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目的探讨新辅助化疗对宫颈癌术后患者近远期疗效的影响。方法选取2010年12月至2016年3月间在四川省达州市中心医院行广泛全子宫切除+盆腔淋巴结清扫术的100例Ⅰb~Ⅱa2期巨块型宫颈癌(直径≥4cm)患者临床资料,根据治疗方法不同分成观察组与对照组,观察组44例患者,术前采用新辅助化疗,对照组56例患者,单纯手术治疗。比较两组患者化疗前和化疗后48h、7d及14d等时间点临床症状改善效果、肿瘤最大横断直径、组织学有效率及宫颈癌病理组织中p16蛋白表达动态变化情况,并比较两组近远期疗效差异。结果观察组化疗后7d和化疗后14d临床症状总改善率为65.9%和79.5%,组织学有效率为68.2%和88.6%均较化疗后48h明显提升,差异有统计学意义(P<0.05),且患者除化疗后48h肿瘤最大横断直径、p16蛋白表达阳性率同化疗前比较,差异均无统计学意义(均P>0.05)外,化疗后7d、14d等时间点肿瘤最大横断直径[(4.5±0.8)cm、(4.1±0.6)cm]及病理组织中p16蛋白表达阳性率(86.4%、72.7%)均显著低于化疗前的(5.4±1.3)cm和100.0%,差异均有统计学意义(P<0.05)。观察组术中出血量显著低于对照组[(355.6±159.2)ml vs(583.5±200.6)ml,P<0.05];但两组受试者手术成功率和术后并发症发生率对比差异无统计学意义(P>0.05)。观察组三年复发率显著低于对照组(15.9%vs 35.7%),且5年生存率显著高于对照组(65.9%vs 42.9%),差异均有统计学意义(P<0.05)。结论将以顺铂为基础的新辅助化疗应用于行广泛全子宫切除+盆腔淋巴结清扫术的Ⅰb~Ⅱa2期巨块型宫颈癌患者临床治疗中,利于病情恢复,近远期疗效均较为理想。
Objective To investigate the effect of neoadjuvant chemotherapy on the short-term and long-term effects of postoperative patients with cervical cancer. Methods From December 2010 to March 2016, 100 patients with stage Ⅰb ~ Ⅱa2 giant cervical cancer (diameter≥4cm) underwent radical hysterectomy and pelvic lymphadenectomy in Central Hospital of Sichuan Province, According to different treatment methods, the observation group and the control group were divided into observation group (n = 44) and neoadjuvant chemotherapy group (n = 56). Surgical treatment was performed in 56 patients in the control group. The clinical symptoms, the maximum transection diameter, the histological effective rate and the dynamic changes of p16 protein expression in the pathological tissues of cervical cancer before and 48h, 7d and 14d after chemotherapy were compared between the two groups. The changes of p16 protein in the two groups were compared Differences in efficacy. Results The total improvement rates of clinical symptoms in the observation group at 7 days after chemotherapy and at 14 days after chemotherapy were 65.9% and 79.5%, the histological effective rates were 68.2% and 88.6%, respectively, significantly higher than those at 48 hours after chemotherapy (P <0.05) , And there was no significant difference between the two groups (P> 0.05). The maximum cross-sectional diameter of tumor at 48h after chemotherapy and the positive rate of p16 protein expression were not significantly different from those before chemotherapy (all P> 0.05) 4.5 ± 0.8 cm, (4.1 ± 0.6) cm] and the positive rate of p16 protein in pathological tissues (86.4%, 72.7%) were significantly lower than those before chemotherapy (5.4 ± 1.3) cm and 100.0% Significance (P <0.05). The bleeding volume in the observation group was significantly lower than that in the control group [(355.6 ± 159.2) ml vs (583.5 ± 200.6) ml, P <0.05]. However, there was no significant difference between the two groups in the surgical success rate and postoperative complication rate Statistical significance (P> 0.05). The relapse rate in observation group was significantly lower than that in control group (15.9% vs 35.7%), and the 5-year survival rate was significantly higher in the observation group than in the control group (65.9% vs 42.9%, P <0.05). Conclusion The neoadjuvant chemotherapy based on cisplatin is applied in the clinical treatment of stage Ⅰb ~ Ⅱa2 giant cervical cancer patients with extensive hysterectomy and pelvic lymphadenectomy, which is beneficial to the recovery of the disease and the short-term and long-term curative effects are satisfactory.