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目的 评价术前介入化疗联合根治术治疗局部晚期宫颈癌的可行性和疗效。方法 5 9例确诊为局部晚期宫颈癌的患者 ,采用Seldinger′s法股动脉穿刺插管进行盆腔介入化疗 ,药物为DDP80mg、5 Fu15 0 0mg、AT12 5 86 0mg。阴道B超和CT测量化疗前后的肿瘤大小 ,计算肿瘤消退百分比。经 1～ 3个疗程后行根治性子宫切除和盆腔淋巴清扫术。术后根据病理检查 ,如有盆腔淋巴结转移、宫旁组织浸润、脉管内有瘤栓或阴道切缘 (+)者都给予术后补充外放射治疗。结果 化疗总疗程数 12 2次 (1～ 3次 /每个病人 ) ,化疗总有效率为95 % ,其中 18例完全缓解 (占 31% ) ,38例部分缓解 (占 6 4% ) ,3例无变化 ,没有病例发生疾病进展。 5 9例中共有 14例发现术后盆腔淋巴结转移 (占 2 4% ) ,且均为化疗部分缓解者和无变化者 ,临床完全缓解者中无一例发生淋巴结转移。 18例临床完全缓解者 17例无复发 ,仅 1例lla期于术后 2 0月阴道复发 ,后经综合治疗病灶也消失 ,18例均无瘤生存。 38例部分消退者中 3例死亡。 3例化疗无效者均已死亡。 5 9例均未发生严重的与化疗和手术相关的并发症。结论 术前介入化疗可缩小肿瘤病灶 ,减少淋巴结转移和亚临床播散。不但方法可行 ,而且有望提高局部晚期宫颈癌的生存率。
Objective To evaluate the feasibility and efficacy of preoperative interventional chemotherapy combined with radical operation in the treatment of locally advanced cervical cancer. METHODS: Ninety-nine patients with locally advanced cervical cancer were treated with Seldinger’s femoral artery catheterization for pelvic intervention. The drugs were DDP80mg, 5 Fu1500mg, and AT125800mg. Vaginal ultrasound and CT measurement of tumor size before and after chemotherapy to calculate the percentage of tumor regression. After 1 to 3 courses of radical hysterectomy and pelvic lymph node dissection. After surgery according to pathological examination, if pelvic lymph node metastasis, uterine tissue infiltration, tumor emboli or vaginal incision (+) were given postoperative external radiotherapy. Results The total course of chemotherapy was 12 2 times (1-3 times per patient). The total effective rate of chemotherapy was 95%. Eighteen patients achieved complete remission (31%), 38 patients achieved partial remission (64%), 3 No case of change, no case of disease progression. Among 49 cases, 14 cases of postoperative pelvic lymph node metastasis (24%) were found, and all of them were partial or no change in chemotherapy, and none of the patients with complete clinical remission had lymph node metastasis. Of the 18 cases with complete clinical remission, 17 cases had no recurrence, only 1 case had a vaginal recurrence 20 days after operation and disappeared after comprehensive treatment. None of the 18 cases survived. Three of the 38 patients with partial resolution died. Three cases of chemotherapy were ineffective deaths. None of the 59 patients had serious chemotherapy- and surgery-related complications. Conclusion Preoperative chemotherapy can reduce tumor lesions, reduce lymph node metastasis and subclinical spread. Not only the method is feasible, but also hopefully to improve the survival rate of locally advanced cervical cancer.