放射治疗对阴道生物力学特性的影响。

The impact of radiation therapy on vaginal biomechanical properties.

机构信息

Department of Obstetrics and Gynecology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.

Department of Radiation Oncology, Rambam Health Care Campus, and Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2021 Sep;264:36-40. doi: 10.1016/j.ejogrb.2021.06.046. Epub 2021 Jul 1.

DOI:10.1016/j.ejogrb.2021.06.046

PMID:34273752

Abstract

OBJECTIVE

In women with cervical cancer (CC), treatment with radiation causes changes in vaginal biomechanical properties, anatomy and function. The aims of the current study were to objectively assess effects of radiotherapy (RT) on vaginal elasticity, wall mobility and contraction strength; and to evaluate associations of these changes with sexual function.

STUDY DESIGN

This prospective cohort study was approved by our Institutional Review Board. Between May 2018 and June 2020, women with CC who were candidates for RT were eligible to participate. Participants underwent vaginal tactile imaging (VTI) evaluation and were asked to fill the Female Sexual Function Index (FSFI) questionnaire at the time of first RT session and at a 6-month post-treatment follow up visit. Women who underwent radical hysterectomy, or had pelvic side-wall, pelvic or distant organ metastasis were not included.

RESULTS

A total of 25 women with locally advanced CC were included in the final analysis. The mean age was 39 ± 2.7 years, the mean BMI was 24.8 ± 2.2 kg/m and the median parity was 2 (range: 1-5). Following RT, the mean scores for vaginal elasticity and vaginal tightening were significantly lower than at pre-treatment: 11.3 ± 2.5 vs. 28.3 ± 9, P < 0.0001 and 2.6 ± 0.7 vs. 16.7 ± 3, P < 0.0001, respectively. Following RT, significant decreases were demonstrated in vaginal wall mobility and pelvic muscle contraction strength: from 1.77 ± 0.34 to 0.36 ± 0.15, P < 0.0001 and from 2.55 ± 0.48 to 0.52 ± 0.23, P < 0.0001, respectively. Compared to pre-treatment, post-RT vaginal length was significantly shorter (3.30 ± 0.22 vs. 7.64 ± 0.63, P = 0.0023) and sexual intercourse frequency significantly lower: 1 (range 1-2) vs. 2 (range 1-4), P = 0.014). The mean total FSFI score was significantly lower following RT (6.7 ± 1 vs. 14.5 ± 2.7, P < 0.0001).

CONCLUSIONS

Women with locally advanced CC who have been treated with RT exhibit persistent vaginal biomechanical changes that compromise sexual activity and result in considerable distress.

摘要

目的

宫颈癌（CC）患者在接受放射治疗后，其阴道生物力学特性、解剖结构和功能发生改变。本研究旨在客观评估放疗（RT）对阴道弹性、壁运动和收缩强度的影响，并评估这些变化与性功能的关系。

研究设计

本前瞻性队列研究获得了我院伦理委员会的批准。2018 年 5 月至 2020 年 6 月，符合 RT 治疗条件的 CC 女性患者有资格参加。参与者接受阴道触诊成像（VTI）评估，并在首次 RT 治疗时和治疗后 6 个月的随访时填写女性性功能指数（FSFI）问卷。未纳入接受根治性子宫切除术或骨盆侧壁、骨盆或远处器官转移的患者。

结果

共纳入 25 例局部晚期 CC 女性患者进行最终分析。平均年龄为 39±2.7 岁，平均 BMI 为 24.8±2.2kg/m，中位产次为 2（范围：1-5）。放疗后，阴道弹性和阴道紧缩的平均评分明显低于治疗前：11.3±2.5 分比 28.3±9 分，P<0.0001 和 2.6±0.7 分比 16.7±3 分，P<0.0001。放疗后，阴道壁运动和骨盆肌肉收缩强度明显下降：从 1.77±0.34 降至 0.36±0.15，P<0.0001 和从 2.55±0.48 降至 0.52±0.23，P<0.0001。与治疗前相比，放疗后阴道长度明显缩短（3.30±0.22 比 7.64±0.63，P=0.0023），性生活频率明显降低：1（范围 1-2）比 2（范围 1-4），P=0.014。放疗后平均总 FSFI 评分明显降低（6.7±1 分比 14.5±2.7 分，P<0.0001）。