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目的观察宫颈癌术前动脉灌注栓塞化疗的组织病理学动态变化及临床结局,探讨二次治疗时机的选择。方法1999年6月至2004年12月,对广州市第一人民医院19例菜花型宫颈癌患者术前行双侧子宫动脉灌注栓塞化疗(介入治疗),化疗药物卡铂(CBP)300mg/m2、博来霉素(BLM)45mg,应用药物总量的2/3进行灌注、1/3药物溶于新鲜明胶海绵颗粒(直径1～3mm)中进行栓塞;术后全部病例按以下时间:1、9、24、48h,7、16d及行根治术时观察癌灶的肉眼变化并取材进行癌组织病理学的动态观察。结果(1)介入治疗后肉眼观察癌灶在早期呈紫黑色,中期呈灰白色烂肉状,晚期部分病例病灶完全消失,未消失的癌灶质地变硬。(2)介入治疗后1h在电镜下即可见癌细胞早期缺氧表现。(3)介入治疗后9h在光镜下可见癌细胞出现结构松散,24h癌细胞出现核固缩,48h见明显坏死,16～21d残存的癌细胞出现形态异常。(4)介入治疗后16～21d对Ⅱa期2例(2/2)、Ⅱb期13例(13/13)、Ⅲa期2例(2/2),Ⅲb期1例(1/2)共18例患者成功实施宫颈癌根治术。结论宫颈癌组织介入治疗后出现明显的变性坏死,残存的癌细胞被增生的纤维结缔组织包裹;二次治疗的合适时机为介入后14～21d;介入治疗可明显提高中、晚期宫颈癌患者的手术切除率。
Objective To observe the histopathological changes and clinical outcomes of preoperative arterial infusion embolization and chemotherapy in cervical cancer and to explore the timing of secondary treatment. Methods From June 1999 to December 2004, 19 cases of cauliflower type cervical cancer in Guangzhou First People’s Hospital were treated with bilateral uterine artery embolization and chemotherapy (interventional therapy), chemotherapy drug carboplatin (CBP) 300mg / m2 , Bleomycin (BLM) 45mg, 2/3 of the total amount of drugs for perfusion, 1/3 of the drug dissolved in fresh gelatin sponge particles (diameter 1 ~ 3mm) embolization; all cases after the following time: 1 , 9,24,48 h, 7,16 d and radical surgery were observed macroscopic changes of foci and drawn for the dynamic observation of histopathology. Results (1) After the interventional treatment, the macroscopic observation showed that the foci showed a purple-black color in the early stage and gray-white rotten flesh in the middle part. The lesions in the late stage completely disappeared and the foci of the non-disappeared lesion became harder. (2) The early hypoxia of cancer cells can be seen under electron microscope 1 h after interventional therapy. (3) At 9h after interventional treatment, the cancerous cells appeared loosely arranged under light microscope. Nuclear condensation was observed at 24 hours and obvious necrosis was observed at 48 hours. The remaining cancerous cells appeared morphologically abnormal after 16 ~ 21 days. (4) After the interventional treatment, there were 2 cases (2/2) in stage Ⅱ a, 13 cases (13/13) in stage Ⅱ b, 2 cases in stage Ⅲa (2/2) and 1 case Eighteen patients underwent radical mastectomy for cervical cancer. Conclusion Cervical cancer tissue after the interventional treatment showed obvious degeneration and necrosis, the residual cancer cells were proliferated fibrous connective tissue wrapped; the second opportunity for the appropriate time after intervention 14 ~ 21d; interventional therapy can significantly improve the patients with advanced cervical cancer Surgical removal rate.