不同方式阴道填塞在宫颈癌后装腔内放疗中的作用

Clinical experiences of differently vaginal packing ways to intracavitary radiotherapy for cervical cancer patients

目的:通过改进阴道填塞技术,探讨宫颈癌后装腔内放疗后放射性直肠炎的发生情况。方法:回顾性分析了我科自2005年至2008年对76例IIb期宫颈鳞癌患者采用192铱高剂量率腔内后装放疗过程中,改良阴道填塞方法,随机分为观察组(手风琴式的阴道填塞组)40例,对照组(常规填塞4-5块盐水纱布)36例。按照RECIST标准评价近期疗效;参照NCICTC3.0标准评价不良反应。结果:全组病例随访36月,随访率达88.16%以上。观察组(手风琴式的阴道填塞组40例):完全缓解20例(50.00%),部分缓解17例(42.50%),病情稳定2例(5.00%),病情进展1例(2.50%),客观有效率(RR)为90.00%,对照组RR为88.89%,近期有效率无显著性差异(P>0.05)。而两组直肠炎发生率I级分别为10.00%和11.11%,II级为2.50%和2.78%,观察组III级与IV级直肠炎未发生,对照组III级、IV级直肠炎分别为5.56%和2.78%,两组直肠炎总体发生率分别为12.50%和22.22%(P<0.05)。结论:手风琴式的阴道填塞技术确保了阴道源与宫腔源的布源合理性,既提高了肿瘤的治疗增益比,又减少了直肠的照射剂量,值得临床广泛应用。

Objective：To explore the occurrence of radiation proctitis after-loading brachytherapy of cervical cancer patients byimproved vaginal packing technology. Methods： A retrospective analysis on 76 patients with cervical squamous cell carcinoma in our department from 2005 to 2008 were treated with IIb 192Ir high dose rate intracavitary after-loading radiotherapy process and improved vaginal packing method in which all patients were randomly divided into accordion-style vaginal packing group（40 cases） and the control group （36 cases conventional saline gauze packing 4~5 blocks） . Short-term effect was evaluated by RECIST criteria, and adverse events were evaluated by NCI CTC3.0 criteria. Results： All the patients were followed up for 36 months in which follow-up rate was more than 88.16%. In observation group （accordion-style vaginal packing group of 40 patients）,complete remission was 20（50.00%） cases, partial remission was 17（42.50%） patients, stable disease was 2（5.00%） cases,disease progression was 1（2.50%） case, objective efficiency（RR） was 90.00%. In control group, RR was 88.89%, and there was no significant difference in short-term effect rate（P0.05）. Proctitis incidence of the two groups was respectively 10.00% and 11.11% in grade I, II grade of 2.50% and 2.78% in the observation group. Proctitis of III and IV grade level did not occur in the observation group, III,IV levels was respectively 5.56 % and 2.78% in control group, and the overall incidence of proctitis in two groups was respectively 12.50% and 22.22%（P0.05）. Conclusion： Accordion-style vaginal packing technology can ensures Yindao Yuan and intrauterine source of cloth source rationality, and can be worthy of wider application,which not only improves the gain ratio of tumor treatment, but also reduce the rectal dose .