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1、巨塊型宮頸癌新輔助化療臨床觀察作者：潘鳳蓮，唐羿，周莉單位：湖北荊州第二人民醫(yī)院，湖北荊州434000【摘要】目的：評(píng)價(jià)新輔助化療治療巨塊型宮頸癌的可行性、療效、毒性及對(duì)患者遠(yuǎn)期生存率的影響。方法：回顧性分析我院1999年6月?2008年10月收治的145例巨塊型宮頸癌患者臨床資料，將其分為兩組，新輔助化療組65例，給予順鉗(DDP)60?80mg+表阿霉素(EPI)50?80mg1?2個(gè)療程的動(dòng)脈介入化療;對(duì)照組80例為單純手術(shù)組，直接行廣泛子宮切除術(shù)加盆腔淋巴結(jié)清掃術(shù)。新輔助化療組2周后判斷局部腫瘤體
2、積的變化，并根據(jù)術(shù)后病理檢查比較兩組盆腔淋巴結(jié)轉(zhuǎn)移、宮頸管浸潤(rùn)、宮旁浸潤(rùn)、陰道切緣腫瘤浸潤(rùn)，分析治療后的近期療效及累積生存率。結(jié)果：新輔助化療2周后總有效率為76.9%,其中完全緩解占13.8%,部分緩解占63.1%,病情穩(wěn)定/病情進(jìn)展占23.1%;新輔助化療組術(shù)后盆腔淋巴結(jié)轉(zhuǎn)移為19.0%,明顯低于對(duì)照組(33.8%,P=0.041),宮頸管浸潤(rùn)、宮旁浸潤(rùn)、陰道切緣陽(yáng)性兩組差異無(wú)統(tǒng)計(jì)學(xué)意義(P值分別為0.121、0.142和0.334);新輔助化療組5年累積生存率(70.12%)明顯高于對(duì)照組(55.2
3、6%)(P=0.04)。結(jié)論：新輔助化療治療巨塊型宮頸癌安全有效，可縮小局部病灶，降低部分患者臨床分期，提高手術(shù)率，控制盆腔淋巴結(jié)轉(zhuǎn)移，并減少化療并發(fā)癥或手術(shù)并發(fā)癥的發(fā)生?！娟P(guān)鍵詞】宮頸腫瘤;藥物療法;輔助;預(yù)后EffectofneoadjuvantchemotherapyonbulkycervicalcarcinomaPANFenglian,TANGYi,ZHOULi(The2ndPeople，sHospitalinJingzhouJingzhou434000,China)[ABSTRACT]Objec
4、tive:Toevaluatethefeasibility,efficacy,toxicitythesurvivalrateofneoadjuvantchemotherapyforbulkycervicalcancer?Methods：BetweenJune1999andOctober2008,145patientswithbulkycancerofthecervixwereseparatedintotwogroups,65patientsinneoadjuvantchemotherapygroup,wh
5、oreceivedneoadjuvantchemotherapywithDDP60~80mgandEPI50?80mgforoneortwocoursesofchemotherapyfollowedbyradicalhysterectomyandpelviclymphadenectomyafter2or3weeks,and80patientsascontrolgroupwhoweretreatedwithradicalsurgeryalone.Thegrosstumorvolumewasassessed?
6、Lymphoidnodemetastasis,involvementofcervicalcanals,parametrialinvasionandpositivesurgicalmarginsofthevaginawereassessedaccordingtothepostoperativepathologytest,aswe11assumsurvivalratewasanalyzed.ResuIts：After2weekswithneoadjuvantchemotherapy,efficacyratei
7、nneoadjuvantchemotherapygroupwas76.9%,13.8%ofpatientsinthisgroupcompleteremission,63.1%ofpatientshadpartialremission,23.1%wereinstableorprogressedstatus?TheLymphoidnodemetastasisratewassignificantlyhigherincontrolgroupthantheneoadjuvantchemotherapygroupaf
8、terradicalhysterectomyandpelviclymphadenectomy(P二0.041).Involvementofcervicalcanal,parametrialinvasionandpositivesurgicalmarginsofthevaginaratewerehigherincontrolgroupthantheneoadjuvantchemotherapygroup,butthediffer
