【摘要】 目的:比较定量注射生理盐水和自主憋尿两种不同膀胱充盈方式对宫颈癌术后调强放疗精确度的影响，为临床应用提供参考。方法:选择我医院放射治疗科2018年6月至2019年6月收治的宫颈癌术后患者50例，将患者分为两组，每组25例，分别在定量注射生理盐水和定量饮水后自行憋尿1小时两种情况下进行CT定位及靶区勾画。计划靶区(planned target volume,PTV)在临床靶区(clinical target volume,CTV)基础上向各个方向外扩6 mm。调强放疗采用7野调强照射，处方剂量为50 Gy/(2 Gy. 25 f)。利用医科达直线加速器机载影像系统采集两组患者在左右方向、头脚方向及腹背方向上的位移偏差值，对100组图像的靶区受照剂量、适形程度进行分析，并通过随访了解放疗不良反应的严重程度。结果:注水组在三个平移方向的位移偏差分别为(1.92±1.81) mm、(2.61±1.95) mm、(1.85±1.14) mm，憋尿组为(2.27±1.77) mm、(3.12±2.48) mm、(2.81±2.17) mm。两组患者在腹背方向的位移偏差有统计学差异(P <0.05);两组患者PTV的最大剂量、靶区覆盖率、适形指数、均匀性指数均有明显差异(P <0.05)，但最小剂量和平均剂量无明显差异(P> 0.05);两组患者小肠、直肠和膀胱的受照体积和剂量均无明显差异(P> 0.05)。两组患者恶心呕吐发生率分别为20%、28%，食欲差发生率分别为72%、80%，腹泻发生率分别为52%、68%，便秘发生率分别为4%、4%，尿频尿失禁发生率分别为0%、64%，排尿困难发生率分别为0%、24%。注水组患者对于注射生理盐水充盈膀胱的舒适度调查结果显示，比较轻松占60%，轻微涨感占12%，涨感明显仍可接受占20%，无法忍受占8%。结论:宫颈癌术后调强放疗时，相比患者自主憋尿，注射生理盐水充盈膀胱可以使靶区的位移偏差更小，提高靶区剂量的准确度和适形度，降低放疗不良反应。更多还原

【Abstract】 Objective:To compare the effects of two different bladder filling methods on the accuracy of intensity-modulated radiotherapy(IMRT)for postoperative cervical cancer in clinical application.Methods:A total of 50 patients were divided into two groups by different bladder filling methods, and 25 cases in each group, they all from department of radiation oncology in our hospital from 2018.6 to 2019.6.Patients in saline infusion group were infused with quantitative saline, and patients in urinary retention group were mandatorily retain urineat least 60 minutes after drinking quantitative water.CT positioning and target area delineation were performed, and the planned target volume(PTV)expanded 6 mm in all directions on the basis of the clinical target volume(CTV).The IMRT adopted 7 fields with the prescription dose of 50 Gy/(2 Gy.25 f).Elekta linear accelerator airborne imaging system was used to collect the displacement deviation values of the two groups of patients in the left-right direction, head-to-foot direction and abdomen-dorsal direction.The exposure dose and conformity of the target area were analyzed, and the severity of adverse reactions to liberation therapy was followed up in 100 groups.Results:The setup errors on the three translational directions in saline infusion group were(1.92±1.81)mm,(2.61±1.95)mm and(1.85±1.14)mm, respectively, while they were(2.27±1.77)mm,(3.12±2.48)mm and(2.81±2.17)mm, respectively, in urinary retention group.There were statistical differences in the setup errors on the abdominal and dorsal directions between these two groups(P<0.05).And the maximum dose of PTV(planning target volume),target coverage, target conformal index and homogeneity index of these two groups were significantly different(P<0.05).However, there was no significant difference in either minimum or average doses of PTV(P>0.05).There was no significant difference in either the exposure volume or dose of the small intestine, rectum and bladder between the two groups(P>0.05).The incidences of nausea and vomiting, poor appetite, diarrhea, constipation, frequent urination/urinary incontinence, dysuresia were 20%,72%,52%,4%,0% and 0%,respectively, in saline infusion group, while they were 28%,80%,68%,4%,64% and 24%,respectively in urinary retention group.Compared with the urinary retention group, the survey of comfortability in saline infusion group showed that the "comfortable", "slight swelling", "obvious swelling" and "intolerability" accounted for 60%,12%,20% and 8%,respectively.Conclusion:Compared to the mandatory urine retention, bladder filling with a saline infusion could relatively reduce the setup errors, improve the accuracy and the conform index and reduce adverse reactions during the IMRT for postoperative cervical cancer.更多还原