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目的研究局部晚期宫颈癌超选动脉化疗栓塞后的临床疗效及安全性。方法对145例局部晚期宫颈癌病例进行回顾性分析,根据术前是否行超选动脉化疗栓塞(新辅助化疗Neoadjuvant chemotherapy NACT)分为两组,NACT组117例为观察组,其中Ib2期24例,ⅡA期49例,ⅡB期44例,术前行1~3疗程PVM(卡铂、长春新碱、丝裂霉素)方案化疗,化疗结束后3周评价疗效,行子宫广泛性切除及盆腔淋巴清扫术,同期直接手术(Direct operation DOR)组28例为对照组,其中ⅠB2期24例,ⅡA期4例,对比分析两组疗效、术后病理及不良反应发生情况。结果局部晚期宫颈癌术前行NACT后肿瘤直径均不同程度缩小、肿瘤标记物SCC-Ag均不同程度下降,较前有显著差异(P<0.05);化疗总有效率91.5%;手术切除率100%,观察组患者术后病理:淋巴结阳性、宫旁累及、脉管浸润、阴道切缘阳性的发生率均显著低于对照组。结论术前NACT可提高局部晚期宫颈癌的近期疗效,为根治性手术创造条件,不增加手术困难程度及术后并发症,且有效降低术后淋巴结阳性、宫旁累及、脉管浸润、阴道切缘阳性发生率,值得临床推广。
Objective To study the clinical efficacy and safety of selective advanced chemoembolization in locally advanced cervical cancer. Methods A retrospective analysis was performed on 145 cases of locally advanced cervical cancer. According to whether preoperative arterial chemoembolization (Neoadjuvant chemotherapy NACT) was divided into two groups, 117 cases of NACT group were treated as observation group, including 24 cases of stage Ib2 , 49 cases of stage IIA, 44 cases of stage IIB, and 1 to 3 courses of PVM (carboplatin, vincristine and mitomycin) regimen were given preoperatively. The curative effect was evaluated 3 weeks after the end of chemotherapy, extensive uterine resection and pelvic cavity Lymphadenectomy and direct operation DOR were performed in 28 patients as control group, including 24 cases in stage ⅠB2 and 4 cases in stage ⅡA. The curative effect, postoperative pathology and adverse reactions were compared between the two groups. Results The diameter of tumor after NACT in all patients with locally advanced cervical cancer was reduced to varying degrees in varying degrees. The tumor marker SCC-Ag decreased to some extent (P <0.05), the total effective rate was 91.5% and the rate of resection 100 %, Postoperative pathology of the observation group patients: lymph node involvement, uterine involvement, vascular invasion, the positive incidence of vaginal margins were significantly lower than the control group. Conclusion Preoperative NACT can improve the short-term curative effect of locally advanced cervical cancer and create the conditions for radical surgery without increasing the degree of surgical difficulty and postoperative complications. It can effectively reduce postoperative lymph node positive, paracrine involvement, vascular invasion, vaginal dissection Marginal positive incidence, it is worth clinical promotion.