子宫颈癌放射治疗致放射性膀胱炎378例临床分析  

Late Bladder Complications following Radiotherapy of Carcinoma of the Uterine Cervix

作　　者：李爱苓[1] 孙建衡[1] 晁红霞[1] 王桂香[1] 

机构地区：[1]中国医学科学院肿瘤医院妇科

出　　处：《中华妇产科杂志》1995年第12期741-743,共3页Chinese Journal of Obstetrics and Gynecology

摘　　要：对１９５８年２月至１９８７年１０月中国医学科学院肿瘤医院宫颈癌放射治疗（放疗）后发生的放射性膀胱炎３７８例进行回顾性分析。结果表明，放射性膀胱炎患者占同期行放疗的宫颈癌患者的３．２％。本病发生与年龄、放疗前ＦＩＧＯ分期、传统腔内治疗及后装腔内放疗无明显关系，但与肿瘤局部情况有失。６６．５％的病例属外生型肿瘤。多数患者（５１．１％）发病于放疗后２～５年，５～１０年间发病者占１６．７％，有３．４％发病于放疗后１年内。本组有３９．４％和３１．６％病例的腔内和体外照射剂量高于常规剂量的１０％。根据临床表现和膀胱镜的特点，特放射性膀胱炎分为３类：突发和暂时性血尿，占３５．７％；顽固性血尿，６３．２％；膀胱阴道瘘，１．１％。保守性治疗可取得一定疗效。放射性膀胱炎患者５年生存率为９０．４％，高于传统腔内放疗的６５．７％和后装治疗的７０．３９％。但仍有３．７％死于本并发症。提示：避免膀胱过量照射及注意自身的保护是减少本病发生的方法。Objective To analyse the causes,clinical features, treatment and prevention of late bladder com-plications following radiotherapy of carcinoma of the uterine cervix.Method This clinical retrospective study included 378 cases of irradiation cystitis following radio-therapy for carcinoma of the uterine cervix from February, 1958 to October,1987.Results The incidence of irradiation cystitis was 3.2%and was not related to age,FIGO stagingand the methods of intracavitary irradiation(conventional or afterloading).It was related to the externalappearance of the local lesion; 66.5%of the tumors of patients with late bladder complications was ofthe exophytic type prior to radiotherapy, 51.1%of the patients developed late bladder complications in aperiOd of 2～5 years after radiotherapy; 1 6.7%in 5～10 years and only 3.4%within the first years.The patients with irradiation cystitis had received a 10%higher dosage than that routine delivered,asfound either in intracavitary irradiation of 39.4%of patients or in external irradiation of 31.6%of pa-tients, Based on the clinical features and cystoscopic findings,late bladder complications can be dividedinto three types:(1)sudden and temporary hematuria(35.7%);(2)persistent hematuria (63.2%);and(3)vesico-vaginal fistula(1.1%).The 5-year survival rate of patients with irradiation cystitis was90.4%which was higher than the survival rates of all patients treated by conventional intracavitary irra-diation(65.7%)and all patients treated by afterloading intracavitary irradiation(70.4%).3.7%of patients died of late bladder complications.Conclusions To decrease the occurrence of late bladder complications and to obtain long termsurvival :(1) Dosage to the bladder should be adequate,and over dose to the bladder should by allmeans be avoided;(2) Patients are to be taught to observe indicated personal care during radiotherapyas well as in the follow-up period;(3) Early institutution of proper conservative treatment of cvstitis isbeneficial.

关 键 词：子宫颈肿瘤 放射疗法 辐射损伤 膀胱炎 

分 类 号：R737.330.5[医药卫生—肿瘤] R694.3[医药卫生—临床医学]