李凤虎， 冉　立， 常建英， 李杰慧， 洪　卫， 单　朗， 栗惠琴

(贵州省肿瘤医院 贵州医科大学附院 乳腺妇科肿瘤科， 贵州 贵阳　550004)



阴道扩张术预防宫颈癌放化疗后阴道狭窄的效果*

李凤虎， 冉立**， 常建英， 李杰慧， 洪卫， 单朗， 栗惠琴

(贵州省肿瘤医院 贵州医科大学附院 乳腺妇科肿瘤科， 贵州 贵阳550004)

目的： 观察阴道扩张术预防局部晚期宫颈癌患者行放化疗后阴道狭窄的效果。方法： 108例行同步放化疗后的局部晚期宫颈癌患者，分为阴道扩张组(n=57)和未扩张组(n=51)，在治疗结束后6个月内, 阴道扩张组定期到医院进行阴道扩张及冲洗，未扩张组自行冲洗阴道(1次/d)，2组患者均随访5年，比较2组患者的阴道狭窄率、阴道粘连率、性生活正常率及患者1、3、5年生存率和阴道感染率。结果： 阴道扩张组患者阴道狭窄、粘连的发生率明显低于未扩张组(P<0.05)，性生活正常率明显高于未扩张组(P<0.05)；两组患者阴道感染率及1、3、5年生存率比较，差异无统计学意义(P>0.05)。结论： 阴道扩张可以明显降低局部晚期宫颈癌患者放化疗后的阴道狭窄。

宫颈肿瘤； 阴道； 扩张术； 放射疗法； 化学疗法,辅助； 粘连

[Abstract]Objective: To observe the effect of vaginal dilatation in the prevention of vaginal stenosis after chemoradiotherapy in patients with locally advanced cervical cancer. Method: 108 cases of locally advanced cervical cancer patients with concurrent radiotherapy and chemotherapy were enrolled in the study and divided into vaginal dilatation group (57 cases) and the non vaginal dilatation group (51 cases). 6 months after treatment, Vaginal dilatation group went to the hospital on a regular basis for vaginal dilatation and douching while non vaginal dilatation group did self-irrigation of vagina (1 times/d). 2 groups of patients were followed up for 5 years. 1, 3, and 5 year survival rate, vaginal infection rate, vaginal stenosis rate, vaginal adhesion rate and the rate of normal sexual life were compared between 2 groups. Result: The incidence of vaginal stenosis and adhesions in vaginal dilatation group were significantly lower than their counterparts in non vaginal dilatation group (P<0.05). The normal sexual life rate in vaginal dilatation group was significantly higher than that of non vaginal dilatation group (P<0.05). There were no statistically significant differences in 1, 3, 5 year survival rate between two groups (P>0.05). Conclusion: Vaginal dilatation can obviously reduce vaginal stenosis after chemoradiotherapy in patients with locally advanced cervical cancer.

[Key words]cervical cancer; vagina； dilatation; radiotherapy； chemotherapy,adjuvant; adhesion

宫颈癌是女性常见的恶性肿瘤之一, 放射治疗是宫颈癌的重要治疗手段,各期的宫颈癌都可以进行局部放射治疗, 包括盆腔外照射及高剂量率后装近距离治疗。研究认为Ⅱa期及以下的宫颈癌患者更适宜行手术治疗,Ⅱa期以上患者宜采用放射治疗[1]。随着放射治疗技术的不断发展，宫颈癌患者的5年生存率可达80%[2]，随着宫颈癌患者的生存期延长，放射治疗后的阴道粘连、阴道狭窄、会阴部感染等并发症严重影响了患者……