【摘要】 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。更多还原

【Abstract】 Objective To access the pathological changes and clinical outcomes in uterine cervical cancer after pre-operational interventional chemotherapy,and explore the option of the second therapy. Methods From June 1999 to Dec.2004,ambi-uterine arterial infusion and embolization chemotherapy were done in 19 patients with papillar uterine cervical cancer before operation in Guangzhou First People’s Hospital. We used carboplatin 300mg/m 2 and bleomycin 45 mg as chemotherapeutic drugs, 2/3 of the total dosage being used for arterial infusion, the other 1/3 being used for embolization with fresh GF(diameter 1-3mm). Pathological tissues of all the patients were taken and observed at 1h,9h,24h,48h,7d,16d and the day purforming the radical surgery.Results (1) In early stage, the color of cancer tissue changed to purple-black after pre-operational interventional therapy. Then it changed to gray-white and looked like erodible meat. At late stage, some of the focus disappeared and the remained focus became more stiff than before. (2) Early changes of hypoxia in cancer cells could be found under electron microscope 1 hour after interventional treatment. (3)Under microscope, the structure of cancer cell appeared to be more porous 9 hours later interventional treatment and karyopyknosis was found 24 hours later, then we found obvious necrosis after 48 hours. Paramorphia of the relic cancer cells were found in 16-21d.(4)18 cases successfully completed cervical radical therapy 16-21d after interventional therapy,including 2 cases(2/2) of Ⅱa,13 cases of Ⅲa(13/13) and 1 case of Ⅲb(1/2). Conclusion Obvious degeneration and necrosis appear in uterine cervical cancer cells after interventional treatment. The relic cancer cells are capsued by the proliferating fibroid connective tissue; the appropriate time for the second therapy is 14-21d after the interventional therapy; the interventional therapy may enhance the excision rate of the cervical cancer in metaphase and late phase.更多还原