宫颈癌术后放射治疗后会阴及下肢淋巴水肿危险因素研究

Risk factors influencing perineal and peripheral lymphedema after postoperative radiotherapy for cervical cancer

目的探讨宫颈癌术后放疗后会阴及下肢淋巴水肿的危险因素。方法选取2017年6月至2018年4月间广东省梅州市人民医院收治的宫颈癌手术后行放疗治疗的109例患者,根据放疗6个月后有无发生会阴及下肢淋巴水肿分为水肿组(47例)和无水肿组(62例)。通过妇科癌症淋巴水肿问卷(GCLQ)分析不同分期患者放疗后淋巴结水肿部位分布情况,比较两组患者的年龄、体质量指数(BMI)、淋巴结清扫数目、肿瘤分期、术后卧床时间、放疗方式、化疗、放疗持续时间、每日站立时间和体力活动不足等临床特征,将差异信息纳入Logistic回归分析模型,明确引起宫颈癌术后放疗后会阴及下肢水肿的危险因素。结果宫颈癌治疗后,淋巴水肿发生率为43.1%,水肿部位最多分布在会阴,占34.0%,最少为双侧下肢、会阴合并双侧下肢,均为8.5%。水肿组年龄≥50岁、淋巴结清扫数目≥20枚、放疗持续时间≥35 d、每日站立时间≥6 h,体力活动不足患者比例高于无水肿组,差异均有统计学意义(均P<0.05)。经Logistic回归分析证实,年龄≥50岁、淋巴结清扫数目≥20枚、放疗持续时间≥35d、每日站立时间≥6h及体力活动不足是引起宫颈癌术后放疗后会阴及下肢水肿的危险因素,差异均有统计学意义(均P<0.05)。结论年龄、淋巴结清扫数目、放疗持续时间、每日站立时间和体力活动程度均可影响宫颈癌患者术后放疗治疗后会阴及下肢淋巴水肿发生率。

Objective To study the risk factors influencing perineal and peripheral lymphedema after postoperative radiotherapy for cervical cancer. Methods Clinical data of 109 patients with cervical cancer who received postoperative radiotherapy at Meizhou People’s Hospital were retrospectively analyzed from June 2017 to April 2018. According to whether perineal and peripheral edema occurred over the followup of 6 months after postoperative radiotherapy,they were divided into an edema group( 47 patients) and a non-edema group( 62 patients). The lymph node edema in patients with different stages after postoperative radiotherapy was analyzed by gynecological cancer lymphedema questionnaire( GCLQ). The differences of clinical characteristics such as age,body mass index( BMI),number of lymph node dissection,tumor stage,postoperative bed rest time,radiotherapy method,chemotherapy,duration of radiotherapy,daily standing time and insufficient physical activity were compared between the two groups. The difference information between the two groups was included in the logistic regression analysis for quantitative evaluation,so as to quantify the risk factors influencing perineum and peripheral edema after postoperative radiotherapy for cervical cancer. Results The incidence of lymphedema after treatment of cervical cancer was 43. 1%. It mostly occurred in perineum,accounting for 34. 0%. The least part was bilateral lower limbs,perineum combined with bilateral lower limbs,accounting for 8. 5%. The proportion of patients aged 50 years plus with more than 20 lymph nodes resected,duration of radiotherapy more than 35 days,daily standing time more than 6 hours,and insufficient physical activities was significantly higher in the edema group than in the non-edema group( all P<0.05). Logistic regression analysis demonstrated that age ≥ 50 years old,number of lymph node dissection ≥ 20,duration of radiotherapy ≥ 35 days,daily standing time ≥ 6 hours,lack of physical activity were the risk factors influencing perineal and peripheral lymphedema after postoperative radiotherapy for cervical cancer( all P<0.05). Conclusion Age,number of lymph node dissection,duration of radiotherapy,daily standing time and degree of physical activity can influence the incidence of perineal and peripheral lymphedema in patients with cervical cancer after postoperative radiotherapy.