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中晚期宫颈癌动脉新辅助化疗的临床分析
The Clinical Analyze of Intra-arterial Neoadjuvant Chemotherapy for Patients with Metaphase or Advanced Cervical Carcinoma
【作者】 潘静；
【导师】 姚丽艳；
【作者基本信息】 新疆医科大学 ， 妇产科学， 2009， 硕士
【摘要】 目的:探讨宫颈癌新辅助化疗方法,在中、晚期患者治疗中的临床疗效和意义。方法:回顾性分析我院就诊治疗的67例Ib-IIIb期宫颈癌患者,分析IIb-IIIb期患者行经皮股动脉双侧髂内动脉灌注疗法的近期临床疗效、手术率、影响因素及副作用;与同期Ib-IIa期手术患者对比,评价晚期患者化疗后进行广泛子宫切除+盆腔淋巴结清扫术的可行性。结果:所有化疗患者临床症状均得到缓解,化疗总体有效率77%,手术率46.7%,II、III期患者临床有效率无明显差异,(P>0.05),临床分期、组织学分化与化疗缓解率之间无明显关系,(P>0.05);化疗后多数患者出现轻度骨髓抑制及肝、肾功能损害,(P<0.05),无临床不能耐受的毒副反应;化疗患者根治术后保留尿管时间略长,(P<0.05),手术时间、术中出血量及淋巴转移率与对照组相比无明显差异,(P>0.05)。结论:新辅助化疗治疗对中晚期宫颈癌患者有较好的近期疗效及手术率,且不增加经腹广泛子宫切除术及盆腔淋巴结清扫术的术中困难程度及术后并发症,是一种有效的综合治疗方法。对远期疗效及生存率的影响,仍需大量临床病例及长期随访的验证。
【Abstract】 Objective: To investigate the curative effect and clinical meaning of scheme intra-arterial neoadjuvant chemotherapy treated patients with metaphase or advanced cervical carcinoma. Methods: A retrospective analysis of 67 patiens within cervical carcinoma stage Ib-IIIb in our hospital. To analyze the short-term clinical curative effect, operation rate, influencing factor and side effect after the Intra-arterial neoadjuvant chemotherapy for the patients with stage IIb-IIIb; to evaluate the feasibility to have the operation with radical hysterectomy and pelvic lymphadenetomy for patients with metaphase or advanced cervical carcinoma after chemotherapy contrasted with Ib-IIa patients. Results: To a certain degree ,clinical symptom of patients had relieved, overall remission rate 77%, and the operation rate is 46.7%,there was no significant difference in the short-termeffect rate ,clinical stage and histology with chemo remission rate between the two groups in stage II and III, (P>0.05). After the neoadjuvant chemotherapy the most patients had light bone marrow depression, liver function and renal function lesion, and didnot exist severe side reaction. (P<0.05), After the operation ,the chemotherapy patient had more time retained the ureter than other, (P<0.05). It is no obvious difference in operation time, operation bleeds and lymph transfer rate compared with the other group,(P>0.05). Conclusion: The Intra-arterial neoadjuvant chemotherapy had better recent curative effect and operation rate for patients with metaphase or advanced cervical carcinoma. It does not increase postoperative complications and the difficult degree of radical hysterectomy and pelvic lymphadenetomy. It is a kind of effective comprehensive therapy. But,its influence for long-term curative effect and survival rate still need a large number of clinical cases and a long time following up to verify.