Li Faping, Guo Hui, Qiu Heping, Liu Shukun, Wang Kaixuan, Yang Chao, Tang Chao, Zheng Qi, Hou Yuchuan
Department of Urology, The First Hospital of Jilin University, Changchun, P.R. China.
Medicine (Baltimore). 2018 Mar;97(13):e0173. doi: 10.1097/MD.0000000000010173.
Radiotherapy is a reliable method to cure cervical cancer patients, but it could cause serious urological complications after the treatment due to the anatomical location of the cervix. The main purpose of this retrospective analysis is to study the incidence, latency, and therapeutic efficacy of urological complications caused by radical hysterectomy with postoperative radiotherapy or radiotherapy alone in patients with cervical cancer.A retrospective analysis was conducted on patients with cervical cancer who received radical hysterectomy with postoperative radiotherapy or radiotherapy alone at the First Hospital of Jilin University between January 2010 and May 2016. The urological complications were confirmed by clinical manifestation, ultrasound, computed tomography (CT), nuclear scintigraphy, and assessment of renal function. All the patients with urological complications received conventional treatment, including conservative, electrosurgery, ureteral stents, nephrectomy, and neoplasty. The onset time of radiation injury symptoms was confirmed according to the medical history and follow-up. The surveillance for the therapeutic effects for these complications was accomplished by cystoscopy, imaging, and laboratory assessment.The overall rate of urological complications after treatment was 3.26%, comprising 2.12% ureteral obstruction, 0.98% radiocystitis, and 0.16% vesicovaginal fistula. The incidence of ureteral obstruction in patients treated with radical hysterectomy with postoperative radiotherapy and radiotherapy alone was not statistically significant (2.18% vs 1.59%, P > .05). The median onset time of radiocystitis and ureteral obstruction was 10 months (0-75 months) and 12 months (2-66.3 months), respectively. The onset time of vesicovaginal fistula was 3.5 months. After the appropriate treatment, the majority of the complications were under control.The incidence of urological complications is acceptable. There was no statistical difference in the risk between patients treated with radical hysterectomy with postoperative radiotherapy and radiotherapy alone. The latency period between radiotherapy and the manifestation of urological complications may be relatively long. So it is crucial to underline long-term follow-up after radiotherapy. The majority of urological complications were alleviated after symptomatic treatment and the patients with cervical cancer achieved long-term remissions or cures.
放射治疗是治愈宫颈癌患者的可靠方法，但由于宫颈的解剖位置，治疗后可能会引起严重的泌尿系统并发症。本回顾性分析的主要目的是研究宫颈癌患者行根治性子宫切除术后放疗或单纯放疗引起的泌尿系统并发症的发生率、潜伏期及治疗效果。
对2010年1月至2016年5月期间在吉林大学第一医院接受根治性子宫切除术后放疗或单纯放疗的宫颈癌患者进行回顾性分析。通过临床表现、超声、计算机断层扫描（CT）、核素显像及肾功能评估确诊泌尿系统并发症。所有泌尿系统并发症患者均接受了包括保守治疗、电外科手术、输尿管支架置入、肾切除术和整形手术在内的常规治疗。根据病史和随访确定放射性损伤症状的发病时间。通过膀胱镜检查、影像学检查和实验室评估对这些并发症的治疗效果进行监测。
治疗后泌尿系统并发症的总发生率为3.26%，其中输尿管梗阻2.12%，放射性膀胱炎0.98%，膀胱阴道瘘0.16%。行根治性子宫切除术后放疗和单纯放疗患者的输尿管梗阻发生率无统计学差异（2.18%对1.59%，P>0.05）。放射性膀胱炎和输尿管梗阻的中位发病时间分别为10个月（0 - 75个月）和12个月（2 - 66.3个月）。膀胱阴道瘘的发病时间为3.5个月。经过适当治疗，大多数并发症得到控制。
泌尿系统并发症的发生率是可以接受的。行根治性子宫切除术后放疗和单纯放疗患者的风险无统计学差异。放疗与泌尿系统并发症表现之间的潜伏期可能相对较长。因此，放疗后强调长期随访至关重要。大多数泌尿系统并发症经对症治疗后得到缓解，宫颈癌患者实现了长期缓解或治愈。
