目的：探讨对Ⅰb2～Ⅱb期宫颈癌患者采用术前新辅助化疗联合宫颈癌根治术治疗的临床效果。方法回顾性分析郁南县第二人民医院2009年7月至2011年9月收治的89例宫颈癌患者的临床资料，根据是否采用术前新辅助化疗分为化疗组（术前化疗＋手术治疗，47例）和手术组（直接采用手术治疗，42例），比较两组患者近期疗效、3年无瘤生存率及3年总生存率差异。结果化疗组不同病理分期化疗总有效率为Ⅰb2期92．86％、Ⅱa期80．00％、Ⅱb期69．23％，不同病理分期患者的化疗效果无显著性差异（χ2＝2．447，P＝0．294）。化疗组鳞癌化疗总有效率为95．83％，显著高于腺癌类型（χ2＝5．738，P＝0．017）。化疗组的手术时间和术中出血量与手术组比较无显著性差异（均P＞0．05）。化疗组和手术组患者术后的标本检查中，阴道切缘阳性率为4．26％和2．38％，两组比较无显著性差异（P＞0．05），化疗组的淋巴结转移率和脉管浸润率分别为12．77％、17．02％，均显著的低于手术组（χ2值分别为4．369、8．957，均P＜0．05）。化疗组术后的3年无瘤生存率为78．72％（37／47），显著高于对照组的50．00％（21／42）（χ2＝8．062，P＝0．005）；化疗组术后的3年总生存率为88．23％（41／47），高于对照组的80．95％（34／42），但无显著性差异（χ2＝0．660，P＝0．416）。结论对Ⅰb2～Ⅱb期宫颈癌患者采用术前新辅助化疗可以显著提高手术切除率，降低淋巴结转移及脉管浸润，提高术后无瘤生存时间。%Objective To discuss the clinical effect of preoperative neoadjuvant chemotherapy (NACT) combined with radical hysterectomy treatment on Ⅰb2-Ⅱb cervical cancer .Methods A retrospective analysis was conducted on clinical data of 89 cases of cervical cancer treated in Yu’nan County Second People ’s Hospital from July 2009 to September 2011.The cases were divided into chemotherapy group (preoperative chemotherapy and surgery , 47 cases) and surgery group (direct use of surgery, 42 cases), and two groups were compared in short-term efficacy, 3-year disease-free survival rate and 3-year overall survival rate .Results The overall effective rate of chemotherapy group was 92.86%, 80.00%and 69.23%, respectively at stage Ⅰb2,Ⅱa andⅡb, and the difference was not significant (χ2 =2.447, P=0.294).The total effective rate of squamous cell carcinoma was 95.83%, which was obviously higher than adenocarcinoma (χ2 =5.738,P=0.017).The differences in operative time and intraoperative blood loss were not significant between chemotherapy group and surgery group (both P>0.05).Of specimens in chemotherapy group and surgery group , vaginal positive margin rate was 4.26% and 2.38%, respectively, and the difference was not remarkable (P >0.05).Lymph node metastasis rate and vascular invasion rate in chemotherapy group was 12.77 % and 17.02%, respectively, which were significantly lower than those in surgery group (χ2 value was 4.369 and 8.957, respectively, both P<0.05).In chemotherapy group 3-year disease-free survival rate was 78.72% (37/47), which was significantly higher than that of surgery group (50.00%, 21/42) (χ2 =8.062, P=0.005), but 3-year survival rate of the former (88.23%, 41/47) was not significantly higher than the later (80.95%,34/42) (χ2 =0.660, P=0.416).Conclusion For patients with cervical cancer at Ⅰb2-Ⅱb, NACT before surgery can significantly improve the resection rate , reduce lymph node metastasis and vascular invasion, and prolong postoperative survival time .
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