放射性肠炎中医药治疗研究进展

放射性肠炎是恶性肿瘤患者接受腹盆腔放疗后的一种常见并发症。治疗较为棘手,目前尚无标准的治疗方法。近年来中医药在治疗放射性肠炎方面取得了良好效果,主要包括：辨证论治、验方治疗、中成药治疗、中药保留灌肠治疗及中西医结合治疗等。     

放射性肠炎临床治疗现状评述

放射性肠炎（radiation enteritis,RE）是盆腹腔恶性肿瘤接受放射治疗引起的常见肠道并发症,主要表现为腹痛腹泻、里急后重、肛门坠痛、粘液便、便血等。轻者症状可耐受,重者症状持续很长时间,常伴有慢性出血,并可能发展为直肠狭窄或形成肠瘘。     

放射性肠炎的诊疗进展

放射性肠炎（radiation enteritis,RE）是因腹部、盆腔恶性肿瘤放疗引起的肠道并发症。RE呈现长期、间歇性加重的便血、里急后重等症状,严重时可以出现肠道穿孔、梗阻,给患者身体、心理和经济带来巨大负担。随着恶性肿瘤发病率的升高,放射治疗应用越来越广泛,RE发病率也随之逐年升高。放射性肠炎的诊断主要依赖于病史、内镜检查、影像学检查及组织学检查。目前治疗方案包括内科治疗、内镜治疗、外科治疗,但尚无高级别证据支持的治疗方案。为提高对RE的认识,并探讨其诊断和治疗策略,本文对其危险因素、临床表现、诊断与治疗最新研究进展进行综述。      

恶性肿瘤慢性放射性肠炎35例

 【摘要】　目的　探讨恶性肿瘤并发慢性放射性肠炎的治疗方法、临床疗效及预后。方法　对35例盆、腹腔恶性肿瘤并发慢性放射性肠炎的患者进行回顾性分析,其中15例采取营养支持、二甲基亚砜为主的灌肠液保留灌肠、胃肠减压等治疗,20例在营养支持的基础上行手术治疗。结果　34例达治愈,治愈率达97.1 %,1例死于严重腹腔感染、多脏器衰竭。15例非手术治疗后,症状明显缓解。20例行手术治疗病例包括肠瘘11例、肠穿孔2例及不可逆性肠梗阻7例。其中11例行病变肠管切除、肠吻合术;7例行病变肠管切除、近端结肠或回肠造口;2例行病变肠管旷置、近端结肠或回肠造口。出院后随访6～24个月,未见症状反复,其中2例死于恶性肿瘤进展。结论　恶性肿瘤放疗后出现严重慢性放射性肠炎并发症应积极治疗,营养支持、二甲基亚砜为主的灌肠液保留灌肠、手术切除病变肠管是较理想的方法。     

放射性肠炎

肠遭损伤常为腹部或盆腔的放射治疗结局之一而出现,而慢性放射性肠炎又是使发病率和死亡率增加的一个重要原因,本文重点就放射性肠炎治疗和预防的进展作一综述。症状及发病情况1.急性放射性肠炎在盆腔和/或腹部的放射治疗过程中,急性放射性肠炎在临床上常表现为伴有腹部痉挛(或无痉挛)的腹泻,它的发生几乎是无法避免的,这些症状常在盆腔常规放疗中的第3周出现。恶心和呕吐亦常发生,特别是在全腹部照射时。急性放射性肠炎一般在放疗后6周得到明显改善,但约20％的病人由于症状严重,     

放射性肠炎的中西医治疗研究进展

放射性肠炎是腹腔、盆腔或腹膜后恶性肿瘤放射治疗后引起的肠道并发症,可累及小肠及结、直肠.腹腔或盆腔放疗期间,约60%-70%病人出现急性胃肠道症状.近年来发病率呈上升趋势,但治疗较为棘手,目前尚无药物预防及治疗的标准策略.西医主要以营养支持、高压氧治疗、手术及对症治疗为主要手段.中医学认为,肿瘤病人正气不足,加之毒邪入侵,正虚邪盛,致脏腑、气血、津液受损是放射性肠炎的基本病机,属本虚标实证.治疗以扶正祛邪,急则治标为基本原则,临床采用辨证论治方法治疗,中药灌肠及针灸疗法也越来越多地应用于临床.     

急性放射性肠炎中西医治疗进展

随着环境污染的日益严重、饮食结构的改变以及外界诸多因素的影响,肿瘤的发病率呈逐年上升的趋势。近年来,随着放疗技术的广泛应用,急性放射性肠炎(acute radiation enteritis,ARE)的发病率也随之升高,作者就目前中西医对ARE的相关治疗进展做一综述。     

放射性肠炎的预防与治疗研究进展

近年来,放射性肠炎（radiation enteritis,RE）的预防与治疗方法不断丰富,一方面是放疗技术的不断改进,放射处方剂量分割的优化以及放疗保护剂的研发与应用,另一方面除激素、肠黏膜保护剂、内镜下治疗和手术治疗之外,微生物、干细胞移植和高压氧疗法等新兴治疗手段有了新的进展,RE的患病率有所降低。这些新技术与治疗方法在减轻症状、保护肠道屏障、促进损伤修复和恢复肠道微生态平衡等方面显示出潜在的疗效。本文就RE治疗与预防的研究进展进行综述,探讨RE放射技术的优化和防治的策略,为制定更加精准、全面、有效的治疗方案提供理论依据。     

中医药治疗放射性肠炎的研究进展

放射性肠炎(RE)是腹腔、盆腔或腹膜后恶性肿瘤经放射治疗后引起的肠道并发症,可分别累及小肠、结肠和直肠.腹腔或盆腔放疗期间,60％～70％的患者出现急性胃肠道症状.放射线对肠管的损害不仅可发生在放疗期间,还可延续至治疗后的10余年.近年来,RE的发病率呈逐渐上升趋势,但目前尚无药物防治的标准策略.而近年来,大量关于中医药防治RE的临床研究表明,中医药治疗RE取得了可喜的疗效,因此,本文就中医药治疗RE的研究进展作一综述.     

思密达与金双歧联合治疗放射性肠炎的效果

目的观察思密达与金双歧配伍治疗放射性肠炎的临床疗效。方法患者随机分组，治疗组用思密达与金双歧口服，思密达3gTid金双歧2gTid；对照组用土霉素0．5gTid。结果治疗组优于对照组，两组疗效比较差异有显著意义。结论思密达与金双歧联合治疗放射性肠炎是一种有效、安全的治疗方法。     

Small bowel CT fat density target sign in chronic radiation enteritis

On CT, a thickened intestinal wall configured with a middle layer of low attenuation surrounded on each side by layers of higher attenuation has been termed the target sign. The presence of fat within the submucosal layer of the small intestine is a well‐known manifestation of Crohn's disease, but has not been reported in other chronic intestinal diseases. We describe CT findings of fat density target sign in a patient with prior radiation.     

宫颈癌盆腔放疗致急性放射性肠炎的临床观察

目的：总结宫颈癌盆腔放射治疗导致急性放射性肠炎的发生规律及防治方法。方法：回顾性分析行盆腔放疗的97例宫颈癌患者，分析腹痛、腹泻症状出现的时间及程度，评价急性放射性肠炎的分级，对比放疗前后血象和KPS的变化情况。结果：急性放射性肠炎多发生在放疗后1周至1个月内，Ⅰ度发生率为41％，Ⅱ度发生率15％，Ⅲ度发生率2％，总发生率为58％；放疗后患者WBC值平均下降23％，PLT值平均下降18％；46％的患者放疗后KPS下降。结论：宫颈癌盆腔放疗患者急性放射性肠炎发生率较高，应引起临床足够重视。     

Chronic radiation enteritis: a community hospital experience

A retrospective study was undertaken to evaluate the operative management of patients with chronic radiation enteropathy. Thirty-eight affected patients from 1974 to 1986 were reviewed. Patients with recurrent cancer responsible for symptoms were excluded. Seventy-one percent of patients presented with bowel obstruction. Twenty-one patients were treated with bowel resection, while 17 were treated with a bypass procedure or diverting ostomy alone. Overall morbidity was 45%, and postoperative mortality was 16%. Patients in the bypass group were significantly older than those in the resection group (70.3 vs. 55.5 years, P = .024), suggesting that age may have been a determinant of the procedure performed. In our study there was no difference in outcome based on preexisting vascular disease, tumor site, type of procedure performed, or radiation dose. We conclude that resection is the procedure of choice in cases of chronic radiation enteritis requiring surgery except in cases with dense adhesions when enteroenterostomal bypass is a viable alternative.     

Surgical treatment of intestinal radiation injury

A review of 43 consecutive patients requiring operation for serious intestinal radiation injury was undertaken to elucidate the efficacy of surgical treatment. The most common site of radiation injury was the rectum (19 cases), followed by the small bowel (13 cases), the colon (7 cases), and the combination of these (4 cases). The overall operative mortality was 14%; morbidity, 47%; and the postoperative symptom-free period, 18 +/- 30 months. Colostomy (N = 20) carried the lowest risk of mortality, 0%, as compared with resection (N = 17) and bypass procedure (N = 6), which were accompanied by the mortalities of 24% and 33%, respectively. During the follow-up (3-13 years) 12 patients (28%) died of recurrent cancer and 9 patients (21%) of persistent radiation injury, which yielded an overall mortality of 65% after resection and 50% and 65% after bypass and colostomy procedures, respectively. Continuing radiation damage led to 15 late reoperations. Ten of these were performed after colostomy, four after resection, and one after bypass. We conclude that colostomy cannot be regarded as a preferred operative method, because it does not prevent the progression of radiation injury and because it is, for this reason, associated with a higher late-complication rate. A more radical surgery is recommended but with the limitation that the operative method must be adapted to the operative finding.     

中药青黛治疗慢性出血性放射性直肠炎

Objective:To evaluate the efficacy and safety of Qing Dai (indigo naturalis).a traditional Chinese medicine,in the treatmenl for chronic hemorrhagic radiation proctitis.Methods:Ten patients with chronic hemorrhagic radiation proctitis between January 2005 to January 2008 were Veated with Qing Dai.Qing Dai was administered orally at a dose of 1.5 g,bid for 5 consecutive days,every 2 weeks for two courses.Patients were followed up every 3 months.The clinical response and side-effects were evaluated.Results:Six patients showed improvement of rectal bleeding to grade 0-1 arer 1 course of Qing Dai therapy.Four patients had reduced rectal bleeding to grade 0-1 after 2 courses of the therapy.The median follow-up time was 10 months frange:6-24).During the follow-up period,1 patient experienced recurrent rectal bleeding and was managed with topical formalin dabbing.which controlled the symptom.No treatment toxidty was observed.Conclusion:Qing Dai may be a safe and effective treatment for chtonic hemorrhagic radiation proctitis.     

蛋珍油加地塞米松保留灌肠治疗放射性肠炎50例

目的:观察蛋珍油加地塞米松保留灌肠治疗放射性肠炎的疗效。方法:选择2006年3月-2009年12月我科收住的放射性肠炎患者50例,治疗1个月后,观察患者临床表现及大便常规、结肠镜检查。结果:治愈21例(42%),好转27例(54%),无效2例(4%)。结论:蛋珍油加地塞米松保留灌肠治疗放射性肠炎安全有效,不良反应少,放射治疗计划完成率高,并发症少。     

蛋珍油加地塞米松保留灌肠治疗放射性肠炎50例

目的：观察蛋珍油加地塞米松保留灌肠治疗放射性肠炎的疗效。方法：选择2006年3月-2009年12月我科收住的放射性肠炎患者50例,治疗1个月后,观察患者临床表现及大便常规、结肠镜检查。结果：治愈21例（42%）,好转27例（54%）,无效2例（4%）。结论：蛋珍油加地塞米松保留灌肠治疗放射性肠炎安全有效,不良反应少,放射治疗计划完成率高,并发症少。     

胃癌的外科治疗

本文分析了东西方学者对胃癌外科治疗的分歧与近年逐渐取得共识的趋向;介绍了早期胃癌与进展期胃癌合理外科治疗的原则;近年主张早期胃癌不必切除大网膜与网膜囊.进一步确定了中、上部胃癌胰脾区清除范围,行保存一线,切除动脉干及脾的临床价值.     

四肢神经鞘瘤的外科治疗

目的：分析四肢神经鞘瘤的手术治疗效果。方法：对31例四肢神经鞘瘤行肿瘤彻底切除,术后随访0.5年-3年,平均15个月。结果：全部病例均无复发;30例无任何功能障碍,1例残留部分功能障碍,经肌腱转移行功能重建后得到改善。结论：四肢神经鞘瘤行手术切除时,只要仔细剥离、耐心解剖,可完整切除、杜绝复发且可防止遗留神经功能障碍。     

左房粘液瘤的外科治疗

目的：总结左房粘液瘤的外科治疗经验。方法：１９９０ 年１ 月～１９９９ 年７ 月手术治疗左房粘液瘤５６ 例,采用中低温体外循环心脏停跳下手术５３ 例,浅低温体外循环心脏跳动下手术３ 例。结果：术后均恢复顺利,未发生院内死亡及栓塞等并发症,随访２ 个月～９６ 个月,无１ 例复发。结论：左房粘液瘤一经确诊应尽早手术治疗,手术可选用常规阻断升主动脉灌注心脏停跳液在心脏停跳状态下进行手术或浅低温不阻断升主动脉在心脏跳动下手术,后者更适用于年龄大、心功能差的病例。术中需注意操作轻柔防止瘤组织脱落且需切除干净完整取出,重视对二尖瓣、三尖瓣的检查和处理。