目的 探讨动脉灌注栓塞化疗治疗宫颈癌的作用机制及临床疗效.方法 将86例Ⅰb2~Ⅱb期宫颈癌患者分为两组:A组(46例)先行动脉灌注栓塞化疗,根据化疗效果决定手术治疗或放疗;B组(40例)直接行广泛全子宫切除+盆腔淋巴结清扫术.根据MRI测量化疗前后宫颈病灶大小,计算手术出血量并统计淋巴结转移率、宫旁浸润率及阴道浸润率,分别检测并计算动脉化疗前(A1组)、后(A2组)及直接手术(B组)患者肿瘤标本的Ki-67指数(LI)及凋亡指数(AI).结果 (1)A组动脉灌注栓塞化疗总有效率为86.96%,其中42例行手术治疗;(2)A组手术病例术中出血量为(364.4±111.5)mL,B组为(527.3±150.6)mL,手术前后血红蛋白差值A组为(16.4±8.8)g/L,B组为(24.7±10.5)g/L,均提示A组术中出血量比B组少(P<0.05);(3)两组比较淋巴结转移率、宫旁浸润率及阴道浸润率,差异均无统计学意义(P>0.05);(4)A1、A2、B组3组检测LI(%)分别为87.22±7.55、66.67±7.79、81.13±8.07,A1组与B组比较差异无统计学意义(P>0.05),A2组较A1、B两组LI降低;(5)3组检测AI(%)分别为0.67±0.21、3.56±1.29、0.83±0.27,A1组与B组比较差异无统计学意义,A2组比A1、B两组AI升高.结论 Ⅰb2~Ⅱb期宫颈癌行动脉灌注栓塞化疗临床疗效显著,可增加手术彻底切除病灶的机会,减少术中出血量,作用机制为抑制肿瘤细胞增殖、促进凋亡.%Objective To investigate the mechanism and efficacy of neoadjuvant intra - arterial chemotherapy.Methods Eighty - six patients with cervical epidermoid carcinoma staged Ⅰ b2 ～ Ⅱ b were randomly divided into two groups: Group A ( n = 46, neoadjuvant intra - arterial infusion chemoembolization with subsequent selected radiotherapy or surgery ) and Group B ( n = 40, surgical operation only ). Patients in Group A before and after chemoembolization were referred as Group A1 and Group A2 , respectively. Proliferation antigen ( Ki - 67 ) and apoptotic cells in cervical cancer specimens were recorded for assessment of Ki - 67 index ( LI ) and apoptotic index ( Al ). Results Total effective rate of intra- arterial infusion chemoembolization was 86. 96％ in Group A, in which 42 cases received surgical treatment. The haemorrhage volume during operation and reduction in hemoglobin were ( 364.4 ± 111.5 )mL and ( 16.4 ± 8.8 )g/L in Group A, and ( 527. 3 ± 150. 6 )mL and ( 24. 7 ± 10. 5 )g/L in Group B with significant differences. No significant difference was observed in lymph node metastasis rate, parametrium infiltration rate or vaginal infiltration rate ( P ＞ 0. 05 ). LI ( ％ ) were 87. 22 ±7. 55, 66. 67 ±7. 79 and 81.13 ±8.07 in Group A1 , A2 and B, respectively. Although no significant difference was revealed in LI between Group A1 and B, significantly lower LI was found in Group A2 than those in Group A1 and B ( P ＜0. 05 ). Al ( ％ ) were 0. 67 ±0. 21, 3.56 ± 1.29 and 0. 83 ±0. 27 in Group A1, A2 and B, respectively.Although no significant difference was revealed in Al between Group A1 and B, significantly higher Al was found in Group A2 than those in Group A1 and B ( P ＜ 0. 05 ). Conclusion Intra - arterial chemoembolization on uterine cervical cancer of Ⅰ b2 ～ Ⅱ b stage significantly reduces the size of lesion, increases opportunity for complete surgical resection, and lowers the haemorrhage volume during operation. Our study suggests that intra - arterial infusion chemoembolization inhibits proliferation and promotes apoptosis of tumor cells.
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