【作者】 刘春艳；

【导师】 付艳；

【作者基本信息】 吉林大学 ， 临床医学， 2011， 硕士

【摘要】 目的：本研究的目的是了解新辅助化疗对中晚期宫颈癌的疗效、对术后不良预后因素(如阴道切缘、宫旁浸润、脉管浸润、淋巴结阳性率等)的影响,以及新辅助化疗导致的不良反应,探讨其临床应用意义。方法：收集吉林大学第一医院2007年1月～2011年1月之间的中晚期宫颈癌100例患者的临床资料,其中术前行新辅助化疗患者占30例,直接手术患者70例作为对照组。采用描述性的、回顾性对照分析方法,应用EXCEL软件建立数据库,应用SPSS17.0软件进行χ2检验及t检验统计分析中晚期宫颈癌100例患者的临床资料,分析新辅助化疗+手术患者、直接手术组的临床特征,分析不同期别、肿瘤类型、病理学分级的宫颈癌临床化疗疗效反应,分析两种新辅助化疗方式的临床疗效反应、不良预后因素以及不良反应,对两种不同化疗方式在化疗次数、化疗手术时间间隔、化疗前后肿瘤最大直径方面进行比较。结果：(1)经股动脉化疗后手术组与经静脉化疗后手术组患者ⅠB2期、ⅡA期、ⅡB期患者比率具有统计学差异,前者以ⅡB患者居多,而后者以ⅡA患者占大多数,总体来说经股动脉化疗后手术组患者病情较重；宫颈癌新辅助化疗+手术患者与直接手术组患者年龄方面无统计学差异,具有可比性。(2)新辅助化疗对于ⅠB2期、ⅡA期、ⅡB期的患者疗效无差异。对于鳞癌和腺癌患者的疗效无差异(因腺癌患者仅为1例,一定程度影响统计的准确性)。对于不同病理学分级的患者疗效无统计学差异。(3)两种新辅助化疗方式均能有效缩小肿瘤最大直径；经股动脉化疗要比经静脉化疗肿瘤缩小更明显；经股动脉化疗的术后患者病理脉管浸润率要低于经静脉化疗后手术患者；而两者在阴道切缘、宫旁情况和淋巴结阳性率方面无统计学差异。(4)经股动脉化疗比经静脉化疗的骨髓抑制发生率、消化系统不良反应发生率、脱发反应率要低；在化疗药物的肝脏损害和发生发热不良反应方面,二者无差异。(5)新辅助化疗+手术组在术后的脉管浸润率和淋巴结阳性率低于直接手术组。结论：(1)新辅助化疗对不同期别、肿瘤类型、病理分级的宫颈癌均有效。(2)宫颈癌新辅助化疗能有效缩小肿瘤最大直径、获得适宜根治手术的机会,股动脉给药缩瘤及术后脉管低浸润率优于经静脉给药。(3)新辅助化疗+根治性手术患者的脉管浸润率和淋巴结阳性率均低于直接手术组患者。(4)经股动脉给药患者的化疗不良反应发生率均低于经静脉给药患者。更多还原

【Abstract】 Objective:The purpose of this study is to understand the effect of neoadjuvant chemotherapy for advanced cervical cancer, the impact on the pathological staging of adverse prognostic factors (such as vaginal surgical margins, parametrial infiltration, vascular invasion, lymph node-positive rate, etc.), and adverse reactions caused by chemotherapy, to investigate its clinical significance.Methods:I collected a total of 100 patients with advanced cervical cancer, 30 cases with preoperative neoadjuvant chemotherapy,70 cases with direct surgical patients as the control group in department of Obstetrics and Gynecology of Jilin University First Hospital during January 2007～January 2011. With descriptive, retrospective comparative methods of analysis, I applied EXCEL software to build database and used chart and SPSS 17.0χ2 test to statistically analyze clinical data, to analysis the clinical features of preoperative neoadjuvant chemotherapy group and direct surgery group, to analysis the chemotherapy response of different stage, tumor type, pathological grade of cervical cancer, to compare the pathology results between preoperative neoadjuvant chemotherapy group and direct surgery group, to analysis of the chemotherapy response, the conditions of pathological downstaging, poor prognostic factors, and adverse reactions between two methods of neoadjuvant chemotherapy.Results:(1) The composition ratio ofⅠb2,Ⅱa,Ⅱb period cervical cancer patients with different methods of neoadjuvant chemotherapy was statistically significant. Overall, patients with Chemotherapy through the femoral artery were much severely illed than patients with postoperative intravenous chemotherapy.The age of cervical cancer patients undergoing neoadjuvant chemotherapy before operation and undergoing direct surgery was not statistically significant. (2) The effect of neoadjuvant chemotherapy toⅠb2,Ⅱa,Ⅱb period cervical cancer patients has no difference. The result is also to the different pathological types and tumor grade of locally advanced cervical cancer. (3) Chemotherapy through the femoral artery and intravenous could effectively reduce the maximum diameter of the tumor,the former had better effect. The vascular invasion rate of patients undergoing the chemotherapy through the femoral artery is lower than the patients undergoing the chemotherapy through the vain.The cutting edge situation of vagina, parametrium and lymph node-positive rate case have no significant difference between two groups. (4) The incidence of myelosuppression, hair loss and digestive system adverse reactions of chemotherapy through the femoral artery is lower than chemotherapy through intravenous. The occurrence of liver damage and febrile adverse reactions has no difference between the two groups. (5) The vessel invasion and lymph node-positive rate of preoperative neoadjuvant chemotherapy group rate is less than the direct surgery group. Conclusion:(1) Neoadjuvant chemotherapy has effect to cervical cancer patients of different period, different pathological types and tumor grade.(2) Chemotherapy through the femoral artery and intravenous could effectively reduce the maximum diameter of the tumor, the former had better effect. The vascular invasion rate of patients undergoing the chemotherapy through the femoral artery is lower than the patients undergoing the chemotherapy through the vain.(3) The vessel invasion and lymph node-positive rate of preoperative neoadjuvant chemotherapy group rate is less than the direct surgery group.(4) The incidence of myelosuppression, hair loss and digestive system adverse reactions of chemotherapy through the femoral artery is lower than chemotherapy through intravenous.更多还原