本文選題：宮頸癌 + NACT��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：觀察新輔助化療用于早期宮頸癌患者的臨床療效。 方法：回顧性分析2010年1月-2014年1月就診于北京軍區(qū)總醫(yī)院的45例b1-ēb期宮頸癌患者。采用順鉑、博萊霉素、絲裂霉素（DBM）方案行動脈灌注栓塞化療1-2個療程，進行婦科檢查、陰道鏡檢查、婦科超聲、盆腔MR及血清SCCA值等多項檢測，收集各項檢查指標，采用Paired-Sample t Test及Wilcoxon檢驗對上述指標進行統(tǒng)計學分析，對比化療前后宮頸局部腫塊大小的變化情況、病變對宮旁組織的累及情況及血清腫瘤標志物的變化。觀察各項觀測指標的差異，并監(jiān)測化療副反應。如無手術禁忌癥行腹腔鏡下廣泛性子宮切除術+盆腔淋巴結清掃，否則行放療。術后將多種檢查結果與病理結果進行比較。 結果：本研究顯示當化療結束后，1）婦科檢查全部病例化療后宮頸局部病灶均較化療前縮小或消失；有23例（23/45）患者目測已經完全消失（CR）；其余22例（22/45）患者的宮頸局部腫瘤體積均縮小了50％以上(PR)；化療有效率（CR+PR）100%。2）將多次陰道鏡圖像進行測量對比，化療后宮頸局部病灶不同程度縮小；3）超聲檢查提示化療前后宮頸局部病灶大小及腫物血流豐富程度均明顯改善，有統(tǒng)計學意義；4）盆腔MR檢查提示化療前后宮頸局部病灶大小明顯改善，有統(tǒng)計學意義；5）主要毒副反應為-ē度白細胞減少、消化道癥狀及輕度脫發(fā)，僅1例患者出現(xiàn)ē度骨髓抑制，用藥后均緩解。6）化療后，除3例ēb期患者因宮旁病灶改善不滿意改行放療，其余42例行腹腔鏡下廣泛性子宮切除術及盆腔淋巴結清掃術，手術成功率100%。7）有14例術后病理結果未發(fā)現(xiàn)任何癌組織，在b1及b2期患者中，婦檢局部病灶緩解的情況與術后病理結果吻合程度高，分別可達到100%、80%；ēa及ēb期化療后多未達到完全清除，陰道鏡檢查可提高殘留病灶的檢出率。8）血清SCCA僅在化療前異常時，對評價化療效果有參考意義。9）所有患者均系統(tǒng)隨診，隨診時間為3-51個月，除有一例患者因遠處轉移于術后27個月時死亡，其余患者目前均無瘤生存。 結論：DBM新輔助化療方案對于b1-ēb期宮頸癌近期療效好，副反應相對較輕，具有較好的臨床推廣應用價值。
[Abstract]:Objective: to observe the clinical effect of neoadjuvant chemotherapy in patients with early cervical cancer. Methods: from January 2010 to January 2014, 45 patients with stage B 1 or B cervical cancer in Beijing military region General Hospital were retrospectively analyzed. One or two courses of arterial infusion embolization chemotherapy were performed with cisplatin, bleomycin and mitomycin (DBM). Gynecological examination, colposcopy, gynecological ultrasound, pelvic Mr and serum SCCA were performed. The Paired-Sample t Test and Wilcoxon test were used to analyze the above indexes. The changes of the size of local cervical mass, the involvement of the lesion to the para-uterine tissue and the changes of serum tumor markers were compared before and after chemotherapy. Observe the difference of observation indexes and monitor the side effects of chemotherapy. If no surgical contraindication is performed, pelvic lymph node dissection is performed under laparoscopy, otherwise radiotherapy is performed. After operation, the results of various examinations were compared with the pathological results. Results: this study showed that the local cervical lesions were reduced or disappeared in all cases after chemotherapy, and 23 cases (23 / 45) were completely disappeared after gynecological examination. In the other 22 patients, the local tumor volume of cervix decreased by more than 50%, and the effective rate of chemotherapy was 100%. 3) Ultrasonography showed that the size of local cervical lesions and the abundance of blood flow were significantly improved before and after chemotherapy, with statistical significance (4) pelvic Mr examination showed that the size of local cervical lesions was significantly improved before and after chemotherapy, with statistical significance. 5) the main side effects were leukopenia, alopecia, gastrointestinal symptoms and mild alopecia. Only one patient developed myelosuppression, all of which were relieved after chemotherapy. The remaining 42 cases underwent laparoscopic extensive hysterectomy and pelvic lymph node dissection. The successful rate of operation was 100. 7%. The remission of local lesions in women's examination was in good agreement with the postoperative pathological results, which could reach 100% and 80% respectively, and most of them were not completely cleared after stage A and B chemotherapy. Colposcopy examination could increase the detection rate of residual lesions. 8) Serum SCCA was only abnormal before chemotherapy. All patients were followed up systematically for 3-51 months. Except one patient died of distant metastasis 27 months after operation, all patients survived without tumor. Conclusion the new adjuvant chemotherapy regimen of 7% DBM has good short-term curative effect and relatively mild side effect in the treatment of B1-B stage cervical cancer, so it has a good clinical application value.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R737.33

【參考文獻】

相關期刊論文 前2條

1 龍梅;吳楠;王樹鶴;胡春艷;王麗梅;張文晶;徐婉;尚麗新;;腹腔鏡治療早期宮頸癌的臨床療效分析[J];山西醫(yī)科大學學報;2012年10期

2 鄭榮壽;張思維;吳良有;李光琳;趙平;赫捷;陳萬青;;中國腫瘤登記地區(qū)2008年惡性腫瘤發(fā)病和死亡分析[J];中國腫瘤;2012年01期

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本文編號：2039136