局部晚期宫颈癌新辅助化疗近期临床疗效的观察

发布时间：2018-08-04 21:46

【摘要】：目的：探讨新辅助化疗治疗局部晚期宫颈癌的近期临床疗效。 方法：选取52例局部晚期宫颈癌患者，临床分期为Ⅰb2、Ⅱa2期，分为治疗组（A组）和对照组（B组），治疗组在接受2个疗程的TP方案化疗后再行宫颈癌根治术，对照组则直接行宫颈癌根治术。通过盆腔MRI测量治疗组化疗前后宫颈肿瘤体积、盆腔淋巴结最大直径，通过阴道彩色超声多普勒测量化疗前后宫颈局部病灶的血流指数（RI）并进行对照，并比较两组在手术时间、术中出血量及术后病理等方面的差异，以此来评估新辅助化疗近期疗效。 结果：化疗反应率总的临床有效率达85.44％；首次化疗前宫颈癌平均体积为24688.03±7659.23mm3，末次化疗后宫颈癌平均体积为6327.11±1169.02mm3；首次化疗前盆腔淋巴结最大直径平均值为17.81±2.37mm，，末次化疗后盆腔淋巴结最大直径平均值为9.19±1.38mm；首次化疗前RI平均值为0.386±0.035，末次化疗后RI平均值为0.489±0.061，上述数据前后对照差异具有统计学意义（P值均小于O.05)。手术时间治疗组平均为3.6±0.4h、对照组平均为4.2±0.5h，术中出血量治疗组平均为430±157ml、对照组平均为720±142mL；治疗组术后宫颈病灶阳性率为88.46%；治疗组和对照组的盆腔淋巴结阳性率分别为11.53%、26.92%；治疗组和对照组脉管受累阳性率分别为15.38%、38.46%；治疗组和对照组浸润深层间质发生率分别为19.23%、53.84%，以上两组数据比较差异具有统计学意义（P值均小于O.05）。化疗不良反应骨髓抑制I度为61.53%，Ⅱ度为38.46%，胃肠道反应I度为45.45%，Ⅱ度为36.36%，Ⅲ度为18.18%。 结论：新辅助化疗能明显缩小宫颈癌病灶体积、减小盆腔淋巴结直径、增加RI指数，从而为手术切除创造了条件。但新辅助化疗同时也掩盖宫颈间质深层浸润、脉管受累、及淋巴结转移的病情，干扰了临床医师对宫颈癌手术后后续治疗方案的制定，患者是否获益值得商榷。
[Abstract]:Objective: to investigate the short-term clinical effect of neoadjuvant chemotherapy for locally advanced cervical cancer. Methods: 52 patients with locally advanced cervical cancer were divided into two groups: treatment group (group A) and control group (group B). The control group was treated with radical resection of cervical cancer. The volume of cervical tumor and the maximum diameter of pelvic lymph nodes were measured by pelvic MRI before and after chemotherapy. The blood flow index (RI) was measured by vaginal color Doppler ultrasound before and after chemotherapy, and the operation time was compared between the two groups. To evaluate the short-term efficacy of neoadjuvant chemotherapy by the difference of intraoperative bleeding volume and postoperative pathology. Results: the total effective rate of chemotherapy was 85.44 mm, the average volume of cervical cancer was 24688.03 卤7659.23 mm 3 before the first chemotherapy and 6327.11 卤1169.02 mm 3 after the last chemotherapy. The mean maximum diameter of pelvic lymph nodes was 17.81 卤2.37 mm before the first chemotherapy and 9.19 卤1.38 mm after the last chemotherapy. The mean RI was 0.386 卤0.035 before the first chemotherapy and 0.489 卤0.061 after the last chemotherapy (P < 0.05). The average time of operation was 3.6 卤0.4h in the treatment group, 4.2 卤0.5h in the control group, 430 卤157ml in the treatment group and 720 卤142mL in the control group, and the positive rate of the cervical lesion in the treatment group was 88.46ml, the positive rate of the pelvic lymph nodes in the treatment group and the control group was 11.53 and 26.92respectively. The positive rate of vascular involvement in the treatment group and the control group was 15.38 and 38.46, respectively, and the incidence of infiltrating deep stroma in the treatment group and the control group was 19.23 and 53.84, respectively. The difference between the above two groups was statistically significant (P < 0.05). The side effects of chemotherapy were as follows: I was 61.53, 鈪

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