一体化超分割后装治疗中晚期宫颈鳞癌的疗效和并发症观察

目的 观察一体化超分割后装治疗中晚期宫颈鳞癌的疗效及并发症的发生情况,并将其和常规后装治疗进行比较。方法 观察组为2004年1月至2005年1月接受一体化超分割后装治疗的患者,共328例,每周治疗2次,每次A点剂量2.5~3.0 Gy,每周累积剂量5.0~6.0 Gy。A点平均总剂量Ⅱ_b期49.8Gy,Ⅲ_b期52.6Gy。对照组选择2002年1月至2003年12月接受常规后装治疗的患者,共331例,每次A点剂量5.0~7.0 Gy,每周治疗1次。A点平均总剂量Ⅱ_b期50.1 Gy,Ⅲ_b期53.5 Gy。体外照射开始时同时行腔内后装治疗,两组的体外照射方式相同,均采用直线加速器产生的15MV X线行盆腔体外照射。结果 观察组Ⅱ_b期近期控制率97.2%(104/107),Ⅲ_b期近期控制率94.1%(208/221)。3年总生存率80.5%(264/328),5年总生存率为68.6%(225/328)。放射性膀胱炎的发生率为5.2%(17/328),放射性直肠炎的发生率为14.6%(48/328)。对照组Ⅱ_b期近期控制率95.4%(103/108),Ⅲ_b期近期控制率92.8%(207/223)。3年总生存率75.2%(249/331),5年总生存率为62.5%(207/331)。放射性膀胱炎的发生率为13.3%(44/331),放射性直肠炎的发生率为32.3%(107/331)。结论 一体化超分割后装加盆腔体外照射治疗中晚期宫颈鳞癌,在近期控制率和远期生存率方面与常规后装加盆腔体外照射相当,但是明显降低了并发症的发生率。     

一体化超分割后装治疗中晚期宫颈鳞癌的疗效和并发症观察

Objective To observe and cpmpare the efficacy and complications of hyperfractional integrated intraeavitary brachtherapy in middle-advanced squamous-cell carcinoma with the traditionsl brachytherapy.Methods In the observed group,328 patients with cervical cancer received hypeffractional integrated intracavitary after loading therapy between Jan 2004 and Jan 2005 were selected.The dose of point A was 2.5 Gy-3.0 Gy/fraction,2 fractions per week,and the total dose of reference point A was 49.8 Gy in stage Ⅱ b,52.6 Gy in stage in Ⅲb.In the control group,331 cases treated with traditional aflerloading brachytherapy between Jan 2002 and Dec 2003 were selected.The dose of point A was 5.0～7.0 Gy/fraction,1 fraction per week,and the total dose of point A was 50.1 Gy in stage Ⅱb,53.5 Gy in stage Ⅲb.In vitro irradiation began at the same time with the intracavitary brachytherapy.The whole pelvic was irradiated with 15 MV X-rays.Results In the observed group,the recent control rate of stage Ⅱb was 97.2%(104/107),94.1%(208/221)for stage Ⅲb.The 3-year survival rate was 80.5%(264/328).and the 5-year survival rate was 68.6%(225/328).The complication rate was 5.2%(17/328)for cystitis, 14.6%(48/328) for proctitis.Out of 331 cases in control group,the recent control rate of stage Ⅱb was 95.4%(103/108),92.8%(207/223)for stage Ⅲb.The 3-year survival rate was 75.2%(249/331),the 5-vear survival rate was 62.5%(207/331).The complication rate was 13.3%(44/331)for cystitis,and 32.3%(107/331)for proctitis.Conclusions Compared with combination of traditional brachytherapy and external radiotherapy,combination of hyperfraetional integrated brachtherapy therapy and external radiotherapy has no significant improvement for recent control rate and long-term survival rate,but could reduce the complication rates of cystitis and proctitis.     

单孔悬吊腹腔镜手术在妇科良性疾病中的临床应用

目的:探讨单孔悬吊腹腔镜手术治疗妇科良性疾病的安全性、可行性、有效性及优越性。方法:回顾分析2015年1月至2017年10月为72例妇科良性疾病患者行单孔悬吊腹腔镜手术的临床资料,包括卵巢囊肿(n=39)、子宫腺肌病(n=16)、子宫内膜病变(n=17)。观察3组患者体重指数、手术时间、手术出血量、术后住院时间、手术并发症。结果:71例成功完成手术。1例子宫腺肌病因合并严重子宫内膜异位症中转开腹。手术时间平均(48.8±14.3)min,其中卵巢囊肿(45.4±16.2)min,子宫腺肌病(51.3±11.5)min,子宫内膜病变(54.6±12.4)min;手术出血量平均(10.3±3.1)mL;术后平均住院(2.7±0.9)d,其中卵巢囊肿(2.2±0.6)d,子宫腺肌病(3.4±1.5)d,子宫内膜病变(3.2±1.1)d。中位随访时间10.8个月,3例出现慢性腹痛,经保守治疗后好转,无其他严重并发症发生。结论:单孔悬吊腹腔镜手术治疗妇科良性疾病是安全、可行、有效的。与常规腹腔镜手术相比,切口瘢痕隐蔽,避免了CO_2气腹对机体的不良影响。