宫颈癌常规放疗后输尿管狭窄的危险因素分析

Analysis of risk factors associated with ureteral stricture in patients with cervical cancer after radiotherapy

目的探讨宫颈癌患者放疗后致输尿管狭窄的相关危险因素。方法回顾性分析332例接受常规放疗后宫颈癌患者发生输尿管狭窄的情况,并对年龄、诱导化疗、同时期化疗、辅助化疗、临床分期、病理类型、分化程度、是否近距离治疗、近距离治疗剂量、盆腔外照射剂量、总剂量、是否手术以及是否合并糖尿病或高血压等因素进行分析,筛选与输尿管狭窄有关的危险因素。进一步采用Logistic回归进行独立危险因素的分析,并用Kaplan-Meier法分析了临床分期和双"J"管置入后输尿管狭窄患者的中位时间。结果 332例患者有33例(9.9%)出现输尿管狭窄;664侧输尿管有40侧(6.02%)出现狭窄。Logistic回归分析证实手术和总剂量是宫颈癌放疗后输尿管狭窄发生的独立危险因素。输尿管狭窄发生后双"J"管置入和Ⅰ/Ⅱ期肿瘤的预后明显好于未行双"J"管置入和Ⅲ/Ⅳ期肿瘤,P均<0.05。结论手术和总剂量是宫颈癌患者放疗后发生输尿管狭窄的独立危险因素。

Objective To investigate the risk factors associated with ureteral stricture（US）in patients after radiotherapy. Methods Retrospectively analyzed the clinical characteristics of 332 patients with cervical cancer,including age,induction chemotherapy,concurrent chemotherapy,adjuvant chemotherapy,clinical stage,pathology,differentiation,brachytherapy（BT）,BT dose,external beam radiation therapy dose（EBRT）,total dose,surgery,diabetes or hypertension. Multivariate Logistic regression analysis was performed to analyze the independent risk factors of US. Kaplan-Meier analysis was used to analyze the overall survival rate. Results Totally 33 in 332 patients developed US（9.9%）,and 40 in 664 ureteral developed US（6.02%）. Multivariate analysis confirmed that surgery and total dose were independent risk factors of US. Kaplan-Meier analysis showed that patients with Ⅰ/Ⅱ stage and double-J-catheter had significant high overall survival rate. Conclusion Surgery and total dose were independent risk factors of US in patients with cervical cancer after radiotherapy.