【摘要】 目的 :探讨电化学治疗中晚期宫颈癌的临床疗效 ,分析影响其疗效的临床病理相关因素以及探讨电化学治疗中晚期宫颈癌的可能机制。方法 :对 114例临床分期为 b 期以上的中晚期宫颈癌采用电化学加放射治疗 (电化学治疗组 )并与同期采用单纯放射治疗的 6 8例期别相同的中晚期宫颈癌 (单纯放疗组 )进行中远期疗效对比分析。分别采用苏木桂 -伊红染色、流式细胞仪、组织 DNA电泳、透射电镜、TUNNEL 末端标记、酶免和免疫组化技术对其中采用电化学加放射治疗的 2 0例患者进行治疗前后的局部病灶组织病理改变、细胞凋亡、癌基因和抑癌基因改变以及机体免疫状况的测定和对比分析。结果 :1电化学治疗组患者 3,5年生存率明显高于单纯放疗组 (P <0 .0 5 ) ,但 1年生存率两组无明显差异 (P >0 .0 5 ) ;2临床期别早、肿瘤直径小及病灶呈菜花型患者电化学治疗后远期疗效较好 (P <0 .0 5 )。但疗效与肿瘤的病理类型和分化级别无关 (P >0 .0 5 ) ;3治疗剂量以 15 0 C/1cm肿瘤直径计算 ,2次或以上的治疗其远期疗效较好 ;4电化学治疗组的复发率低于单纯放疗组 (P <0 .0 5 ) ;5电化学治疗局部病理形态改变 ,阳极以凝固性坏死为主 ,阴极以液化性坏死为主。在其病灶均有大量淋巴细胞浸润 ;6电化学治疗后患者外周血中 T3、T4 ?更多还原

【Abstract】 Objective:To appraise the clinical effect after the treatment of mid late stage cervical cancer with electrochemical therapy and analyse the relative clinical factor in electrochemical therapy and to evaluate the probable mechanism of electrochemical therapy Methods: 104 cases and 68 cases of mid late stage cervical carcinomas were treated with electrochemical therapy (EChT) and radiation respectively and log rank test was used to analyse the 3 and 5 years survival rate The immunohistochemical method was used to determin bcl 2, c myc, mutative p53 and raf gene protein expression Electron microscop technique, flow cytometric, DNA gel electrophoresis analysis and TUNNEL assay were used to evaluate apoptosis indices in cervical carcinoma tissue before and after EChT T lymphocyte subgroup, lymphocyte immune function and serum immunoglobulin were also determined Results: ① The 3 and 5 years survival rate in the patients treated with EChT was higher than that treated with radiation(P<0 05) ② The response was better in the treatment of cauliflower like, relative small mass and early clinical(P<0 05) stage But there was no significant correlation between the long clinical effect after EChT and pathological types and differentiation of carcinoma(P>0 05) ③ It was better that the number of treatments was two times and the total electric quantity of the treatment was calculated by 150 C/1cm mass diameter ④ The recurrence rate after treatment with EChT was lower than that with raditation(P<0 05)  ⑤The local pathological appearance after treatment with EChT showed mainly coagulated necrosis around the positive electrode and liquified necrosis around the negative electrode with marked inflammatory cell infiltration around the necrotic area ⑥ The cell mediated immunologic function after treatment with EChT was more active than that before(P>0 05) ⑦ In post-EChT, the positive expression of bcl 2, p53, c myc and raf in cervical carcinoma was lower than that in pre EChT(P<0 05) ⑧ DNA gel electrophoresis, electron microscopic, flow cytometry and TUNNEL assay showed that the induction of apoptosis in cervical carcinoma with post EChT was higher than that with pre EChT(P<0 05) Conclusion: It is a new way to treat the mid late stage cervical cancer with EChT combined with radiation The mechanism of electrochemical therapy was not only to kill the tumor cell but may also be to induct apoptosis in cervical carcinoma and to increase cell mediated immunologic function更多还原