Manifestation, latency and management of late urological complications after curative radiotherapy for cervical carcinoma
Manifestation, latency and management of late urological complications after curative radiotherapy for cervical carcinoma
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DOI：
10.1159/000072091
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发表时间：
2003-08-01
期刊：
影响因子：
0.3
通讯作者：
Wirth, MR
中科院分区：
文献类型：
--
作者：
Gellrich, J;Hakenberg, OW;Wirth, MR
背景：放射治疗单独或联合根治性子宫切除术仍然是一种潜在的治疗宫颈癌。根治性放射治疗后的晚期泌尿系统并发症是罕见的，但由于放射性组织损伤的渐进性，往往存在难以处理的问题。我们回顾了过去10年来在我院治疗的宫颈癌放疗后放射性泌尿系统并发症的所有病例。患者和方法：在一项回顾性分析中，在所有接受肾积水治疗的女性患者（n = 543）中，确定了93例妇科恶性肿瘤根治性治疗后发生肾积水的患者。最常见的原因是疾病进展（n = 55）; 30例无复发的患者发生了严重的放射性泌尿系统并发症（研究人群）。结果如下：在30例平均年龄为44.9岁的宫颈癌患者中，6例接受了原发性放疗，24例在根治性子宫切除术后接受了辅助放疗。晚期泌尿外科并发症包括：输尿管远端狭窄（双侧4例，单侧15例），输尿管远端坏死1例，双侧输尿管反流3例，膀胱阴道瘘5例，膀胱肠瘘1例，严重纤维化膀胱缩小6例，尿道狭窄2例。几乎所有患者均观察到放射性膀胱炎的明显体征。放射治疗和严重放射性泌尿系统后遗症的表现之间的平均潜伏期为19.4年（范围0.5-41.5）。泌尿系并发症的主要治疗包括经皮肾造瘘术或输尿管内支架置入术的临时尿流改道。对所有总体健康状况良好的患者进行放射性输尿管狭窄的永久性治疗包括手术或腔内尿流改道或重建。然而，大多数患者通过永久性腔内泌尿外科措施进行管理。下尿路瘘采用远端输尿管阻断和分流术治疗。结论：虽然严重的晚期泌尿系统后遗症的根治性放射治疗宫颈癌是罕见的，他们的主要并发症，导致相当大的痛苦的病人，并经常提出困难的治疗问题，泌尿科医生。由于这些泌尿系统并发症可能有极长的潜伏期，因此建议进行重点随访以早期发现。
Background: Radiotherapy alone or in combination with radical hysterectomy remains a potentially curative treatment for cervical carcinoma. Late urological complications after curative radiotreatment are rare but often present difficult problems of management due to the progressive nature of radiogenic tissue damage. We reviewed all cases of radiogenic urologic complications after radiotherapy for cervical carcinoma treated at our institution over the past 10 years. Patients and Methods: In a retrospective analysis, out of all female patients treated for hydronephrosis (n = 543), 93 patients with hydronephrosis occurring after curative treatment for gynecological malignancies were identified. The most frequent cause was progressive disease (n = 55); 30 patients without recurrence had severe radiogenic urological complications (study population). Results: Out of 30 patients with a mean age of 44.9 years at the time of treatment for cervical cancer, 6 had undergone primary radiotherapy and 24 had received adjuvant radiotreatment after radical hysterectomy. The observed late urological complications were: distal ureteral stenoses (bilateral in 4 cases, unilateral in 15 cases), distal ureteral necrosis In = 1), bilateral ureteral reflux (n = 3), vesico-vaginal fistulae (n = 5), vesico-intestinal fistula (n = 1), severe fibrotic bladder shrinkage (n = 6) and urethral stenosis (n = 2). Marked signs of radiogenic cystitis were observed in almost all patients. The mean latency time between radiotherapy and manifestation of severe radiogenic urological sequelae was 19.4 years (range 0.5-41.5). Primary treatment of urological complications consisted in temporary urinary diversion by percutaneous nephrostomies or insertion of internal ureteral stents. Permanent treatment for radiogenic ureteral stenosis in all patients with sufficient general health consisted of surgical or endourological urinary diversion or reconstruction. However, the majority of patients were managed by permanent endourological measures. Lower tract fistulae were treated by distal ureteral occlusion and diversion. Conclusions: Although severe late urological sequelae of curative radiotherapy for cercvical carcinoma are rare they represent major complications, result in considerable distress for the patient, and often present difficult therapeutic problems for the urologist. As these urological complications can have extremely long latency times, focussed follow-up for early detection may be advisable.