术前顺铂联合表阿霉素介入栓塞化疗对晚期宫颈癌疗效及肿瘤标志物水平的影响  

Influences of preoperative interventional embolization with cisplatin and epirubicin on the therapeutic outcome and tumor marker levels in patients with advanced cervical cancer

作　　者：刘保清 姬海利 李军[1] 李慧智[2] LIU Baoqing;JI Haili;LI Jun;LI Huizhi(Department of Intervention,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang453003,China;Department of Obstetrics and Gynecology,the Third Affiliated Hospital of Xinxiang Medical College,Xinxiang453003,China)

机构地区：[1]新乡医学院第三附属医院介入科,河南新乡453003 [2]新乡医学院第三附属医院妇产科,河南新乡453003

出　　处：《中华实用诊断与治疗杂志》2020年第5期513-516,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技发展计划项目(162102310233)。

摘　　要：目的探讨晚期宫颈癌患者术前行顺铂联合表阿霉素介入栓塞化疗的近远期疗效及对血清鳞状细胞癌抗原(squamous cell carcinoma antigen,SCC-Ag)、癌胚抗原(carcinoembryonic antigen,CEA)、糖链抗原19-9(carbohydrate antigen 19-9,CA19-9)水平的影响。方法晚期宫颈癌患者100例,根据术前化疗方式分为2组。静脉组34例采用顺铂联合表阿霉素静脉化疗3个周期;介入组66例采用顺铂联合表阿霉素介入栓塞化疗,疗程依据首次化疗结束后病情变化确定。疗程结束评估术前化疗效果及行广泛子宫切除术+盆腔淋巴结清扫术的可行性。术后根据患者情况行同步放化疗,至出现严重不良反应或肿瘤进展停药。记录术前化疗期间不良反应发生情况;比较手术完成率、术中出血量、手术时间、术后病理切缘阳性率;检测术前化疗前及化疗结束后血清SCC-Ag、CEA、CA19-9水平;随访比较2组3年生存率及生存期。结果静脉组均完成3个周期化疗,介入组完成1次化疗者56例、2次者9例、3次者1例。介入组术前化疗总缓解率(84.85%)高于静脉组(61.76%)(P<0.05)。介入组手术完成率(84.85%)高于静脉组(67.65%),术中出血量[(275.50±54.37)mL]较静脉组[(346.21±67.90)mL]少,病理切缘阳性率(1.79%)低于静脉组(17.39%),手术时间[(181.20±35.48)min]较静脉组[(208.11±28.71)min]短(P<0.05)。介入组术前化疗Ⅱ+Ⅲ度骨髓抑制、肝功能损伤发生率(15.15%、10.61%)低于静脉组(32.35%、26.47%)(P<0.05)。介入组术前化疗后血清SCC-Ag[(2.58±0.24)μg/L]、CEA[(15.11±2.29)μg/L]及CA19-9[(25.72±3.54)ku/L]水平均低于静脉组[(3.44±0.67)μg/L、(20.65±2.80)μg/L、(31.84±4.60)ku/L](P<0.05)。介入组3年生存率(37.88%)高于静脉组(20.59%)(P<0.05),生存期[23(12,32)个月]较静脉组[15(10,26)个月]长(P<0.05)。结论顺铂联合表阿霉素经介入栓塞治疗晚期宫颈癌近期疗效确切,可增加患者行手术治疗的机会,降低血清肿瘤标志物�Objective To investigate the short-and long-term effects of preoperative interventional embolization with cisplatin and epirubicin in patients with advanced cervical cancer and its influence on serum squamous cell carcinoma antigen(SCC-Ag),carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels.Methods Totally 100patients with advanced cervical cancer were divided into 34patients receiving intravenous injection of cisplatin and epirubicin(intravenous injection group)and 66patients receiving interventional embolization with cisplatin and epirubicin(interventional treatment group)according to the preoperative chemotherapy.All patients received different treatment course according to the disease progress after initial chemotherapy.After treatment,the preoperative chemotherapeutic result and the feasibility of extensive hysterectomy+pelvic lymphadenectomy were evaluated.After operation,concurrent radiotherapy and chemotherapy were carried out according to the patient's condition,and were not terminated unless serious adverse reactions or propress of cancer occurred.The adverse reactions in preoperative chemotherapy were recorded.The operation completing rate,intraoperative blood loss,operation lasting time and positive rate of postoperative pathological cutting were compared.The serum levels of SCC-Ag,CEA and CA19-9were detected before and after chemotherapy.The 3-year survival rate and survival time were compared between two groups.Results Intravenous injection group completed 3cycles of chemotherapy,while interventional treatment group completed 1cycle in 56patients,2cycles in 9and 3cycles in 1.The total response rate of preoperative chemotherapy was higher in interventional treatment group(84.85%)than that in intravenous injection group(61.76%)(P<0.05).The operation completing rate was higher in interventional treatment group(84.85%)than that in intravenous injection group(67.65%)(P<0.05).The intraoperative blood loss was less and the positive rate of pathological cutting was lower in intervention

关 键 词：宫颈癌 晚期 顺铂 表阿霉素 介入栓塞 鳞状细胞癌抗原 癌胚抗原 糖链抗原19-9 

分 类 号：R737.33[医药卫生—肿瘤]