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目的:通过分析膀胱不同充盈体积对三维后装靶区及危及器官体积、剂量的影响，探讨宫颈癌术后三维后装近距离治疗时最佳膀胱充盈体积。方法:纳入术后病理明确的早期宫颈癌切缘阳性及安全边界不够的患者共111例，采用随机数表法给予膀胱灌注50、60、70、80、90、100 ml生理盐水共6组，每组依次为66、69、66、69、72、56人次分别行CT模拟定位，按照国际辐射单位和测量委员会(ICRU)89号报告勾画高危临床靶区及膀胱、直肠、小肠、乙状结肠等危及器官，采用Oncentra计划系统制定治疗计划，分别记录不同体积下的高危临床靶区(the high-risk clinical target volume，HR-CTV)体积、n D90及危及器官(organ at risk，OAR)的1 cmn 3受照剂量(n D1 cmn 3)、2 cmn 3受照剂量(n D2 cmn 3)。n 结果:60 ml组与50 ml组、70 ml组、80 ml组、90 ml组及100 ml组比较，HR-CTV体积、剂量差异无统计学意义(n P>0.05)，膀胱n D2 cmn 3、n D1 cmn 3及直肠n D2 cmn 3、n D1 cmn 3明显降低，差异具有统计学意义(n t膀胱 ＝3.21、5.83、2.89、12.95、7.96，n P膀胱＝0.031、0.010、0.041、0.000、0.001；n t直肠 ＝2.94、4.66、2.53、5.89、4.13，n P直肠＝ 0.037、0.024、0.049、0.005、0.028)。其他组两两比较，HR-CTV体积、剂量、膀胱n D2 cmn 3、n D1 cmn 3及直肠n D2 cmn 3、n D1 cmn 3差异无统计学意义(n P>0.05)。乙状结肠及小肠n D2 cmn 3、n D1 cmn 3各组间差异无统计学意义(n P>0.05)。n 结论:在早期宫颈癌术后三维后装近距离治疗时，膀胱灌注60 ml时较其他体积能够保证HR-CTV体积、剂量，又能够更好保护膀胱和直肠。“,”Objective:To investigate the optimal bladder filling volume in the 3D brachytherapy of postoperative cervical cancer.Methods:Totally 111 early cervical cancer patients with positive incisal margins or insufficient safety boundaries were included. The normal saline 50, 60, 70, 80, 90, and 100 ml were filled into their bladders, and accordingly six groups were determined, and 66, 69, 66, 69, 72, 56 person-times in each group, respectively. The CT-based simulation positioning was performed. According to the ICRU 89 report, high-risk clinical target volume and organs at risk such as bladder and rectum were delineated. The Oncentra planning system was used to prepare the treatment program. The high-risk clinical target volume (HR-CTV), n D90, and the n D2 cmn 3 and n D1 cmn 3 of organs at risk under different volumes were recorded.n Results:Compared to the 60 ml group, the volume and dosage of HR-CTV in the groups of 50, 70, 80, 90, and 100 ml had no significant difference (n P>0.05). Then D2 cmn 3 and n D1 cmn 3 of the bladder and rectum of patients in these groups significantly decreased, and the difference was statistically significant (n tbladder = 3.21, 5.83, 2.89, 12.95, 7.96, n Pbladder = 0.031, 0.010, 0.041, 0.000, 0.001; n trectum = 2.94, 4.66, 2.53, 5.89, 4.13, n Prectum = 0.037, 0.024, 0.049, 0.005, 0.028). The pairwise comparison among these groups except for the 60 ml group showed that the volume and dosage of HR-CTV and the n D2 cmn 3 and n D1 cmn 3 of bladder and rectum had no significant difference (n P > 0.05). Moreover, the n D2 cmn 3 and n D1 cmn 3 of sigmoid colon and small intestine of these groups had no significant difference (n P > 0.05).n Conclusions:In the 3D brachytherapy of postoperative early cervical cancer, a bladder filling volume of 60 ml can ensure the volume and dose of HR-CTV and can protect the bladder and rectum compared with other filling volumes.