Temozolomide Combined with Irradiation as Postoperative Treatment of Primary Glioblastoma Multiforme Phase I/II Study

Background and Purpose:   

The role of radiochemotherapy in the treatment of primary glioblastoma multiforme is still discussed controversially. To evaluate the feasibility and toxicity of irradiation and concomitant administration of 50 mg/m² temozolomide in patients with primary malignant glioma, this phase I/II study was conducted.     

Postoperative Radiotherapy of Glioblastoma Multiforme

BACKGROUND AND PURPOSE: Different factors influence glioblastoma patients' prognosis. The aim of this retrospective, explorative analysis was to define the role of recent treatment strategies and to examine the value of different prognostic factors. PATIENTS AND METHODS: A total of 110 patients was analyzed. Complete resection, partial resection, and biopsy was accomplished in 69, 22, and 19 patients, respectively. 56 patients received conventionally fractionated radiotherapy with a median total dose of 60 Gy, 2 Gy daily. 54 patients received hyperfractionated accelerated radiotherapy with a median total dose of 54 Gy, 2 x 1.8 Gy daily. 20 patients had concomitant temozolomide (50-75 mg/m2/d), and 20 patients concomitant topotecan (0.5 mg/m2 as continuous venous infusion over 21 days). 37 patients received temozolomide as salvage therapy. RESULTS: Median overall (OS) and disease-free survival (DFS) were 8.7 and 4.8 months. After complete resection, partial resection, and biopsy, OS was 9.5, 8.5, and 5.5 months, respectively. OS was 8.5, 13.8, and 8.2 months for radiotherapy alone, concomitant temozolomide, and concomitant topotecan, respectively. Hazard ratio was 0.29 (OS; p = 0.002) and 0.32 (DFS; p = 0.003) for concomitant temozolomide compared to radiotherapy alone. Topotecan led to an increased toxicity. With 9.7 months for conventionally fractionated radiotherapy and 8.1 months for hyperfractionated radiotherapy, OS differed significantly (p = 0.003, log-rank test). OS in patients with RPA (recursive partitioning analysis) score III, IV, V, and VI was 14.1, 10, 9.5, and 5.8 months (p = 0.003, log-rank test). In the univariate (p = 0.0001, log-rank test) and multivariate analysis (p = 0.002, Cox regression), salvage temozolomide led to a statistically significant survival benefit (10.6 vs. 7.7 months). CONCLUSION: Concomitant topotecan or the use of hyperfractionated radiotherapy did not show to be superior in outcome in this retrospective analysis. Topotecan led to an increased toxicity. An attempt at complete resection is justified. Temozolomide should be integrated in therapy initially. As salvage therapy, temozolomide is also effective.     

多形性胶质母细胞瘤的影像与病理分析

目的:通过分析多形性胶质母细胞瘤的影像与病理间对应关系,探讨其影像表现的病理基础。方法:经手术病理证实的多形性胶质母细胞瘤21例,其中20例行CT扫描,18例行MRI检查,分析其影像表现与病理间关系。结果:多形性胶质母细胞瘤CT表现为混杂密度影,瘤内常伴有囊变、坏死及出血,瘤周水肿及占位效应明显;MRI表现为长T1长T2或混杂信号团块,增强扫描呈厚薄不一的不规则环状、花瓣状强化,部分可见壁结节。结论:多形性胶质母细胞瘤的影像学表现与瘤体内的病理改变密切相关,认真分析其影像特征有助于术前明确诊断及评价预后。     

Prognostic Factors in Glioblastoma Multiforme 10 Years Experience of a Single Institution

BACKGROUND: To analyze prognostic factors in patients with a glioblastoma multiforme treated in an academic institute over the last 10 years. PATIENTS AND METHOD: From 1988 to 1998, 198 patients with pathologically confirmed glioblastoma multiforme were analyzed. Five radiation schedules were used mainly based on pretreatment selection criteria: 1. 60 Gy in 30 fractions followed by an interstitial iridium-192 (Ir-192) boost for selected patients with a good performance and a small circumscribed tumor, 2. 66 Gy in 33 fractions for good performance patients, 3. 40 Gy in eight fractions or 4. 28 Gy in four fractions for poor prognostic patients and 5. no irradiation. RESULTS: Median survival was 16 months, 7 months, 5.6 months, 6.6 months and 1.8 months for the groups treated with Ir-192, 66 Gy, 40 Gy, 28 Gy and the group without treatment, respectively. No significant improvement in survival was encountered over the last 10 years. At multivariate analysis patients treated with a hypofractionated scheme showed a similar survival probability and duration of palliative effect compared to the conventionally fractionated group. The poor prognostic groups receiving radiotherapy had a highly significant better survival compared to the no-treatment group. Patients treated with an Ir-192 boost had a better median survival compared to a historical group matched on selection criteria but without boost treatment (16 vs 9.7 months, n.s.). However, survival at 2 years was similar. Analysis on pretreatment characteristics at multivariate analysis revealed age, neurological performance, addition of radiotherapy, total resection, tumor size post surgery and deterioration before start of radiotherapy (borderline) as significant prognostic factors for survival. CONCLUSION: Despite technical developments in surgery and radiotherapy over the last 10 years, survival of patients with a glioblastoma multiforme has not improved in our institution. The analysis of prognostic factors corresponded well with data from the literature. A short hypofractionated scheme seems to be a more appropriate treatment for patients with intermediate or poor prognosis as compared to a conventional scheme. The benefit in median survival for patients treated with an interstitial boost is partly explained by patient selection. Since there were no long-term survivors with this boost treatment, its clinical value, if there is one, is still limited.     

Efficacy and Toxicity of Postoperative Temozolomide Radiochemotherapy in Malignant Glioma

Purpose: To evaluate the feasibility, safety and efficacy of daily temozolomide concurrent with postoperative radiotherapy in malignant glioma. Patients and Methods: From 11/1999 to 03/2003, n = 81 patients aged 15–72 years (median 52 years, Karnofsky score 80–100% in 83%) suffering from primary glioblastoma (n = 47), anaplastic astrocytoma (n = 6), anaplastic oligodendroglioma (n = 16), and recurrent glioma (n = 12) were treated. Patients with primary gliomas received a combination of postoperative radiotherapy (60 Gy/1.8- to 2.0-Gy fractions) and daily oral temozolomide (75 mg/m²) at all irradiation days (30–33 doses), while recurrent tumors were treated with 45–60 Gy and temozolomide. Initially, 6/81 patients had daily temozolomide doses of 50 mg/m². Results: In total, 70/81 patients (86%) completed both radio- and chemotherapy. Grade 1 nausea/vomiting was seen in 28%, grade 2 in 11%, grade 3 in 1%. Antiemetics were applied in 41%. Hematologic toxicities were observed as follows: leukopenia grade 3/4 1%, lymphopenia grade 3/4 46%, thrombopenia grade 3/4 1%. Two patients under dexamethasone suffered herpes encephalitis after one and 16 doses of temozolomide (75 mg/m²). Median survival was 15 months for glioblastoma. In oligodendroglioma patients, a 4-year survival rate of 78% was observed. Conclusion: Postoperative radiochemotherapy with 30–33 daily doses of temozolomide (75 mg/m²) is safe in patients with malignant glioma. The combined schedule is effective in oligodendroglioma patients and may prolong survival in glioblastoma. Effort should be taken to minimize corticosteroid doses, since both steroids and temozolomide lead to immunosuppression.     

Efficacy and Toxicity of Postoperative Temozolomide Radiochemotherapy in Malignant Glioma

Purpose:   

To evaluate the feasibility, safety and efficacy of daily temozolomide concurrent with postoperative radiotherapy in malignant glioma.     

MR Imaging–Based Analysis of Glioblastoma Multiforme: Estimation of IDH1 Mutation Status

BACKGROUND AND PURPOSE:Glioblastoma multiforme is highly aggressive and the most common type of primary malignant brain tumor in adults. Imaging biomarkers may provide prognostic information for patients with this condition. Patients with glioma with isocitrate dehydrogenase 1 (IDH1) mutations have a better clinical outcome than those without such mutations. Our purpose was to investigate whether the IDH1 mutation status in glioblastoma multiforme can be predicted by using MR imaging.MATERIALS AND METHODS:We retrospectively studied 55 patients with glioblastoma multiforme with wild type IDH1 and 11 patients with mutant IDH1. Absolute tumor blood flow and relative tumor blood flow within the enhancing portion of each tumor were measured by using arterial spin-labeling data. In addition, the maximum necrosis area, the percentage of cross-sectional necrosis area inside the enhancing lesions, and the minimum and mean apparent diffusion coefficients were obtained from contrast-enhanced T1-weighted images and diffusion-weighted imaging data. Each of the 6 parameters was compared between patients with wild type IDH1 and mutant IDH1 by using the Mann-Whitney U test. The performance in discriminating between the 2 entities was evaluated by using receiver operating characteristic analysis.RESULTS:Absolute tumor blood flow, relative tumor blood flow, necrosis area, and percentage of cross-sectional necrosis area inside the enhancing lesion were significantly higher in patients with wild type IDH1 than in those with mutant IDH1 (P < .05 each). In contrast, no significant difference was found in the ADC_minimum and ADC_mean. The area under the curve for absolute tumor blood flow, relative tumor blood flow, percentage of cross-sectional necrosis area inside the enhancing lesion, and necrosis area were 0.850, 0.873, 0.739, and 0.772, respectively.CONCLUSIONS:Tumor blood flow and necrosis area calculated from MR imaging are useful for predicting the IDH1 mutation status.

Glioblastoma multiforme (GBM) is highly aggressive and the most common type of primary malignant brain tumor in adults. The characteristic histologic appearance of GBM includes hypercellularity, nuclear polymorphism, high mitotic activity, prominent microvascular proliferation, and/or necrosis. MR imaging is the main noninvasive technique for diagnosing GBM. Conventional MR imaging techniques including pre- and postcontrast T1WI show precise anatomic localization and/or centrally nonenhancing regions, which are typically related histologically to necrotic areas. Diehn et al¹ provided evidence that the amount of necrosis correlated with outcome in patients with GBM. In addition, correlations were recently identified between the prognosis of patients with GBM and several functional imaging parameters, including ADC derived from DWI, tumor blood volume calculated from DSC, and tumor blood flow (TBF) calculated from arterial spin-labeling (ASL) perfusion MR imaging.^2–7 ASL is a recently developed MR perfusion imaging technique that has advantages of being noninvasive, not requiring an extrinsic tracer, and allowing reliable absolute quantification, which is not affected by a disrupted blood-brain barrier.⁸ ASL is increasingly recognized as a noninvasive method for quantitative CBF measurement for assessing stroke, neurodegenerative diseases, and brain tumors.^8–14 ADC measurement is a widely used method. Good correlations have been reported between ADC and tumor cellularity, and its utility for application in glioma grading has been addressed in many studies.^15–19GBMs are classified into primary and secondary GBMs. Primary GBMs develop rapidly de novo, without clinical or histologic evidence of a less malignant precursor lesion.²⁰ In contrast, secondary GBMs develop by progressing from a low-grade diffuse astrocytoma or anaplastic astrocytoma.²⁰ These GBM subtypes are usually indistinguishable histologically. However, genetic evidence suggests that mutations in isocitrate dehydrogenase (IDH1) can be used to identify most secondary GBMs. The IDH1 mutation status is an independent prognostic factor in patients with gliomas.^21–23 In previous reports, patients with gliomas with IDH1 mutations had a better clinical outcome (median overall survival = 2.0–3.8 years) than those without such mutations (median overall survival = 0.8–1.1 years).^24,25 In addition, a specific compound impairs the growth of mutant IDH1 but not wild type IDH1 glioma cells.²⁶ These approaches may offer new possibilities for targeted therapy. The status of O⁶-methylguanine-DNA methyltransferase (MGMT) promotor methylation is also an important factor for the prognosis of patients with GBM. Patients with GBM with MGMT promotor methylation are more responsive to temozolomide therapy and have better clinical outcome than those without it.^27–29 Therefore, the detection of IDH1 mutations and MGMT promotor methylation is of great importance for patients with GBM. Carrillo et al²⁹ suggested that patients with mutant IDH1 have low vascular endothelial growth factor levels, which are associated with contrast enhancement. These findings led to the hypothesis that measurement of tumor vascularity and the necrosis area would be helpful to differentiate IDH1 mutation status.Our purpose was to investigate whether the IDH1 mutation and MGMT methylation status in GBM can be predicted by using MR imaging.     

Postoperative Irradiation of Incompletely Excised Gemistocytic Astrocytomas

BACKGROUND AND PURPOSE: Although gemistocytic astrocytomas are considered slow-growing tumors, they often behave aggressively and carry the least favorable prognosis among low-grade astrocytomas. The aim of this study is to evaluate the outcomes and prognostic factors of patients with incompletely excised gemistocytic astrocytomas irradiated postoperatively. PATIENTS AND METHODS: Records of 48 patients with incompletely excised gemistocytic astrocytoma, irradiated between 1976 and 1998 at the Department of Radiation Oncology, Maria Sk?odowska-Curie Memorial Cancer Center, Cracow, Poland, were reviewed. The total dose ranged from 50 to 60 Gy (mean: 59.35, median: 60 Gy) delivered in daily fractions of 2 Gy, 5 days a week. The treatment volume covered the residual tumor with a margin of 1-2 cm. RESULTS: Toxicity was acceptable. The overall actuarial survival rates at 5 and 10 years were 30% and 17%, respectively. Age and gender had an influence on overall survival by univariate and multivariate analysis (p < 0.05). Patients < or = 35 years of age and female patients carried the best prognosis. CONCLUSION: In most patients with gemistocytic astrocytoma, combined surgery and postoperative radiotherapy result in only short-term survival. Older age is the most important unfavorable prognostic factor in patients with gemistocytic astrocytoma.     

脑恶性胶质瘤术后同步放化疗的潜在价值附5例长期生存报告

目的探讨脑恶性胶质瘤长期生存患者的主要治疗方法和安全性。方法比较分析5例经病理组织学证实的脑恶性胶质瘤长期生存患者的临床资料。结果尤以术后同步放化疗（卡莫司汀或紫杉醇）为主的治疗方法，患者的生存时间长，可达7年以上，且毒副反应轻微。结论术后同步放化疗对脑恶性胶质瘤患者具有潜在的治疗价值，并很少增加毒性反应。     

Perthes病17例治疗分析

目的回顾性分析Perthes病治疗的经验,结合系统文献复习,以确定治疗的指征和方法。方法17例(平均6.4岁)Perthes病中,CatterallⅠ型3例,Ⅱ型4例,Ⅲ型7例,Ⅳ型3例。分别采取支具或石膏固定(4例),滑膜切除髓腔减压或植骨(3例),Salter或Chairi截骨治疗(10例)。采用临床和X线片动态随访,按Stulberg标准进行疗效评价。结果术后平均随访24(6~52)个月。4例采用石膏或支具外固定的CatterallⅠ和Ⅱ型病例均取得全优效果;采用滑膜切除髓腔减压或植骨的CatterallⅠ和Ⅱ型病例,2优,1中;采用Salter或Chairi截骨治疗CatterallⅢ和Ⅳ型的10个病例,5优,3良,2中。结论严格应用Perthes病临床分型,选择合适的治疗方法是提高此疾患治愈效果的重要手段。     

Semiautomated Volumetric Measurement on Postcontrast MR Imaging for Analysis of Recurrent and Residual Disease in Glioblastoma Multiforme

BACKGROUND AND PURPOSE:A limitation in postoperative monitoring of patients with glioblastoma is the lack of objective measures to quantify residual and recurrent disease. Automated computer-assisted volumetric analysis of contrast-enhancing tissue represents a potential tool to aid the radiologist in following these patients. In this study, we hypothesize that computer-assisted volumetry will show increased precision and speed over conventional 1D and 2D techniques in assessing residual and/or recurrent tumor.MATERIALS AND METHODS:This retrospective study included patients with native glioblastomas with MR imaging performed at 24–48 hours following resection and 2–4 months postoperatively. 1D and 2D measurements were performed by 2 neuroradiologists with Certificates of Added Qualification. Volumetry was performed by using manual segmentation and computer-assisted volumetry, which combines region-based active contours and a level set approach. Tumor response was assessed by using established 1D, 2D, and volumetric standards. Manual and computer-assisted volumetry segmentation times were compared. Interobserver correlation was determined among 1D, 2D, and volumetric techniques.RESULTS:Twenty-nine patients were analyzed. Discrepancy in disease status between 1D and 2D compared with computer-assisted volumetry was 10.3% (3/29) and 17.2% (5/29), respectively. The mean time for segmentation between manual and computer-assisted volumetry techniques was 9.7 minutes and <1 minute, respectively (P < .01). Interobserver correlation was highest for volumetric measurements (0.995; 95% CI, 0.990–0.997) compared with 1D (0.826; 95% CI, 0.695–0.904) and 2D (0.905; 95% CI, 0.828–0.948) measurements.CONCLUSIONS:Computer-assisted volumetry provides a reproducible and faster volumetric assessment of enhancing tumor burden, which has implications for monitoring disease progression and quantification of tumor burden in treatment trials.

Glioblastoma multiforme (GBM) is an invasive and highly aggressive tumor with a median patient survival of 14.6 months with combined radiation therapy and temozolomide.¹ New therapies are being developed to treat GBM, which may decrease morbidity and lengthen the period of progression-free survival. However, to fully use new therapies in the treatment of GBM, quantitative MR imaging metrics are needed to guide therapy, risk stratify patients undergoing therapy, and prognosticate outcome.^2,3 A major limitation is this lack of prognostic imaging parameters.⁴ Simple radiographic monitoring with freehand measurements of the amount of contrast-enhancing tumor in 2 or 3 planes is commonly used for assessing response to different therapies, which is used to guide treatment strategies.^5,6 Commonly used techniques include the Response Evaluation Criteria in Solid Tumors and the MacDonald criteria, which use unidimensional and bidimensional measurements, respectively.^7–9 However, the postsurgical cavity tends to be highly irregular in shape, which may increase the difficulty in obtaining accurate and reproducible measurements. In particular, single-dimensional techniques may be inaccurate, given the propensity of high-grade gliomas to grow in an eccentric and nodular fashion, and may not be reflective of change in actual tumor burden.¹⁰Recently, the Response Assessment in Neuro-Oncology (RANO) Working Group proposed new recommendations for assessing response criteria for high-grade gliomas, which included a modification to the MacDonald criteria.¹¹ While the RANO criterion used 2D measurements, the Working Group suggested that volumetric analysis could provide more accurate measurements with respect to bidimensional techniques.¹¹ Outside the central nervous system, volumetric assessment has been proved superior to unidimensional measurements when used to assess treatment response in hepatic, pulmonary, and pancreatic malignancies.^12,13Despite the potential advantages of volumetric assessment, this technique requires manual outlining of the contrast-enhancing border, which can be both time-consuming and technically challenging.^5,10 This technique may be further limited in cases with irregular enhancement and subependymal extension.¹⁰ For these reasons, computer-aided volumetry techniques applied to the contrast-enhancing tissue represent a potential tool to aid the radiologist in following these patients. Such techniques may increase both the accuracy and reproducibility in assessing GBM recurrence. Thus far, such automation has been explored in the assessment of advanced lung cancer with promising results.¹⁴ Application of computer-assisted volumetry (CAV) has been explored for the evaluation of gliomas; however, these studies have dealt with native nontreated disease and have not been validated against other measurement techniques.^15–17In this study, we describe a novel CAV technique for assessment of tumor burden in the patient with GBM. Specifically, we describe the reliability and feasibility of this technique compared with traditional linear-based measurements in the patient with postresection GBM.     

激光血管内照射结合电针治疗血管性痴呆的临床疗效分析

探讨激光血管内照射结合电针治疗血管性痴呆（ｖａｓｃｕｌａｒ ｄｅｍｅｎｔｉａ,ＶＤ）的作用。方法 将６６例ＶＤ患者按区组随机法分为激光结合电针组和药物组（氢化麦角碱,ＤＨＥＴ）,每组各３３例。检测治疗前后长各川痴呆修改量表、社会活动功能调查、日常生活能力、神经功能缺损、脑电图、超氧化物歧化酶、脂质过氧化物、一氧化氮及观察主要症状等的变化情况,共４２天。结果 激光结合电针组上述指标的改善较药物组显著（Ｐ〈０．０５～Ｐ〈０．００１）,其有效率为６９．７％,而药物组２１．２％。结论 该法可促进ＶＤ患者智能、社会活动功能及日常生活自理能力的康复,提高生活质量,其近期疗效优于ＤＨＥＴ。     

原发性肝癌的复合性栓塞治疗

目的：通过对原发性肝癌（PHC）三种介入治疗方法的疗效比较，评估其应用价值。材料和方法：根据不同的治疗方法，分为3组。A组：30例，为单纯动脉内抗癌药灌注（TAI）；B组：15例，为单纯用碘化油动脉栓塞（TA）；C组：45例，碘化油与抗癌药再加明胶海绵复合性动脉栓塞（TACE）。对三组的肿瘤直径缩小率、甲胎蛋白的变化、累计生存率及生存期进行观察对比。结果：TACE组甲胎蛋白降至正常者高于TAI或TAE组（p＜0．01）。TACE组肿瘤缩小率高于TAI或TAE组（p＜0．01）。TACE组累计生存率显著高于TAI或TAE组（p＜0．01）。TACE组平均生存期也高于TAI或TAE组（p＜0．05）。结论：含抗癌药碘油加明胶海绵复合性栓塞治疗原发性肝癌是目前一种比较好的方法。     

Prediction of Response to Concurrent Chemoradiotherapy with Temozolomide in Glioblastoma: Application of Immediate Post-Operative Dynamic Susceptibility Contrast and Diffusion-Weighted MR Imaging

ObjectiveTo determine whether histogram values of the normalized apparent diffusion coefficient (nADC) and normalized cerebral blood volume (nCBV) maps obtained in contrast-enhancing lesions detected on immediate post-operative MR imaging can be used to predict the patient response to concurrent chemoradiotherapy (CCRT) with temozolomide (TMZ).ResultsThe 99th percentile of the cumulative nCBV histogram (nCBV C99) on immediate post-operative MR imaging was a significant predictor of one-year progression (p = 0.033). ROC analysis showed that the best cutoff value for predicting progression after CCRT was 5.537 (sensitivity and specificity were 72.7% and 76.9%, respectively). The patients with an nCBV C99 of < 5.537 had a significantly longer PFS than those with an nCBV C99 of ≥ 5.537 (p = 0.026).ConclusionThe nCBV C99 from the cumulative histogram analysis of the nCBV from immediate post-operative MR imaging may be feasible for predicting glioblastoma response to CCRT with TMZ.     

Enhanced Renal Toxicity of Total Body Irradiation Combined with Radioimmunotherapy

PURPOSE: Total body irradiation (TBI) with and without additional radioimmunotherapy (RIT) was examined for renal toxicity after stem cell transplantation. PATIENTS AND METHODS: Serum creatinine levels of 35 patients (15 female, 20 male, median age 40.5 years, range 17-60 years) after TBI alone and of 23 patients (eight female, 15 male, median age 47, range 16-58 years) after TBI with additional RIT were determined between 10/1997 and 11/1999. TBI was performed by external-beam radiotherapy in six fractions over 3 days with renal doses of 12 Gy in the TBI-alone group and 6 Gy in the group with additional RIT. The mean kidney dose due to the (188)Re-radiolabeled antibody was estimated to be 8.3 Gy (2.3-11.6 Gy). RESULTS: Within 12 months after treatment, creatinine levels increased from 77 mmol/l (SD +/- 11) to 89 mmol/l (SD +/- 20) for TBI alone and from 78 mmol/l (SD +/- 13) to 144 mmol/l (SD +/- 52) for combined TBI and RIT. CONCLUSION: Despite a 50% reduction of the external-beam contribution to the kidney dose, the application of approximately 10 GBq (188)Re-labeled anti-CD66 monoclonal antibody with a calculated renal dose of 8.3 Gy (range 2.3-11.5 Gy) led to renal toxicity, as reported previously. In the absence of a positive dose-response relationship for the (188)Re-labeled antibody, the observation may be explained by an underestimation of the biologically effective dose and the inaccuracy of the dose determination at the glomerular level.     

湿润烧伤膏联合盐酸丁卡因胶浆在肛瘘术后创面中的应用效果分析

【摘要】 目的 探讨湿润烧伤膏联合盐酸丁卡因胶浆在肛瘘术后创面中的应用效果。方法 选取 2019 年 9月至 2021 年 9 月寿光市中医医院收治的126例低位单纯性肛瘘患者作为研究对象,按照不同治疗方法将其分为联合组 (63例)与对照组 (63例),联合组患者肛瘘术后创面采用湿润烧伤膏联合盐酸丁卡因胶浆治疗,对照组患者肛瘘术后创面单纯采用盐酸丁卡因胶浆治疗,对比观察两组患者术后创面愈合率及疼痛程度。结果 术后第 7、14、21天,联合组患者创面愈合率均明显高于对照组 ( t = 2.358、5.116、8.790, P = 0.019、P < 0.001、P < 0.001);术后第3、5、7 天,联合组患者创面视觉模拟评分法 (VAS)评分均明显低于对照组 ( t = 4.526、5.994、6.742,P均< 0.001)。结论 与单纯应用盐酸丁卡因胶浆相比,湿润烧伤膏联合盐酸丁卡因胶浆治疗肛瘘术后创面,可明显减轻创面疼痛程度,促进创面愈合。