摘要
目的：评价ⅠB2、ⅡA2期宫颈癌术前近距离放疗联合同步化疗（术前近距离放化疗）的近期疗效及安全性。方法：选取2010年6月至2015年5月南京大学医学院附属鼓楼医院妇科收治的ⅠB2、ⅡA2期宫颈癌患者共82例。根据术前处理方式的不同,分为直接手术组（A组,27例）、新辅助化疗组（B组,41例）、近距离放化疗组（C组,14例）。B、C组术前辅助处理后行宫颈癌根治术。比较3组的术后住院时间、术中平均出血量、平均手术时间、临床病理缓解率、并发症发生率及近期生存时间。结果：新辅助化疗组的术后住院时间长于直接手术组,术中出血量多于近距离放化疗组,差异均有统计学意义（P〈0.05）。近距离放化疗组的脉管侵犯率、深肌层浸润率、淋巴结阳性率均低于直接手术组和新辅助化疗组,差异有统计学意义（P〈0.05）;而后两组比较差异无统计学意义（P〉0.05）。近距离放化疗组的术前治疗总有效率（85.7%）高于术前化疗组（36.4%、）,差异有统计学意义（P〈0.05）。3组的神经侵犯率、术后并发症发生率比较,差异无统计学意义（P〉0.05）。A、B、C组的中位生存时间及3年生存率分别为41.2月（95%CI：33.8~48.5月）、63.9%;33.8月（95%CI：28.9~38.7月）、53.1%及48.1月（95%CI：37.5~58.7月）、68.2%;3组中位生存时间及3年生存率比较,差异均无统计学意义（P〉0.05）。淋巴结转移是影响生存时间的独立危险因素（P〈0.05）。结论：术前近距离放化疗较新辅助化疗能明显改善肿瘤病理缓解率,未明显增加手术并发症发生率、手术时间、术中出血量,因而ⅠB2、ⅡA2期宫颈癌术前后装近距离放疗联合同步化疗是安全、有效的处理模式。
Objective： To evaluate the efficacy and security of preoperative brachytherapy combinded concurrent chemotherapy（ preoperative brachy-chemothepapy） in the comprehensive treatment for patients with FIGO stage ⅠB2 andⅡA2 cervical cancer. Methods： Total of 82 patients with FIGO stage Ⅰ B2 and Ⅱ A2 cervical cancer were enrolled retrospectively treated in the department of Gynaecology of Drum Tower Hospital affiliated to Medical College of Nanjing University from June 2010 to May 2015.According to the different preoperative regimens,they were categorized into three groups,including directly surgical group（ Group A,27cases）,neoadjuvant chemotherapy group（ Group B,41 cases）,and brachy-chemotherapy group（ Group C,14 cases）.Radical hysterectomy was performed following the later two regimens.To compare three groups of postoperative hospital stay,average intraoperative blood loss,average surgical time,clinical pathological remission rate,incidence of complications and recent survive time.Results： Postoperative hospital stay was significantly more in group B than group A.Intraoperative blood loss was significantly more in group B than in group C.These difference were statistically significant（ P〈0. 05）. Vascular invasion rate,deep muscle invasion rate and lymph node positive rate in group C were lower than in group A and B.All these difference were statistically significant（ P〈0.05）,and no statistically significant difference were noted in latter two groups（ P〈0.05）,and three groups had no significant difference in nerve invasion rate（ P〈0.05）.The preoperative therapeutic effective rate of 85.7% in group C was much higher than 36.4% in group B with a statistically significant difference（ P〈0.05）. The occurrence rate of surgery-related complications and nerve invasion rate had no statistically significant difference among three groups.Median survival time and 3-year survival rate in group A,B and C were 41.2 months（ 95%CI： 33.8 ~ 48.5 months） and 63.9%,33.8 mon
出处
《现代妇产科进展》
CSCD
北大核心
2016年第2期100-105,共6页
Progress in Obstetrics and Gynecology
关键词
宫颈癌
近距离放疗
后装近距离放疗联合同步化疗
新辅助化疗
近期疗效
病理缓解
手术并发症
Cervical neoplasm
Branchytherapy
Afterloading Brachytherapy combinded concurrent chemotherapy
Neoadjuvant chemotherapy
Short-term efficacy
Pathology remission
Surgery-related complications
