine perforation rate, uterine packing rate, hemoglobin change and recovery time between UAE group and non-UAE group （all P〉0.05）. The median hospital day was 7 days in UAE group versus 5 days in non-UAE group （P〈0.01）. The median hospital stay cost was 13 654 yuan in UAE group versus 9 108 yuan in non-UAE group （P〈0.01）. Serious complication occurred in 4 patients （6%, 4/67） in UAE group and 2 patients （5%, 2/67） in non-UAE group （P=0.906）.Conclusions Hysteroscopic surgery is effective and safe for patients with type Ⅱ CSP in the first trimester with size ≤30 mm in diameter

关 键 词：宫颈肿瘤 近距离放射疗法 放射疗法 调强适形 放射疗法 适形 放射治疗剂量 

分 类 号：R737.33[医药卫生—肿瘤]