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[目的]探讨巨块型宫颈癌动脉介入新辅助化疗的疗效及对患者远期生存的影响。[方法]回顾性分析145例巨块型宫颈癌患者,其中新辅助化疗组60例和单纯手术组(对照组)85例。新辅助化疗组给予DDP60～80mg+EPI50～80mg或DDP80mg+5-Fu1000mg动脉介入化疗1～2个疗程,化疗后2～3周行根治性子宫切除术+盆腔淋巴结清扫术,观察化疗后局部肿瘤体积的变化,并比较两组盆腔淋巴结转移、宫颈管浸润、宫旁浸润、阴道切缘肿瘤浸润,术中出血情况,治疗后的近期疗效及远期生存率。[结果]新辅助化疗2周后进行评价,有效率83.3%(50/60),其中完全缓解(CR)12例,部分缓解(PR)38例。宫旁浸润(10.9%,6/55),盆腔淋巴结转移(10.9%,6/55)均低于对照组(27.1%、25.9%)(P值分别为0.032、0.033)。术中出血两组比较差异无显著性(t=0.345,P=0.730)。3年和5年生存率新辅助化疗组为92.35%和72.36%,对照组为78.55%和43.89%,两组差异有统计学意义(P<0.05)。[结论]巨块型宫颈癌动脉介入新辅助化疗可以缩小局部病灶以利于手术,可以控制淋巴管、血管内转移,提高患者的生存率,但并不增加手术并发症。
[Objective] To investigate the effect of interventional neoadjuvant chemotherapy for massive cervical cancer and its effect on the long-term survival of patients with cervical cancer. [Methods] A retrospective analysis of 145 cases of giant cervical cancer patients, including 60 cases of neoadjuvant chemotherapy group and surgery alone group (control group) 85 cases. Neoadjuvant chemotherapy group was given DDP60 ~ 80mg + EPI50 ~ 80mg or DDP80mg +5-Fu1000mg arterial interventional chemotherapy for 1 to 2 courses of chemotherapy, 2 to 3 weeks after radical hysterectomy + pelvic lymph node dissection, chemotherapy after local tumor Volume changes, and compared the pelvic lymph node metastasis, cervical canal invasion, uterine infiltration, marginal tumor infiltration, intraoperative bleeding, the short-term efficacy and long-term survival after treatment. [Results] The neoadjuvant chemotherapy was evaluated after 2 weeks, with an effective rate of 83.3% (50/60), including 12 cases of complete remission (CR) and 38 cases of partial remission (PR). Parathyroid invasion (10.9%, 6/55) and pelvic lymph node metastasis (10.9%, 6/55) were lower than those in the control group (27.1%, 25.9%, P = 0.032, 0.033, respectively). Intraoperative bleeding was no significant difference between the two groups (t = 0.345, P = 0.730). The 3-year and 5-year survival rates were 92.35% and 72.36% in the neoadjuvant chemotherapy group and 78.55% and 43.89% in the control group, respectively. There was significant difference between the two groups (P <0.05). [Conclusion] Arterial interventional neoadjuvant chemotherapy for giant-type cervical cancer can reduce the local lesion in order to facilitate surgery, control lymphatic vessels and intravascular metastasis, and improve the survival rate of patients without increasing the complications of surgery.