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目的探讨髂内动脉灌注化疗加栓塞术在晚期宫颈癌患者放疗前的临床应用价值。方法92例放疗前的晚期宫颈癌患者在数字减影血管造影术监视下,采用Seldinger技术行双侧髂内动脉插管,以顺铂、博莱霉素和丝裂霉素等药物缓慢灌注化疗,明胶海绵颗粒栓塞肿瘤供血最明显分支。结果临床症状均有改善,显效率100%;巨块型患者在治疗后7d,肿块缩小超过50%的病例占76.2%,90.5%患者3~4周后宫颈外形清晰可见;颈管型患者治疗后颈管部肿块均缩小,缩小超过50%的病例占66.7%;38例溃疡型患者合并出血,36例(94.7%)在治疗后即刻出血停止,溃疡型患者3~4周时盆腔组织明显变软,尤以宫颈旁组织和阴道穹窿为著,1/3患者肿块缩小达50%以上;盆腔疼痛缓解率100%,下肢水肿缓解率100%。结论髂内动脉灌注化疗加栓塞术对放射治疗前的晚期宫颈癌有非常好的近期疗效,可作为提高晚期宫颈癌患者长期缓解率和治愈率的常规辅助治疗手段。
Objective To investigate the clinical value of intra-iliac arterial infusion chemotherapy and embolization before radiotherapy in patients with advanced cervical cancer. Methods Ninety-two patients with advanced cervical cancer before radiotherapy underwent digital subtraction angiography. Seldinger technique was used to perform bilateral internal iliac artery cannulation. Drugs such as cisplatin, bleomycin and mitomycin were slowly infused through chemotherapy , Gelatin sponge particles embolism tumor blood supply the most obvious branch. Results The clinical symptoms were improved with a markedly effective rate of 100%. In the bulky patients, 76.2% of the cases had a mass shrinkage of more than 50% at 7 days and 90.5% of the patients showed clear shape after 3 to 4 weeks. The size of the posterior neck tumor was reduced and 66.7% of cases were reduced by more than 50%. Bleeding was found in 38 patients with ulcerative disease and bleeding stopped immediately after treatment in 36 patients (94.7%). The pelvic tissue in the ulcer patients was obvious at 3 to 4 weeks Softening, especially in cervical tissue and vaginal fornix, 1/3 of the patients shrink more than 50%; pelvic pain relief rate of 100%, lower extremity edema remission rate of 100%. Conclusion Intra-iliac arterial chemoembolization and embolization have a very good short-term curative effect on advanced cervical cancer before radiotherapy and can be used as routine adjuvant therapy to improve the long-term remission rate and cure rate of patients with advanced cervical cancer.