宫颈癌患者放射治疗的护理

宫颈癌是女性常见的恶性肿瘤之一,发病率呈逐年上升趋势。随着新技术的不断出现,放射治疗设备、放射治疗理念均在迅速更新,宫颈癌患者也从中获益;而放射治疗前后的规范化护理,能够最大限度地减轻放射治疗带来的不良影响。本研究回顾性总结了2009～2010年我院收治的60例需行放射治疗的宫颈癌患者的护理经过,以期为广大护理同仁提供有益借鉴。     

局部晚期宫颈癌CT图像引导下192Ir三维腔内后装治疗剂量体积参数与疗效关系

目的 观察CT图像引导下192Ir三维腔内后装治疗的肿瘤靶区及危及器官受照射体积剂量参数与肿瘤局部控制率及晚期副反应之间关系.方法 10例局部晚期宫颈癌患者在完成盆腔外照射40 Gy及同期化疗后开始每周1次的CT图像引导下192Ir三维腔内后装治疗,每次治疗前进行CT扫描定位,勾画肿瘤靶区(GTV、CTV)和危及器官,利用PLATO治疗计划系统进行逆向治疗计划设计及优化,CTV单次处方剂量为6 Gy,治疗5～7次.结果 1年盆腔控制率为90%,1～2级放射性肠炎发生率为50%,无≥3级副反应.90%CTV等效生物剂量(BED)和相当于2 Gy分次的等效剂量(EQD2)分别为(95.50±7.81)Gy和(79.73±6.57)Gy(α/β=10).90%GTV的BED和EQD2分别为(101.86±7.27)Gy和(84.95±6.1)Gy(α/β=10).90%处方剂量对GTV、CTV的覆盖率分别为92%±4%、87%±7%.直肠、乙状结肠2 cm3体积受到的最小照射剂量分别为(74.97±1.64)、(67.93±4.30)Gy(EQD2,α/β=3).与二维治疗计划相比,三维治疗计划在没有改变A点剂量、直肠参考点剂量情况下提高了GTV、CTV的90%体积受照射剂量及90%处方剂量对GTV、CTV的覆盖率.结论 CT图像引导下192Ir三维腔内后装治疗提高了处方剂量对肿瘤靶区的覆盖率,1年盆腔控制率为90%且无严重副反应,远期疗效观察中.

Abstract：

Objective To investigate the correlation between dose volume histogram(DVH)of tumor targets and organs at risk(OAR)at CT-image based 192Ir brachytherapy and effects and complications for patients with locally advanced cervical cancer. Methods Ten patients with FIGO stage ⅢB cervical cancer received CT image-based 192Ir intracavitary brachytherapy after 54 Gy of three-dimentional four-field pelvic external beam radiotherapy and concurrent weekly cisplatin chemotherapy. Before each brachytherapy,CT images were acquired with applicators in place. Gross tumor volume(GTV), clinical target volume (CTV)and OAR were contoured and inverse treatment planning was designed and optimized by using PLATO treatment planning system. Conventional two-dimensional plans were also designed for comparison.The total intracavitary brachytherapy dose was 30 -42 Gy in 5 -7 fractions. The patients were followed, and the local control and complications were analyzed. The biologically equivalent dose(BED)and biologically equivalent dose in 2 Gy fractions(BED2)for GTV, CTV and OAR were calculated. The minimum dose in the most irradiated tissue volume 2 cm3(D2 cm3)adjacent to the applicator of the sigmoid colon, rectum,bladder and small bowel was determined from the DVH. Results The 1-year local pelvic control rate was 90% and grade 1-2 late complication of sigmoid colon and rectum was 50%. No grade 3 or more complications developed. On CT-image based planning, the BED and BED2 to 90% of the CTV(D90)were 95.50 Gy ± 7. 81 Gy and 79. 73 Gy ± 6. 57 Gy. The BED and BED2 to 90% of the GTV(D90)were 101.86 Gy ± 7.27 Gy and 84. 95 Gy ± 6. 1 Gy. The volume enclosed by 90% of prescribed dose(V90)for GTV and CTV were 92% ±4% and 87% ±7% respectively. The D2cm3 for rectum and sigmoid colon were 74. 97 Gy ±1.64 Gy and 67. 93 Gy ± 4. 30 Gy(EQD2, α/β = 3). Comparing with 2D brachytherapy plans , CT - image based planning has improved D90 and V90 for GTV and CTV with similar dose at point A and rectum reference point. Conclusions Computer tomography-image based 192Ir brachytherapy has resulted in the better dose distribution to the tumor targets with excellent tumor control and acceptable toxicity.     

临终患者的症状护理

临终关怀是指对那些已失去治愈希望的患者，在生命即将结束时所实施的一种积极的综合护理。目的是尽最大努力减轻患者痛苦，缓解症状。其宗旨是：始终贯穿热爱生命、尊重科学、顺应人情、精心护理，尽量满足和体现人在生命的最后阶段渴望得到理解和尊重的需要，从而真正维护人的尊严。而对临终患者出现的各种症状，有效地进行护理，可提高患者临终前的生命质量。     

全脑全脊髓放疗不同照射方式的疗效

目的：回顾性分析不同照射方式下全脑全脊髓放疗对生殖细胞瘤及髓母细胞瘤的疗效,并探讨最佳放疗方法。方法：1999年8月至2010年2月本院收治的42例中枢神经系统肿瘤患者行术后全脑全脊髓放疗,放疗方式分为标准全脑全脊髓照射（连续照射）和分段照射（先全脑后全脊髓）两种类型,观察不同照射方式的近期疗效、不良反应、血液学毒性、远期疗效以及复发情况。结果：42例患者经全中枢照射治疗达完全缓解（complete response,CR）者32例。不同照射方式有一定差异,分段照射延长了疗程且不良反应较多,随访显示复发率高于连续照射组,分段照射并未使患者得到明显的生存获益。结论：术后全脑全脊髓放疗对生殖细胞瘤及髓母细胞瘤疗效较好,与以往文献资料相比,可明显提高治愈率及生存期。从最佳照射方式角度出发,分段照射延长疗程,且复发率高,仍以连续照射为佳。     

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P0.05)。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。