| Objective: In recent years,the incidence of gynecological malignant tumor has increased significantly.Gynecologic malignant tumors could be treated by surgery and radiotherapy or chemotherapy.But to some advanced patients,the operative opportunity had been lost.Besides,the clinical curative effect is unsatisfactory and easy to recur due to radiation and chemotherapy can not effectively control the proliferation and metastasis.The epithelial ovarian cancer with the highest incidence of drug resistance and recur in spite of continuous improvement of operative conception and operative skills.The satisfactory rate of primary surgery is just 3.9%-62.9%.On the other hand,as the new chemotherapy drugs and schemes improved constantly,the first chemotherapy remission rate increased.But in some advanced cases,recurrence usually happened after a-2-years of complete remission and the recurrence rate reached 80%.The recurrence rate of cervical cancer had intimate relationship with pathological stage,which is 10% in I B,17% in II A,23% in II B,42% in III,and 74% in IV.Moreover,it has relationship with the size of tumor,which is 1.2% in focal diameter?2cm and 21% in diameter >2cm.Sertoli cell tumor is highly sensitive to chemotherapy and the prognosis is ideal.The cure rate in low-risk cases is 100%,and the drug resistance and recurrence in high-risk cases is about 20%.Patients with gynecological malignant tumor usually have a poor body tolerance.They experience the first surgery,chemotherapy or radiotherapy and the body tolerance is weaker than the new patients.So it is particularly important to choose a suitable treatment for the patients in advanced stage.With the development of medical levels and minimally invasive equipment,the treatment for gynecological malignant tumor continuously appears.The clinical reports about interventional techniques to treat advanced gynecology malignant tumor have appeared.Vascular intervention therapy which perspective by X ray could suppress and kill the tumor cells by blocking the tumor-feeding artery and injecting antineoplastic drugs.The technical has a characteristic of small trauma,rapid recovery,fewer complications,relatively simple procedure and wide Indications.After the artery embolism and perfusion chemotherapy procedure,drug concentration in tumor is more than 10 times than the distal venous.If vascular thrombosis is then applied,the time of chemotherapy drugs contact with tumors will be increased,and the clinical effective will be better.In this study,gynecologic malignant tumor patients with complete clinical medical records were enrolled at the fourth hospital of hebei medical university.The short-term efficacy and untoward effect were recorded and compared between arterial infusion chemotherapy and intravenous chemotherapy,in order to investigate the value of artery embolism and perfusion chemotherapy in the treatment of gynecologic malignant tumor.Methods: From August 2011 to October 2014,128 cases of gynecologic malignant tumor patients who match the standard accepted the treatment in our hospital.Based on the treatment,they were divided into 2 groups.There were 65 cases in experimental group(group A),aged 38~75 years,mean(50.3±13.6)years,accepted the procedure of artery embolism and perfusion chemotherapy.Which contain 33 cases of ovarian cancer,16 cases of cervical cancer,7 cases of invasive mole and 9 cases of choriocarcinoma.There were 63 cases in control group(group B),aged 40~76 years,mean(51.5±14.9)years,accepted the same chemotherapy drugs by intravenous infusion.There were 31 cases of ovarian cancer,15 cases of cervical cancer,7 cases of invasive mole and 10 cases of choriocarcinoma.All patients had definite pathological diagnosis and stage before the treatment,and there was no statistically significant difference between the 2 groups.The survival time arrange from beginning therapy day to the cut-off day and calculated in month.The deadline follow-up was October 31,2015.The total rate of follow-up was 90.3% in experimental group and 91.8% in control group,and the withdraw rate in experimental group was 9.2% and in control group was 7.9%.The effective rate,short-term survival rate and adverse reactions were recorded and compared between the groups.Results:1 The overall efficiency in experimental group was 67.7%,and the control group was 38.1%,which was significant difference between the 2 groups(P<0.05).The effective rate of ovarian cancer,cervical cancer,erosion sex hydatidiform moleand and velvet carcinoma in experimental group was 63.6%,68.8%,71.4% and 77.8%,respectively.The effective rate in control group was 35.5%,40.0%,42.9% and 40.0%.So,in the treatment of all kind of gynecological malignant tumor,artery embolism and perfusion chemotherapy had a better effective rate than intravenous chemotherapy(P<0.05).2 Both of the groups had a significant decrease in ?-HCG when compare with the pre-operation level(P<0.05).However,the experimental group had a more significant decrease than the control group in treating resistance and recurrent of trophoblastic tumor(P<0.05).The result showed that single artery embolism perfusion chemotherapy was superior than single intravenous chemotherapy(P<0.05).3 The complication rate was 10.8%(7/65)in experimental group and 23.8%(15/63)in control group.There was significant difference between the 2 groups(P<0.05).4 The ovarian cancer patients in experimental group had a higher 1 year survival rate than the control group(P<0.05).However,there was no significant difference in 2 and 3 years survival rate(P>0.05).Which showed that artery embolism and perfusion chemotherapy could improve 1 year survival rate,but had no effective to 2 and 3 years survival rate.The cervical cancer patients in experimental group had a similar 1 year survival rate compared with the control group(P>0.05),but there was a significant difference in 2 and 3 years survival rate(P<0.05).This proved that artery embolism and perfusion chemotherapy could improve the short-term efficacy the cervical cancer patients.The trophoblastic tumor patients in the 2 group had no significant difference in 1,2 and 3 years survival rate(P>0.05).This proved that artery embolism and perfusion chemotherapy could just decrease the value of ?-HCG,narrowing the lumps,controlling the bleeding of the metastases and control the clinical symptoms,but had no improvement on short-term survival.Conclusion: For gynecology malignant tumor patients who have lost the opportunity of operation,the procedure of artery embolism and perfusion chemotherapy could shrink the tumor size,control the progress of tumor,improve the quality of life and the short-term survival rate to ovarian cancer and cervical cancer patients.It also could reduce the incidence of bone marrow suppression,Moreover,this procedure has the characteristic of the reduce liver and kidney impairment,improve the quality of life.So it deserves a further clinical application. |
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