介入治疗中晚期宫颈癌24例疗效分析
|
| 时间：2009-02-02 18:46:57 来源： 作者： |
|
Interventional therapy in 24 patients with intermediate and advanced stage uterine cervix cancer
ZHANG Xiao-yuan.Department of Gynecology and Obstetrics，Ankang Peoples Hospital，Ankang 725000，China
［Abstract］ Objective To observe the efficacy of interventional therapy in patients with intermediate and advanced stage uterine cervix cancer.Methods Twenty-four patients were staged asⅡb or above or relapsed uterine cervix cancer after operation and radiotherapy was treated once to three times with arterial chemotherapy and embolotherapy by hibateral internal iliac artery and uterine artery per cutem.Results The overall symptomatic relief rate was 91.7%.The number of CR，PR and MR were 18，2 and 2 respectively.The total effective rate of tumor was 87.5%.CR and PR were observed in 3 and 18 cases.Of all the 17 patients whose stages were lowed in different extent，8 were operated.Conclusion Interventional therapy is one of the effective treatments to relief symptom，improve the quality of life and degrade the stage.The short-term effective was observed in this study.Some patients were medically operable after interventional therapy.
［Key words］ uterine cervix cancer；interventional therapy；arterial chemotherapy；arterial embolism
宫颈癌是妇科常见的恶性肿瘤，早期的宫颈癌采用手术的放射治疗均可获得较好的疗效，对于中晚期失去手术机会或手术、放疗后复发者往往难以获得理想的治疗效果。近年来，介入治疗的经双侧髂内动脉或子宫动脉灌注化疗栓塞术应用于中晚期宫颈癌患者，在中晚期宫颈癌的综合治疗中取得了较为满意的疗效。使部分患者获得了手术机会，生活质量得到了明显改善。现将结果报告如下。
1 资料与方法
1.1 一般资料 2005年4月～2007年6月，接受介入治疗的宫颈癌患者共计24例，年龄32～72岁，平均53.6岁。按国际妇产科联盟（FIGO）标准分期Ⅱb 14例，Ⅲb 2例，Ⅳa 1例，术后及放疗后复发者7例。病理类型：鳞癌22例，鳞腺癌1例，腺癌1例。合并阴道出血者3例，宫颈癌合并子宫肌瘤者1例。24例患者中行1次介入治疗者5例，2次者16例，3次者3例。每次介入治疗间隔3～4周。
1.2 方法 采用Seldinger技术，将5F眼镜蛇或子宫动脉导管经一侧股动脉插入腹主动脉，成袢后分别选插入双侧髂内动脉或子宫动脉，先行造影了解肿瘤供血情况，根据肿瘤血供情况决定药物灌注量以及是否进行栓塞，主要供血侧灌注化疗药物总量2/3，对侧灌注1/3。常用化疗药物有：阿霉素（ADM）50～60 mg，顺铂（DDP）60～100 mg，氟尿嘧啶（5-FU）1 000～1 500 mg，博莱霉素（BLy）15～30 mg，2～3种药物联合应用。栓塞剂采用明胶海绵颗粒或碘化油乳剂，本组采用明胶海绵栓塞者8例，碘化油乳剂栓塞者2例。术毕拔管行加压包扎。
1.3 疗效判定标准 介入治疗后临床症状缓解率。症状包括：疼痛、下坠感、排便困难、阴道排液或出血、下肢肿胀等。症状缓解情况分为5级，0级：完全缓解；1级：明显缓解；2级：中度缓解；3级：轻度缓解；4级：未缓解或加重。0～2级为总缓解率，肿瘤大小变化按WHO的疗效判定标准。完全缓解（CR）、部分缓解（PR）、无变化（NR）、进展（PD），介入治疗后每周查血常规两次，血生化一次，观察治疗引起的毒副反应。术后由专科医生行妇科检查、阴道脱落细胞或组织学及相关影像学检查。
|
|
|
|
