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目的通过检测宫颈癌综合治疗前后癌组织中survivin蛋白表达率和表达量及细胞凋亡情况,分析其预后因素,对比研究双侧髂内动脉化疗栓塞(TACE)对宫颈癌的近期疗效。方法60例临床分期为Ⅰb～Ⅱb期宫颈鳞癌,应用TACE、放疗、放化疗3种方法治疗,TACE组:DDP+E-ADM+5-Fu;放疗组:腔内后装A点和外照射;放化疗组:DDP+5-Fu静脉化疗,同步腔内后装A点照射。治疗后10～14d内手术治疗。应用TUNEL法和免疫组织化学S-P法和图像分析系统检测治疗前后各组细胞凋亡指数(AI)、survivin蛋白表达率和表达量,分析术后盆腔淋巴结转移率、脉管浸润率、间质浸润率、宫旁浸润率及阴道浸润率等影响临床预后的因素。结果(1)宫颈癌3种治疗方法的总有效率分别为70.00%、55.00%和55.00%,FACE组与其他两组相比,差异有统计学意义(P<0.05),巨块型(>4cm)宫颈癌的治疗有效率分别为83.34%、53.85%和58.33%,TACE组与其他两组相比,差异有高度统计学意义(P<0.01);(2)3种方法治疗后宫颈癌组织survivin蛋白的阳性表达率及表达量均明显下降,提高了细胞AI,TACE组与其他两组比差异有统计学意义(P<0.05);(3)TACE降低了盆腔淋巴结转移率、宫旁浸润率、脉管浸润率、深肌层浸润率和阴道浸润率的比例。结论双侧髂内动脉TACE降低了宫颈鳞癌组织survivin蛋白表达,提高了细胞AI,缩小了肿瘤体积,降低了预后因素的比例,提高了临床手术切除率。
Objective To detect the expression of survivin protein and its apoptosis in cervical cancer before and after treatment, and to analyze the prognostic factors. The curative effect of bilateral internal iliac artery chemoembolization (TACE) on cervical cancer was compared. Methods Sixty patients with stage Ⅰb-Ⅱb cervical squamous cell carcinoma were treated with TACE, radiotherapy and radiotherapy and chemotherapy. TACE group: DDP + E-ADM + 5-Fu; radiotherapy group: Radiotherapy; radiotherapy and chemotherapy group: DDP + 5-Fu intravenous chemotherapy, synchronized with a cavity after the installation of point A irradiation. Surgical treatment within 10 ~ 14d after treatment. The apoptosis index (AI), the expression of survivin and the expression of survivin in each group before and after treatment were detected by TUNEL method, immunohistochemical SP method and image analysis system. The rates of pelvic lymph node metastasis, vascular invasion rate, interstitial infiltration Rate, paracancer infiltration rate and vaginal infiltration rate affect the clinical prognosis factors. Results (1) The total effective rates of three kinds of treatment for cervical cancer were 70.00%, 55.00% and 55.00%, respectively. There was significant difference between FACE group and other two groups (P <0.05) (P <0.01). (3) The effective rates of cervical cancer treatment were 83.34%, 53.85% and 58.33%, respectively. There was a statistically significant difference between the two groups (P <0.05); (3) TACE reduced the rate of pelvic lymph node metastasis, the paracancer Infiltration rate, vascular invasion rate, deep myometrial invasion rate and the proportion of vaginal infiltration rate. Conclusion TACE of bilateral internal iliac artery reduces the expression of survivin protein in cervical squamous cell carcinoma, increases the cell AI, reduces the tumor volume, decreases the proportion of prognostic factors and improves the surgical resection rate.