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三种治疗方案治疗ⅠB2和ⅡA2期子宫颈癌临床对比研究
作者:郑蕊  王宝金  赵书君 
单位:安阳市人民医院妇产科  河南 安阳 455000 
关键词:宫颈肿瘤/外科学 宫颈肿瘤/放射疗法 化学疗法 辅助 综合疗法 治疗结果 病例对照研究 
DOI:R737.33;R730.56
出版年,卷(期):页码:2018,33(1):53-57
摘要:

目的 探讨手术、新辅助化疗+手术及术前同步放化疗+手术治疗ⅠB2和ⅡA2期子宫颈癌的疗效及安全性差异。方法 回顾性分析180例ⅠB2和ⅡA2期子宫颈癌患者的临床资料。根据治疗方案分为A组、B组及C组,每组各60例;分别采用手术(单纯全子宫切除术+盆腔淋巴结清扫术)、新辅助化疗(顺铂30 mg/m2+紫杉醇脂质体55 mg/m2)+手术及术前同步放化疗(术前放疗采用192Ir近距离后装放疗,A点放射剂量为16 Gy/次,每周4次,连用2周;术前化疗方案为顺铂30 mg/次+紫杉醇脂质体120 mg/次,每周1次,连用2周)+手术治疗。比较3组患者手术相关临床指标水平、术后局部浸润率、术后淋巴结转移率、术后1年和3年生存率和术后并发症发生率。结果 C组患者术中失血量少于A组和B组(均P<0.05)。C组术后脉管浸润率、术后深肌层浸润率及淋巴结转移率均低于A组和B组(均P<0.05)。3组手术用时、总住院时间、神经浸润率、术后1年和3年生存率和术后并发症发生率比较,差异均无统计学意义(均P>0.05)。结论 术前同步放化疗+手术方案治疗ⅠB2和ⅡA2期子宫颈癌患者有助于减轻医源性创伤程度,降低术后局部浸润率和淋巴结转移率,且未增加术后并发症发生风险,疗效及安全性均优于手术和新辅助化疗+手术方案。

Objective To investigate the efficacy and safety of surgery alone, neoadjuvant chemotherapy combined with surgery, and preoperative concurrent chemoradiotherapy combined with surgery, in the treatment of patients with stage ⅠB2 and ⅡA2 cervical cancer. Methods One-hundred-and-eighty cases of stage ⅠB2 and ⅡA2 cervical cancer patients were retrospectively analyzed. According to the treatment strategies, these patients were divided into 3 groups, with 60 cases per group. The surgery approach was simple total hysterectomy with pelvic lymph node dissection. Group A was treated with surgery alone. Combined with surgery, group B was treated with neoadjuvant chemotherapy (30 mg/m2 cisplatin with 55 mg/m2 paclitaxel liposomes), whereas group C was treated with preoperative radiotherapy (192Ir brachytherapy, A point dose at 16 Gy/F, 4 times a week for 2 weeks) and chemotherapy (30 mg cisplatin, 120 mg paclitaxel liposomes, once every week, for 2 weeks). The operation-related clinical index, postoperative local invasion, postoperative lymph node metastasis, 1-year and 3-year survival rates, and the incidence of postoperative complications were compared for the three groups. Results The patients in group C has significantly lower level of intraoperative blood loss than the other two groups(both P<0.05). Besides, the incidences of postoperative vascular invasion, deep muscular layer invasion and lymph node metastasis were all significantly lower in group C than group A or B (all P<0.05). Moreover, there was no significant difference in the duration of operation, duration of hospital stay, the incidence of nerve invasion, 1-year and 3-year survival rates, and the incidence of postoperative complications among the three groups (all P>0.05). Conclusions Concurrent chemoradiotherapy combined with surgery can reduce the degree of iatrogenic trauma, avoid local invasion and lymph node metastasis, without increasing the risk of postoperative complications in the treatment of patients with stage ⅠB2 and ⅡA2 cervical cancer. It has higher clinical efficacy and safety than surgery alone or neoadjuvant chemotherapy combined with surgery.

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