宫颈癌同步放化疗患者阴道微生态状况及影响因素分析

Investigation of Vaginal Microecology in Patients with Cervical Cancer

目的探讨宫颈癌治疗后患者阴道微生态状况及其相关的影响因素。方法选取2015年9月至2017年9月在首都医科大学附属北京妇产医院妇瘤科初治的223例行单纯手术、手术+放疗以及同步放化疗治疗后的宫颈癌患者为研究对象,对其行阴道分泌物检查,评价阴道微生态状况,并进行相关因素的问卷调查。结果单纯手术组、手术+放疗组以及同步放化疗组患者治疗后阴道清洁度异常率和病原体感染率分别为20.6%(14/68)、33.9%(20/59)、52.1%(50/96)和11.8%(8/68)、11.9%(7/59)、29.2%(28/96)。同步放化疗组阴道清洁度异常率和病原体感染率高于单纯手术组及手术+放疗组(P<0.05)。多因素分析结果显示,文化程度及是否规范阴道冲洗为同步放化疗组患者阴道清洁度异常的影响因素(P<0.05)。结论宫颈癌治疗后患者存在一定比例的阴道微生态失调,同步放化疗较其他治疗方案更易导致阴道分泌物异常。居住环境差、文化程度低、不规范阴道冲洗的宫颈癌患者更易在同步放化疗后出现阴道微生态失调。应对此类患者加强宣教,并进行相关检查,以提高宫颈癌患者的生活质量。

Objective To investigate the vagina microecology and its related factors of the patients with cervical cancer after treatment. Methods A total of 223 patients with cervical cancer who received surgery alone,surgery ＋ adjuvant radiotherapy,or concurrent chemoradiotherapy at the Gynecologic Oncology Department of Beijing Obstetrics and Gynecology Hospital from Sep. 2015 to Sep. 2017 were selected. The vaginal secretions were examined to evaluate the vaginal microecology,and to conduct a questionnaire survey of the related factors. Results The abnormal rates of vaginal cleanliness and infection rates of cervical cancer patients in the surgery group,the surgery ＋ adjuvant radiotherapy group,the concurrent chemoradiotherapy group were 20. 6%（ 14/68）,33. 9%（ 20/59）,52. 1%（ 50/96） and 11. 8%（ 8/68）,11. 9%（ 7/59）,29. 2%（ 28/96）. The abnormal rate of vaginal cleanliness and infection rates of cervical cancer patients in the concurrent chemoradiotherapy group were higher than those in the simple operation group and the surgery ＋ adjuvant radiotherapy group（ P〈0. 05）. The results of multifactor analysis showed that cultural level and whether vaginal irrigation were the factors affecting the vagina cleanliness of the patients in the concurrent chemoradiotherapy group（ P〈0. 05）. Conclusion After the treatment of cervical cancer,there is a certain proportion of vaginal microecologic maladjustment. Concurrent chemoradiotherapy is more likely to lead to abnormal vaginal secretions than other treatments. Cervical cancer patients with poor living environment,low educational level and unregulated vaginal irrigation are more likely to have vaginal microecologic maladjustment after concurrent radiotherapy and chemotherapy. In order to improve the quality of life of the patients,clinicians should strengthen the education of this type of patients and carry out related examinations.