新辅助化疗在局部晚期宫颈癌治疗中的应用——附86例临床分析

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1、贵阳医学院2013届硕士研究生论文《中国图书资料分类法》单位代码：10660分类号：R737.33学号：S100331贵阳医学院2013届临床医学硕士专业学位材料（临床论文部分）新辅助化疗在局部晚期宫颈癌治疗中的应用—附86例临床分析研究生：王楠导师：杨英捷教授年级：2010级专业：妇产科学2013年5月15日贵阳医学院2013届硕士研究生论文目录摘要„„„„„„„„„„„„„„„„„„„„„„„„„1缩略词表„„„„„„„„„„„„„„„„„„„„„„„„2前言„„„„„„„„„„„„„„„„„„„„„„„„„3临床资料与方法„„„„„

2、„„„„„„„„„„„„„„„„4结果„„„„„„„„„„„„„„„„„„„„„„„„„7讨论„„„„„„„„„„„„„„„„„„„„„„„„„12结论„„„„„„„„„„„„„„„„„„„„„„„„„15参考文献„„„„„„„„„„„„„„„„„„„„„„„„16致谢„„„„„„„„„„„„„„„„„„„„„„„„„18英文摘要„„„„„„„„„„„„„„„„„„„„„„„„19论文原创性声明„„„„„„„„„„„„„„„„„„„„„21综述„„„„„„„„„„„„„„„„„„„„„„„„„22附：临床能力考核有关材料：临床轮转考核表（

3、按时间顺序）学术活动情况表（按时间顺序）临床能力考试及学位答辩情况表贵阳医学院2013届硕士研究生论文新辅助化疗在局部晚期宫颈癌治疗中的应用—附86例临床分析专业名称：妇产科学，研究生：王楠，导师：杨英捷教授摘要[目的]探讨新辅助化疗（NeoadjuvantChemotherapy，NACT）在局部晚期宫颈癌（LocallyAdvancedCervicalCancer，LACC）治疗中的效果及价值。[方法]回顾性分析贵州省肿瘤医院妇瘤外科2007年8月至2012年6月收治的宫颈癌ⅠB1～ⅡA2期332例，LACC行NACT组（研究组）86

4、例，LACC手术组（对照组1）66例,ⅠB1期组（对照组2）180例的临床资料。评价NACT近期疗效，各组手术后病理、切缘切净率及生存曲线等相关因素。[结果]NACT有效率为62.79%，其中34例完全缓解；化疗效果与期别、病理类型及肿块大小无关（P＜0.05）。化疗相关毒副反应轻微；研究组手术时间、平均出血量、淋巴结阳性率、脉管癌栓阳性率，低于对照组，差异有统计学意义（P＜0.05）；阴道切缘阳性率、宫旁浸润率、术后留置尿管时间，差异无统计学意义（P＞0.05）；三组生存分析差异无统计学意义（P＞0.05）。[结论]1.宫颈癌术前NAC

5、T可有效缩小肿瘤体积，改善阴道穹窿情况，提高手术治疗机会；2.宫颈癌的NACT安全、可行；3.术前NACT对LACC近期生存率无明显改善。关键词宫颈癌；新辅助化疗；手术治疗；疗效1贵阳医学院2013届硕士研究生论文英文缩略词表英文缩写英文全称中文全称NACTNeoadjuvantChemotherapy新辅助化疗LACCLocallyAdvancedCervicalCancer局部晚期宫颈癌FIGOInternationalFederationof国际妇产科联盟GynecologyandObstericsCRCompleteRespons

6、e完全缓解PRPartialResponse部分缓解SDStableDisease病灶稳定PDProgressiveDisease疾病进展2贵阳医学院2013届硕士研究生论文1前言宫颈癌是女性最常见的恶性肿瘤之一，发病率及死亡率仅次于乳腺癌。经过几十年广泛开展妇科普查，我国宫颈癌的发病率及死亡率逐渐降低。但从全国范围来看，宫颈癌的患病率及死亡率仍居妇科恶性肿瘤的第一位，且发病年龄有低龄化的趋势。手术治疗及放疗是宫颈癌的两种传统治疗手段，对早期患者可取得[1]较好疗效，但传统的治疗模式对LACC治疗效果并不理想，主要原因是治疗时已有远处转移

7、和局部复发。LACC是一组具有不良预后因素的高危宫颈癌，广义为ⅠB2～ⅣA期，狭义按国际妇产科联盟(InternationalFederationof［2-3］GynecologyandObstetrics,FIGO)2009年分期，为ⅠB2期和ⅡA期宫颈癌。LACC肿瘤负荷大，手术难度高，放疗放射剂量受到周围器官耐受量的限制，对放射野外的亚临床病灶无法控制，故肿瘤控制率偏低，长期生存率不超过40%，复[4]发者的存活率不超过30%，且放疗对卵巢功能、阴道完整性和邻近器官的功能都有不良影响，再加上放疗的远期后遗症，很多年轻的希望保留性功能

8、的患者不愿接受放疗，更多的是首选手术治疗。近年来，人们通过NACT来提高疗效，并得到广泛关注。NACT是指恶性肿瘤患者局部治疗（手术或放疗）前给予的短程化疗。从1982[5]年Friedlan