Experiences with the Use of Vaginal Dilator by Cervical Cancer Women Who Received Pelvic Radiotherapy at Cancer Diseases Hospital, Lusaka Zambia

Background: Cancer of the cervix is the commonest cancer in women seen at Cancer Diseases Hospital in Zambia and Pelvic Radiotherapy is the main treatment modality used on cervical cancer patients. Radiotherapy to the pelvis has a potential to causes vaginal stenosis but the stenosis can be prevented by regular sexual intercourse or use of vaginal dilators as recommended by cancer organizations. Despite the well-established benefits of vaginal dilators, there was reluctance by women to adopt this practice as seen by the number of survivors with vaginal stenosis at Cancer Diseases Hospital. The objective of this study was to explore experiences with the use of vaginal dilators by cervical cancer women who received Pelvic Radiotherapy. Methodology: A descriptive phenomenological design was used to explore experiences with the use of vaginal dilators by cervical cancer women. The study was conducted at Cancer Diseases Hospital in Lusaka District of Zambia. Participants were identified and purposefully sampled during the follow up clinics, they were then followed for interviews into their homes in Lusaka and data saturation was attained after interviewing 22 participants. Data were analyzed using thematic analysis. Results: Five themes from the study emerged on how women with cervical cancer experienced the use of vaginal dilator;such as uncomfortable dilators, pity for the husband, changed lifestyle, embarrassment and fear. Conclusion: It was acknowledged that the use of vaginal dilator was associated with negative experiences such as uncomfortable dilators, pity for the husband, changed lifestyle, fear and embarrassment. Therefore, this study recommends that Health care providers from CDH and other health institutions should give appropriate information to patients concerning the use of vaginal dilators and the Ministry of Health to provide vaginal dilators instead of 50 milliliter syringes currently in use.

Rhabdomyosarcoma in Children: About 10 Cases

Introduction: Rhabdomyosarcoma (RMS) is a malignant soft-tissue tumor arising from striated muscle cells. It accounts for 60% - 70% of malignant mesenchymal tumors and 5% of pediatric cancers. Two-thirds of these cancers are diagnosed in children under 6 years of age, with a slight male predominance. Materials and Methods: This is a retrospective descriptive study of 10 cases of RMS collected in the pediatric hematology and oncology department of the Oujda university hospital, over a 5-year period, running from January 2018 to December 2022. Results: The median age at diagnosis was 3 years, with a sex ratio of 1. The mean time to diagnosis was 2 months. The most common site was the head and neck (50%), followed by the genitourinary tract (20%), the extremities (20%) and finally the abdomen (10%). The most frequent mode of discovery was a mass or swelling found in 90% of patients (all sites included), followed by exophthalmos in 30% of cases. At the diagnostic stage, CT scans were performed in 70% of cases and MRI in 5 patients (50%). Histological diagnosis was determined by immunohistochemical pathology in all our patients, with a predominance of embryonal (70%) versus alveolar (20%) and spindle cell types (10%). All patients underwent an extension workup, and a cervico-thoraco-abdominopelvic CT was performed in all patients (100%);MRI was performed in 2 patients (20%);lymph node involvement was present in 5 patients (50%). Metastases at the time of diagnosis were noted in only 1 patient (10%), who simultaneously presented with two metastatic sites;testicular and abdominal wall. Sixty percent of patients presented with advanced disease (high risk) and 40% with standard risk. Chemotherapy was used in all patients (100%), with upfront tumor resection performed in 40%. Fifty percent of patients received radiotherapy at a mean dose of 43 Gy, with the orbit the most frequently irradiated area (30%). All patients underwent CTscan and/or MRI and/or ultrasound surveillance. Follow-up during and after treatment was marked by complete remission in 8patients, loss of sight in one patient, and one patient died as a result of progressive disease. Conclusion: RMS is a malignant tumor of striated muscle. The epidemiological and clinical features of this tumor in our study are generally similar to those described in the literature. Management of these tumors requires multidisciplinary collaboration involving oncopediatric, radiologist, pediatric surgeon, pathologist and radiotherapist.

Blue LED as a new treatment to vaginal stenosis due pelvic radiotherapy:Two case reports

BACKGROUND Currently,the advancement cancer treatment technology improves overall survival,however,adverse events are still a challenge for health professional.Genitourinary syndrome of menopause and vaginal stenosis are conditions that impact the quality of life of patients undergoing radiotherapy.We present two such cases in patients with previous cervical and endometrial cancer.These conditions were handled with an innovative method using an energy-based device with blue light emitting diode for concomitant vaginal and vulvar irradiation.Positive impact in clinical findings,cytologic changes,and referred symptoms were documented.CASE SUMMARY One patient diagnosed with vaginal severe vaginal stenosis with previous cervix cancer treatment and other patient diagnosed with mild stenosis with severe dyspareunia and recent endometrium cancer treatment were considered for vulvovaginal treatment with weekly blue led device and closely evaluated with repeated validated questionnaires and cytological samples.CONCLUSION This innovative technique showed an improvement in all areas of the examiner's criteria,the cytological criteria,and most bothered symptoms.

中药溻渍联合情绪舒缓疗法与视觉艺术疗法对宫颈癌放疗患者心理、生活质量的影响及对放射性阴道炎的防治作用

目的观察中药溻渍联合情绪舒缓疗法与视觉艺术疗法对宫颈癌放疗患者心理、生活质量的影响及对放射性阴道炎的防治作用。方法选择2020年2月至2021年10月收治的宫颈癌放疗患者120例为研究对象,按照随机数字表法分为2组,对照组60例予西医常规干预措施,治疗组60例在对照组的基础上加用中药溻渍联合情绪舒缓疗法与视觉艺术疗法干预。2组均干预治疗6个月。比较2组治疗前后焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分、心理忍受程度评分、心理痛苦程度评分及简明健康状况量表(SF-36)(包括生理与精神健康2个领域的生理功能、生理职能、躯体疼痛、社会功能、活力、情感职能、精神健康及总体健康)评分变化情况,比较2组治疗期间放射性阴道炎发生率、发生时间及严重程度。结果与本组治疗前比较,2组治疗后SAS评分及SDS评分均降低(P<0.05),且治疗组治疗后SAS评分及SDS评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后心理忍受程度评分及心理痛苦程度评分均降低(P<0.05),且治疗组治疗后心理忍受程度评分及心理痛苦程度评分均低于对照组(P<0.05)。与本组治疗前比较,2组治疗后SF-36生理功能、生理职能、躯体疼痛、社会功能、活力、情感职能、精神健康及总体健康评分均升高(P<0.05),且治疗组治疗后SF-36各项评分均高于对照组(P<0.05)。治疗组放射性阴道炎发生率低于对照组(P<0.05),发生时间晚于对照组(P<0.05),严重程度轻于对照组(P<0.05)。结论中药溻渍联合情绪舒缓疗法与视觉艺术疗法在宫颈癌放疗患者中具有重要应用价值,可明显改善患者焦虑抑郁状态,改善心理状况,提高生活质量,减少和推迟放射性阴道炎的发生,减轻病情严重程度。

Individualized vaginal applicator for stage IIb primary vaginal adenocarcinoma:A case report

BACKGROUND Primary vaginal cancer is rare and most vaginal tumors are metastatic,often arising from adjacent gynecologic structures.Primary vaginal cancers are also more common among postmenopausal women and most of these are squamous cell carcinomas,with adenocarcinomas being relatively rare.Vaginal bleeding is the most common clinical manifestation of vaginal adenocarcinoma.About 70%of vaginal adenocarcinomas are stage I lesions at the time of diagnosis,for which radical surgery is recommended.However,more advanced vaginal cancers are not amenable to radical surgical treatment and have poor clinical outcomes.Optimal treatments modes are still being explored.Here,we report a rare case of stage IIb primary vaginal adenocarcinoma for which an individually designed vaginal applicator for after-loading radiotherapy was used to achieve good tumor control.CASE SUMMARY A 62-year-old woman presented to our clinic after 3 months of abnormal postmenopausal vaginal bleeding.Gynecological examination,computed tomography(CT),and positron emission tomography-CT showed a large mass(about 5 cm)on the anterior vaginal wall.Colposcopy biopsy confirmed adenocarcinoma of vaginal origin.After three cycles of carboplatin plus paclitaxel chemotherapy,the lesion partially shrunk.The patient then received external irradiation of 45 gray(gy)in 25 fractions,which further reduced the vaginal lesion,followed by after-loading radiotherapy of 30 gy in 5 fractions with an individually designed vaginal applicator.Three months later,magnetic resonance imaging showed a slight thickening CONCLUSION Primary vaginal adenocarcinoma is rare,and prognosis is poor in most vaginal cancers of locally advanced stages,which cannot be treated with radical surgery.Better tumor control can be achieved with an individualized vaginal applicator that allows administration of a higher radical dose to the tumor area while protecting normal tissues.

Pediatric Nasopharyngeal Rhabdomyosarcoma: About a Case and Review of Literature

Introduction: Rhabdomyosarcoma (RMS) is the most common soft tissue tumor in children, with the head and neck location accounting for up to 40% of cases. The embryonal and alveolar histologic variants are more commonly seen in pediatric patients. The treatment is multimodal and the prognosis of this clinical entity is always gloomy. We report the case of nasopharyngeal rhabdomyosarcoma in a 7-year-old boy child with a good response to early post-therapy. Case Presentation: The patient was diagnosed with nasopharyngeal RMS revealed by a congested nose, ptosis and bilateral blindness, and who received induction chemotherapy followed by concurrent radiotherapy followed by adjuvant chemotherapy. The evolution is marked by a good clinical course but persistence of bilateral blindness. Conclusion: The RMS nasopharyngeal often presents with nonspecific symptoms. Multimodal therapy should be performed including surgery, chemotherapy and radiotherapy.

Overview of embryonal rhabdomyosarcoma of cervix in women over 40-year-old

The literature on cervical embryonal rhabdomyosarcoma(RMS) is reviewed here to identify management guidelines for middle-aged women diagnosed with this rare type of gynecologic cancer. Specifically, the Pub Med, Web of Science and Google Scholar databases, were searched to find published case series on cervical embryonal RMS reporting on four or more patients, of whom at least one was > 40-year-old. The χ2 test was used to assess heterogeneity. Five articles published between 1986 and 2013 were identified, reporting on a total of 47 patients, of whom 22(46.8%) were older and 25(53.2%) younger than 40-year-old. Although the two age groups did not differ significantly by stage of disease or radiotherapy treatment, the older age groupreceived less chemotherapy(55% vs 90%, P = 0.008)and had more hysterectomy(86% vs 43%, P = 0.009).Follow-up data was missing for 18/47(38.3%) patients.Among the 29 patients with follow-up data, survival was shorter in the older group, with 8/12(67%) alive and3 with disease at a median follow-up of 2.6 years, as compared with the younger group that had 15/17(88%)alive and none with disease at a median follow-up of 3.5years. The longest survivals among the older women were observed in those who received radiotherapy,including one case with a resected lung metastasis.A prospective multi-institutional collaboration and better follow-up are needed to determine the optimal management of cervical embryonal RMS. Long-term survival appears feasible if management is accompanied by chemotherapy and radiotherapy.

复方甲硝唑栓联合结合雌激素软膏治疗宫颈癌放疗后阴道炎的效果观察

目的探讨复方甲硝唑栓联合结合雌激素软膏治疗宫颈癌放疗后阴道炎患者的临床效果。方法选择2019年12月至2021年2月我院收治的宫颈癌放疗后阴道炎患者62例,随机分为两组各31例。在常规冲洗基础上,对照组给予复方甲硝唑栓治疗,观察组给予复方甲硝唑栓联合结合雌激素软膏治疗。比较两组的治疗效果、雌二醇(E2)水平及安全性。结果观察组的治疗总有效率为96.77%,显著高于对照组的74.19%(P<0.05)。治疗后,两组的E2水平均较治疗前提高,且观察组的E2水平显著高于对照组(P<0.05)。两组均未发生严重不良反应。结论复方甲硝唑栓联合结合雌激素软膏治疗宫颈癌放疗后阴道炎患者可有效减轻临床症状,改善激素水平,促进恢复,且具有较高的安全性。

原发性阴道癌治疗的研究进展

原发性阴道癌是一种罕见的妇科恶性肿瘤,且是目前唯一一种在美国国立综合癌症网络中没有临床实践指南的女性生殖系统肿瘤。对于原发性阴道癌的治疗,目前尚未提出最佳的治疗方案,个体化的放化疗仍然是该病的主要治疗方法,其改善了疾病的局部控制率和总体生存率。早期原发性阴道癌通常采用手术或放疗,而对于晚期原发性阴道癌,同步放化疗成为了一种有效的替代治疗。与其他恶性肿瘤一样,原发性阴道癌诊断时的临床分期是重要的预后因素,而年龄、病灶大小和组织学类型等也会影响生存结局,其中免疫治疗有望成为改善原发性阴道癌预后的新策略。综述原发性阴道癌的手术方法、放疗、放化疗和免疫治疗及其预后的最新进展。

子宫颈癌患者后装放疗所致阴道放射性损伤风险预测模型构建与验证

目的:完成子宫颈癌患者后装放疗所致阴道放射性损伤风险预测模型的构建并验证其临床价值。方法:回顾性选取南昌大学第二附属医院肿瘤科于2021年4月—2023年6月收治的行后装放疗的子宫颈癌患者360例,按照7∶3的分配比例分为建模组252例和验证组108例。收集建模组患者治疗前临床基线资料,行因素分析筛选独立危险因素。以独立危险因素建立预测模型,通过验证组资料收集配合完成预测模型的验证与价值分析。结果:肿瘤病理分期晚、肿瘤大小大与后装放疗剂量高为影响子宫颈癌患者后装放疗所致阴道放射性损伤的独立危险因素(P<0.05)。预测模型验证结果提示,校准图显示预测模型性能良好;建模组受试者操作特征(ROC)曲线的线下面积(AUC)为0.753;验证组ROC的AUC为0.754。结论:子宫颈癌患者肿瘤病理分期晚、肿瘤大小大与后装放疗剂量高均影响子宫颈癌患者预后质量,以此为基础建立预测模型对患者后装放疗是否发生放射性损伤具有较高预测价值。

延续性护理指导对宫颈癌放疗患者家庭阴道冲洗依从性、阴道粘连情况与生活质量的影响

目的探讨延续性护理指导对宫颈癌放疗患者家庭阴道冲洗依从性、阴道粘连情况与生活质量的影响。方法选取2021年8月至2022年7月在菏泽市妇幼保健院接受放疗治疗的92例宫颈癌患者为研究对象,以随机数字表法分为两组,每组各46例。对照组采取常规护理措施,研究组在对照组的基础上采用延续性护理指导进行家庭阴道冲洗。比较两组患者的家庭阴道冲洗依从性、阴道粘连情况,以及出院时与出院6个月时生命质量测定量表(QLQ-C30)评分。结果研究组家庭阴道冲洗的总依从率高于对照组(P<0.05)。研究组阴道粘连发生率低于对照组(P<0.05)。研究组出院6个月时QLQ-C30评分高于对照组(P<0.05)。结论宫颈癌放疗患者采用延续性护理指导进行家庭阴道冲洗,能够有效提高冲洗的依从性,降低阴道粘连发生率,保障生活质量。

儿童横纹肌肉瘤临床治疗评估

目的分析评价横纹肌肉瘤(RMS)的临床治疗及预后。方法回顾分析2009年12月至2016年12月收治的31例RMS患儿的临床资料。结果 31例患儿中男19例、女12例,发病中位年龄42.2(7.2~109.9)个月;Ⅰ期2例,Ⅱ期6例,Ⅲ期16例,Ⅳ期7例。均采用上海儿童医学中心RS-2009方案化疗,随访至2017年5月1日。2例患儿治疗疗程中失访,1例停药复发后失访,中位随访时间39.3个月。Ⅰ期患儿均完全缓解并长期存活;Ⅱ期复发2例;Ⅲ期复发4例;Ⅳ期复发继而死亡3例,治疗无效进展死亡1例。Ⅰ、Ⅱ、Ⅲ期患儿3年无事件生存率(EFS)(61.8±12.9)%,3年总生存率(OS)100%;Ⅳ期3年EFS和OS均为(42.9±18.7)%。未放疗组3年EFS(37.7±14.2)%,正规放疗组(82.1±11.7)%。结论RS-2009方案对Ⅰ、Ⅱ和Ⅲ期儿童RMS疗效尚可,但对Ⅳ期尚需进一步优化;放疗可以显著提高EFS。

原发性宫颈及阴道恶性黑色素瘤51例的临床分析

背景与目的:原发性宫颈及阴道恶性黑色素瘤是一类罕见的、恶性程度高、预后极差的肿瘤。本研究旨在探讨原发性宫颈及阴道恶性黑色素瘤患者的临床特点、治疗方式及预后。方法:对复旦大学附属肿瘤医院1998年12月—2011年7月收治的51例宫颈及阴道恶性黑色素瘤患者的临床资料进行回顾性分析。结果:2、4年无进展生存率分别为32.8%、13.1%,2、4年总生存率分别为67.2%、39.8%,3例带瘤生存超过5年。随访期内,29例(56.9%)患者发生复发转移,主要部位为阴道残端/盆腔(10例,34.5%)、肝(4例,13.9%)、肺(3例,10.3%)、骨(3例,10.3%)和外阴(3例,10.3%)等。单因素分析显示,肿瘤大小和脉管癌栓是影响患者总体生存的重要因素(P<0.05),盆腔淋巴结转移是影响无进展生存的重要因素(P=0.05)。术后联合放化疗和免疫治疗组中位疾病进展时间为17个月,而单纯化疗组为9个月,单纯免疫治疗组为11个月。结论:原发性宫颈及阴道恶性黑色素瘤预后差。手术、放化疗和免疫综合治疗具有控制疾病进展、延长患者生存的作用。

放疗及二次根治手术对儿童横纹肌肉瘤的疗效影响分析

目的探讨儿童横纹肌肉瘤(RMS)的治疗手段与疗效、预后的关系。方法回顾性分析中山大学孙逸仙纪念医院儿科2013年1月—2017年12月收治的24例儿童RMS的临床资料,总结儿童RMS的治疗策略、疗效,分析放疗及二次根治手术对儿童RMS预后的影响。结果初治儿童RMS共24例,男18例,女6例,发病中位年龄3.6岁(11个月~11岁),其中原发于颌面部14例,颈部1例,腹盆腔2例,肢体4例,生殖系统2例,肝脏1例;病理类型包括胚胎型22例,腺泡型2例;低危组3例,中危组18例,高危组3例。所有患儿均按横纹肌肉瘤全国协作组重庆方案(RMS-CQ-2009)进行化疗,并依据实际病情及疗效反应选择性采取根治手术及放疗。截止2020年6月1日共9例患儿死亡,3年总体生存率(OS)为65.7%。化疗+放疗组的3年OS(80.0%)高于化疗+二次根治术组(50.0%)(χ^(2)=3.896,P=0.048)。对于颌面部RMS,行二次根治术的患儿3年0S(25.0%)低于未行二次根治术的患儿(80.0%)(χ^(2)=6.521,P=0.011);行放疗的患儿3年OS(80.0%)高于未行放疗的患儿(25.0%)(χ^(2)=4.168,P=0.041)。对于非颌面部RMS,行二次根治术和未行二次根治术的患儿3年OS分别是68.6%和66.7%(χ^(2)=0.035,P=0.852),行放疗和未行放疗的患儿3年OS分别为53.3%和80.0%(χ^(2)=0.076,P=0.783)。结论放疗有助于提高儿童RMS生存率,二次根治术并不能显著改善颌面部RMS的预后。

立体定位放射治疗在儿童头颈部横纹肌肉瘤综合治疗中的应用和疗效分析

目的:分析综合治疗中立体定位放疗技术应用于儿童头颈部横纹肌肉瘤的初治或复发病例的临床意义和价值。方法:回顾性分析本院儿科2002年1月至2009年1月应用立体定位放疗技术作为规范化综合治疗措施,用于儿童头颈部横纹肌肉瘤术后辅助治疗或局部复发、进展的补救治疗,对总体生存率和肿瘤局部控制率的影响。全部24例儿童头颈部横纹肌肉瘤患儿中22例曾接受立体定位放射治疗(包括三维适形放疗、调强放疗和X刀、射波刀治疗),放射总剂量28～60Gy,标准治疗剂量50.4Gy,中位随访时间为42个月。结果:22例可分析病例中男12例,女10例,中位年龄6.5岁;临床分期Ⅰ期1例,Ⅱ期6例,Ⅲ期14例,Ⅳ期1例。所有病例治疗后2年总生存率68.18%(15/22),肿瘤局部控制率77.27%(17/22);局部复发、进展病例再次治疗后2年总生存率55.56%(5/9),肿瘤局部控制率66.67%(6/9)。6例患儿死于脑或其他部位的转移,大部分患儿仅出现局部水肿、黏膜溃疡等放射反应,均未影响放疗进程,患儿视力、听力等功能无明显影响,目前未见第二癌的发生。结论:儿童头颈部横纹肌肉瘤应用立体定位放射治疗安全有效,对邻近器官的功能保护优于普通放疗技术。

回肠阴道延长术修复宫颈癌手术结合放疗后阴道残端挛缩的临床应用

目的探讨采用带血管蒂的回肠移植延长阴道的手术方法以及治疗宫颈癌根治性手术结合放疗后阴道残端挛缩的效果。方法选取本院2011~2014年收治的经妇产科转诊并接受根治性手术后再行放疗发生阴道残端挛缩的宫颈癌患者22例。治疗方法为开腹松解阴道残端与直肠和膀胱的粘连,切除挛缩的阴道残端,仅保留阴道外口,用带血管蒂的回肠延长阴道。结果 22例患者无感染、出血等并发症发生,出院后佩戴阴道模具。随访1~2年不等,所有患者均对延长后的阴道长度和宽度满意,对再造阴道的分泌物表示可接受;所有患者均已有性生活,其中5例患者诉术后半年仍有性交时或性交后阴道出血,经阴道镜检查未见特殊异常。结论宫颈癌根治术结合放疗后的阴道残端挛缩并不鲜见,给年轻患者的家庭生活带来很大影响。目前对此种情况尚无便捷有效的修复方法,而回肠阴道延长术不失为一种参考。

改良冲洗器联合苯扎氯铵溶液在宫颈癌患者放疗护理中的应用效果

目的探讨改良冲洗器联合苯扎氯铵溶液在宫颈癌患者放疗护理中的应用效果。方法2015年3月至2016年7月,便利抽样法选取在第四军医大学西京医院放射治疗科治疗的中晚期宫颈癌患者80例为研究对象,按随机数字表法将其分为观察组和对照组,每组40例。观察组患者采用改良冲洗器联合苯扎氯铵溶液,经窥阴器进入阴道进行阴道冲洗。对照组患者采用一次性灌肠袋冲洗,经窥阴器撑开阴道进行阴道冲洗。比较两组患者阴道冲洗效果。结果两组患者在盆腔感染、出血、阴道炎、阴道黏连、阴道损伤等并发症发生率上的差异均有统计学意义(均P<0.05)。结论改良冲洗器在宫颈癌放疗患者阴道冲洗中效果满意,提高了患者的临床治疗效果。

原发性阴道腺癌24例临床分析

背景与目的:原发性阴道腺癌的发病率低,治疗困难,预后差。本文将对其临床特点、治疗和预后进行探讨。方法:对1964-1999年我院收治的24例原发性阴道腺癌进行回顾性分析。结果:24例原发性阴道腺癌患者的临床分期为:Ⅰ期5例,Ⅱ期10例,Ⅲ期5例,Ⅳ期4例;主要临床症状为阴道流血和流水。病变位于阴道前壁8例(33.3%),后壁5例(20.8%),左侧壁1例(4.2%),多壁10例(41.7%)。24例患者均行放射治疗(体外和腔内放疗);2例同时行化疗,8例因放疗后肿瘤未控、复发或转移而行化疗。病人的3年生存率为47.3%,5年生存率为34.2%;Ⅰ+Ⅱ期病人的平均生存时间60.3个月,明显长于Ⅲ+Ⅳ期病人的平均生存时间14.8个月(P<0.01);年龄>40岁与≤40岁病人的平均生存时间无显著性差异(P>0.05)。局部复发8例,占57.8%;肿瘤局部复发是治疗失败的主要原因。结论:原发性阴道腺癌采用放疗为主的综合治疗,但预后较差,分期是影响预后的重要因素。

46例原发性阴道癌临床分析

目的 :探讨原发性阴道癌临床治疗方法及失败原因。方法 :本组 4 6例患者 ,单纯放疗 2 7例 ,手术 8例 ,采用放疗同时辅以PDD为主的全身化疗 11例。结果 :总的 5年生存率为 5 4 3% ,各期 5年生存率分别为Ⅰ期 90 90 %、Ⅱ期6 8 4 2 %、Ⅲ期 2 2 2 2 %、Ⅳ期 0 %。Ⅰ～Ⅱ期早期患者与Ⅲ～Ⅳ期晚期患者 5年生存率分别为 76 6 7%及 12 5 % (P <0 0 5 )。Ⅰ～Ⅱ期早期患者中单纯放疗或加化疗与手术治疗相比 ,5年生存率分别为 86 36 %和 5 0 0 % (P >0 0 5 )。Ⅲ～Ⅳ期晚期患者中单纯放疗及放疗加化疗 5年生存率分别为 0 %及 2 2 2 2 % (P >0 0 5 )。局部未控 8例患者 ,仅 1例为Ⅱ期 ;远处转移 5例全为Ⅲ～Ⅳ期晚期患者。结论 :早期阴道癌患者治疗失败原因为局部控制失败 ,有效控制局部可以获得好的预后 ,手术与放疗或加化疗疗效一样 ;而晚期患者同时控制远处转移是十分必要的 ,单纯放疗对晚期患者疗效不佳 ,联合化疗可以提高生存率。

藻酸盐敷料治疗放射性阴道黏膜损伤的护理

目的观察藻酸盐敷料在治疗放射性阴道黏膜损伤中的临床效果，探索护理方法。方法方便性抽样选择2011年1月至2012年8月放疗后出现放射性阴道黏膜损伤的妇科肿瘤患者35例，采用随机数字表法将患者分为两组，观察组患者17人采用常规方法处理加用藻酸盐敷料填塞阴道治疗；对照组患者18人仅用常规方法处理。观察两组患者阴道黏膜损伤的治疗效果、疼痛情况及对肿瘤放射治疗的影响。结果观察组患者放射性阴道黏膜损伤治疗有效率及创面愈合时间优于对照组；观察组患者以轻度疼痛为主，对照组以中、重度疼痛为主；观察组患者中断放疗3例，中断时间为1～3d，对照组为8例，中断时间为5～14d。肿瘤放射治疗引起的不良反应观察组小于对照组，差异有统计学意义（P〈0．05）。结论与常规治疗相比，使用藻酸盐敷料治疗放射性阴道黏膜损伤总有效率高、创面愈合时间短，可缩短放疗中断时间，提高肿瘤控制率，缓解患者疼痛，提高其生活质量。