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目的评价髂内动脉灌注新辅助化疗在宫颈癌治疗中的作用。方法对1997年3月—2002年1月间收治的186例巨块型(肿瘤直径≥4cm)宫颈癌随机分为2组,化疗加放疗组105例,经髂内动脉灌注化疗,采用Seldinger技术髂内动脉插管或腹壁下动脉插管2种方法注药,化疗以顺铂为主的联合方案,同时采用192Ir高剂量率腔内后装治疗,A点剂量为12~24Gy,分2~4次;放疗组81例,术前予腔内后装治疗,A点剂量同前。两组患者均于治疗后2周行子宫颈癌根治术。结果化疗加放疗组肿瘤消退总有效率为97 1%,明显高于放疗组的79 0% (P<0 01)。其中,临床Ⅰb期患者中,化疗加放疗组总有效率为100 0%,明显高于放疗组的78 3% (P<0 01 );Ⅱa期患者中,化疗加放疗组总有效率为93 2%、放疗组为79 3%,两组比较,差异无统计学意义(P>0 05);Ⅱb期患者中,化疗加放疗组总有效率为96 1%、放疗组为5 /6,两组比较,差异无统计学意义(P>0 05 )。术后病理检查,宫颈肿瘤残留、宫旁浸润、盆腔淋巴结转移发生率,化疗加放疗组(分别为51 4%、8 6%、7 6% )均明显低于放疗组(分别为79 0%、23 5%、21 0%, P<0 01);而2年内复发率放疗组为23 5%,明显高于化疗加放疗组的6 7% (P<0 01)。2年生存率化疗加放疗组为94 5%、放疗组为84 7%,两组比较,差异无统计学意义(P>0 05)。结论髂内?
Objective To evaluate the role of neoadjuvant chemotherapy for internal iliac artery in the treatment of cervical cancer. Methods A total of 186 giant tumor (tumor diameter ≥4cm) treated in our hospital from March 1997 to January 2002 were randomly divided into two groups. Chemotherapy and radiotherapy group (n = 105) were treated with intra-iliac artery infusion chemotherapy. Seldinger technique Internal iliac artery or abdominal artery cannulation two kinds of methods of injection, chemotherapy cisplatin-based joint program, while using 192Ir high dose rate intracavity afterloading treatment, A dose of 12 ~ 24Gy, divided into 2 ~ 4 times; radiotherapy group of 81 cases, preoperative intracavitary after treatment, A dose with the former. Two groups of patients underwent radical mastectomy for cervical cancer two weeks after treatment. Results The total effective rate of tumor regression in chemotherapy plus radiotherapy group was 97.1%, which was significantly higher than that in radiotherapy group (79.0%, P <0.01). Among them, the total effective rate of chemotherapy plus radiotherapy group was 100 0% in clinical stage Ib patients, which was significantly higher than 78 3% in radiotherapy group (P <0.01). The total effective rate of chemotherapy plus radiotherapy group was 93 2% and 79.3% in the radiotherapy group. There was no significant difference between the two groups (P> 0.05). The total effective rate was 96.1% in the radiotherapy and chemotherapy group and 5/6 in the radiotherapy group, There was no significant difference between the two groups (P> 0.05). Postoperative pathological examination, residual cervical cancer, parametrial invasion, the incidence of pelvic lymph node metastasis, chemotherapy plus radiotherapy (51.4%, 86%, 76%) were significantly lower than the radiotherapy group (79.0% , 23 5%, 21 0%, P <0.01). The relapse rate within 2 years was 23 5% in radiotherapy group, which was significantly higher than that in chemotherapy plus radiotherapy group (P <0.01). The 2-year survival rate was 94.5% in the chemotherapy plus radiotherapy group and 84.7% in the radiotherapy group. There was no significant difference between the two groups (P> 0.05). Conclusion Internal iliac?