【摘要】 目的探讨术前放疗联合手术治疗Ⅱ期宫颈癌的疗效、晚期不良反应及预后因素。方法 82例病理确诊的初治Ⅱ期宫颈癌患者,采用术前放疗联合手术治疗模式。放疗:外照射采用6mV X线全盆腔照射,总剂量20～40Gy,中位剂量40Gy;192Ir高剂量率后装治疗,每周1次,每次A点剂量6～8Gy,共照射2～4次。手术:术式为60例行子宫广泛切除及盆腔淋巴结清扫,22例行子宫次广泛切除和盆腔淋巴结部分清扫。放疗后3周行手术。结果 5年局部控制率为85.4%,总生存率为78.0%,无瘤生存率为75.6%;Ⅱ级及以上晚期反应发生率,膀胱为8.5%、直肠为12.2%,下肢水肿发生率为8.5%;单因素分析血红蛋白(Hb)≥110g/L(χ2=6.736,P=0.009)、术后无残留(χ2=5.818,P=0.016)、术后病检阴性(χ2=12.177,P=0.000)及无盆腔淋巴转移(χ2=8.924,P=0.004)的患者预后较好。结论术前放疗联合手术是Ⅱ期宫颈癌临床可行的治疗模式,晚期不良反应可耐受,Hb水平、有无术后残留、术后病检情况是独立预后因素。更多还原

【Abstract】 Objective To investigate the effect,late adverse reactions and prognostic factors of simple preoperative radiotherapy plus surgery in treating stage Ⅱcervical cancer.Methods 82 cases of pathologically diagnosed stageⅡ cervical cancer were performed preoperative radiotherapy plus surgery.Radioetherapy: the total dose of extraorgan radiation to whole pelvic cavity was 20-40 Gy with 6MV X-ray and the median dose was 40Gy,simultaneously,the 192Ir afterloading treatment was enforcing once a week(the dose at A point was 6-8Gy every time,2-4 times).Operation:60 cases were performed radical hysterectomy and pelvic cavity lymph nodes dissection and 22 cases were performed subradical hysterectomy and pelvic cavity lymph nodes dissection.The surgery was followed in 3 weeks after radiotherapy.Results The 5-year control rate was 85.4%,the total survival rate was 78.0% and the survival rate without tumor was 75.6%.The incidence rate of late reactions ≥ gradeⅡ was 8.5% for bladder and 12.2% for rectum.The incidence rate of lower extremity edema was 8.5%.The univariate analysis showed that the patients with HGB≥110g/L(χ2=6.736,P=0.009),without operation residual(χ2=5.818,P=0.016),without pelvic cavity lymph nodes metastasis(χ2=8.924,P=0.004)and with negative postoperative pathologic results(χ2=12.177,P=0.000) had favorable prognosis.Conclusion Preoperative radiotherapy plus surgery is a feasible treatment mode to stage Ⅱcervical carcinoma.The late adverse reactions are tolerable.The HGB level,operation residual and postoperative pathologic results are independent prognosis factors.更多还原