介入治療聯(lián)合后裝及外照射放療提高宮頸癌手術(shù)根治率

摘要：目的 探討對(duì)中晚期宮頸癌行子宮動(dòng)脈灌注化療栓塞治療，聯(lián)合宮腔后裝及盆腔外照射放療的綜合治療價(jià)值。方法 對(duì)52例IIb期及以上分期宮頸癌經(jīng)介入治療、宮腔后裝放療和（或）盆腔外照射的綜合治療結(jié)果進(jìn)行回顧性分析。結(jié)果 經(jīng)綜合治療后所有病例臨床分期均不同程度前移，IIIa期及以下分期病例完全達(dá)到手術(shù)根治標(biāo)準(zhǔn)而行根治，手術(shù)切除率達(dá)96%。結(jié)論 IIb期以上臨床分期的宮頸癌經(jīng)聯(lián)合治療后，在嚴(yán)格控制手術(shù)適應(yīng)癥的前提下，手術(shù)根治幾率明顯提高，患者無(wú)瘤生存期得到延長(zhǎng)。

關(guān)鍵詞：宮頸癌；介入栓塞；后裝；外照射；手術(shù)根治

Intervention Combined After Installation and External Beam Radiation Therapy Improve Surgical Cure Rate of Cervical Cancer

LI He， LI Zi-xiong， DUAN Ning-bo

（Yunnan Chuxiong People's Hospital Radiation Oncology Department， Chuxiong 675000， China）

Abstract：Objective：To discuss value of bsynthesized treatment of advanced cervix patients which proceeded transartery perfusion chemo-embolization，combined with external beam radiotherphy and inteacavitary brachytherapy. Methods：Toanalyzed retrospectively trerapeutic outcome of 52stage Ⅱb～Ⅳ carcinoma of cervix patients which proceeded trans-artery perfusion chemo-embolization，combined with external beam radioitherapy and inteacavitary brachytherapy. Results：Clinical stage ofsynthesiaed treatment of advanced carcinoma of cervix cases had preacted，96 percent of stage Ⅱb～Ⅲ treated patients could proceeded radical hysterectomy. Conclusion：After synthesized treatment stage Ⅱb～Ⅳ carcinoma of cervix patients，on the promise of strict control their adaptation diseace＼，the radical hysterectomy was raised obviously，and prolonged redical hysterectomy in patient's life.

Key words： Cervical cancer； Embolization； After loading； External irradiation； Radical surgery

我院2008年～2011年共收治年齡45歲以下，臨床分期II期以上子宮頸癌患者52例，現(xiàn)分析報(bào)告如下：

1資料與方法

1.1一般資料 52例年齡26～45歲，平均40.5歲，按國(guó)際婦產(chǎn)科協(xié)會(huì)分期IIa 16例，IIb 31例，III-IV期5例。病檢均為鱗狀細(xì)胞癌，病理細(xì)胞分化程度：低分化24例，中分化7例，中-高分化21例。宮旁及陰道侵潤(rùn)36例，盆腔淋巴結(jié)轉(zhuǎn)移5例。所有病例均經(jīng)CT、MRI和陰道鏡檢并取材活檢確定病理及分期。

1.2方法 IIa期16例患者在經(jīng)過(guò)2～3次雙側(cè)髂內(nèi)動(dòng)脈插管順鉑60mg/㎡，平陽(yáng)霉素16 mg/㎡，異環(huán)鱗酰胺1 g/㎡或5-氟脲嘧啶0.75 g/㎡方案灌注化療后1w內(nèi)行子宮全切；IIb期31例分別經(jīng)3次髂內(nèi)動(dòng)脈插管治療（藥物及劑量與IIa期一致），同時(shí)用明膠海綿顆粒對(duì)子宮動(dòng)脈進(jìn)行栓塞，化療間歇期用高劑量銥-192予4～6次（3～6w）近距離后裝治療，總劑量32～48Gy，隨后行廣泛性子宮、附件切除及盆腔淋巴結(jié)清掃術(shù)；III-IV期患者經(jīng)4次動(dòng)脈插管化療及栓塞治療，間歇期分別予6次后裝放療，同時(shí)用6MV直線加速器行盆腔區(qū)域外照射，總劑量50 Gy后，3例行根治手術(shù)，2例分別因膀胱、直腸侵潤(rùn)和盆壁粘連嚴(yán) 重而放棄手術(shù)。……