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目的了解宫颈癌术前动脉插管化疗前后临床及组织病理的变化,以明确动脉导管化疗的疗效。方法自2000~2004年共计25例宫颈癌病例。临床分期为Ⅰ期巨块型或Ⅱb期以上病人。采用双侧超选择性子宫动脉导管化疗,化疗方案:PDD50mg/m2双侧+Bleomycin30mg/m2双侧,每两周重复最多2次。观察给药前后肿瘤病变大小、子宫旁转移病灶、淋巴结转移灶及血肿瘤标记SCC变化。同时观察化疗副反应及组织学改变。结果25例中23例化疗后成功行扩大全子宫切除并且宫旁未见癌灶。仅一次导管化疗15例,完全缓解10例,部分缓解5例,总缓解率60%。行第二次导管化疗10例,完全缓解6例,部分缓解2例,2例无变化改放疗,总缓解率为92%(23/25)。其中完全缓解率80%(16/25),部分缓解率35%(7/20)。无变化2例接受放疗。观察血SCC变化,16例不同程度下降。导管治疗后手术切除标本有肿瘤组织变性、坏死。组织学有效率24%。结论(1)动脉导管术前化疗能够控制局部巨块及晚期宫颈癌肿瘤的生长,使癌灶缩小,降低肿瘤的分期,从而为手术的彻底切除创造条件。(2)降低肿瘤细胞活力,减少术中肿瘤播散及术后转移。(3)清除亚临床病灶减少复发危险。(4)年轻患者卵巢功能保留对性生活及生活质量均有提高。
Objective To understand the clinical and histopathological changes of cervical cancer before and after arterial catheterization in order to confirm the effect of arterial catheter chemotherapy. Methods From 2000 to 2004, a total of 25 cases of cervical cancer. Clinical stage Ⅰ block type or Ⅱ b above patients. Bilateral superselective uterine catheterization chemotherapy, chemotherapy programs: PDD50mg / m2 bilateral + Bleomycin30mg / m2 bilateral, every two weeks to repeat up to 2 times. The changes of tumor size, paracancerous metastasis, lymph node metastasis and blood tumor markers SCC before and after administration were observed. At the same time observe the side effects of chemotherapy and histological changes. Results Twenty-five of 25 patients underwent successful radical hysterectomy and no tumor was found in the uterus. Only one catheter chemotherapy in 15 cases, complete remission in 10 cases, partial remission in 5 cases, the total remission rate of 60%. The second catheter chemotherapy in 10 cases, complete remission in 6 cases, partial remission in 2 cases, 2 cases without change in radiotherapy and radiotherapy, the total remission rate was 92% (23/25). Among them, the complete remission rate was 80% (16/25) and the partial remission rate was 35% (7/20). No change in 2 cases received radiotherapy. SCC changes observed in blood, 16 cases decreased to varying degrees. After surgical resection of the catheter, the tumor tissue degeneration and necrosis. Histology efficient 24%. Conclusion (1) Preoperative catheterization of arterial catheters can control the growth of local giant lumps and advanced cervical cancer, reduce the foci and reduce the tumor staging, so as to create the conditions for the complete resection of the operation. (2) reduce tumor cell viability, reduce intraoperative tumor spread and postoperative metastasis. (3) clear the subclinical lesion to reduce the risk of recurrence. (4) retention of ovarian function in young patients on sexual life and quality of life have improved.