氩离子凝固术加黏膜下药物注射治疗放射性肠炎初步临床分析

目的 初步探讨内镜下氩离子凝固术(APC)联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎的临床疗效,尤其是对难治性放射性肠炎的疗效评估。方法 回顾分析22例患者临床资料,分别采用改良内镜评分法(A)和Sherman′s classification (B)对患者进行严重程度评分。治疗成功的标准是临床症状的改善或便血停止(或仅有少量便血不需要进一步干预)。结果 22例患者疗后均达到临床症状改善,其中18例(82%)便血完全停止。A评估法:轻度肠炎15例(68%),重度肠炎7例(32%)。B评估法:轻度9例(41%),重度13例(59%)。采用A评估法进行相关分析发现,治疗次数与内镜等级(或内镜评分)有很好的相关性(r=0.86,P<0.001)。结论 初步证明内镜下APC联合黏膜下去甲肾上腺盐水注射治疗放射性肠炎不仅对轻-中患者有效,对难治性放射性肠炎同样可维持长久疗效。A评估法更适合在临床中推广。     

氩离子凝固术治疗出血性慢性放射性直肠炎的效果

目的探讨氩离子凝固术(APC)治疗出血性慢性放射性直肠炎(HCRP)患者的有效性和安全性。方法回顾性分析2017年1月至2021年6月山西省肿瘤医院36例接受APC治疗的HCRP患者的临床资料。使用Zinicola内镜评分和维也纳直肠镜评分对HCRP严重程度进行分级。治疗成功定义为最后一次APC治疗后6个月内直肠出血停止或偶尔出现不需要治疗的便血。结果中位随访时间为1.63年(0.85～2.68年)。依据Zinicola内镜评分, 20例(55.6%)患者为重度HCRP。32例HCRP患者在APC治疗后直肠成功止血, 4例重度HCRP患者在进行多次APC治疗后仍有直肠出血的症状。患者使用APC治疗(2.7±1.0)次, APC治疗前后HCRP患者的Zinicola内镜评分分别为(3.6±0.8)分和(1.4±1.1)分, 维也纳直肠镜评分分别为(3.8±0.8)分和(1.2±1.1)分, 差异均有统计学意义(t值分别为22.37、18.96, 均P<0.001)。HCRP患者经APC治疗前后血红蛋白水平分别为(85±15)g/L和(100±17)g/L, 差异有统计学意义(t=1...     

蛋珍油保留灌肠治疗放射性肠炎60例

目的:观察蛋珍油保留灌肠治疗放射性肠炎的临床疗效。方法:选择2010年1月-2012年02月我科收住的放射性肠炎患者60例,蛋珍油10毫升溶于37-38℃生理盐水100毫升中充分混匀,保留灌肠1日2次,治疗1个月后,根据患者临床表现及大便常规、结肠镜检查等判断疗效。结果:治愈27例(45%),好转31例(52%),无效3例(3%)。结论:蛋珍油保留灌肠治疗放射性肠炎安全有效,不良反应少。     

益肠促愈方辅助西药治疗宫颈癌放疗后放射性肠炎疗效观察

目的:探讨益肠促愈方辅助西药治疗宫颈癌放疗后放射性肠炎临床疗效。方法:研究对象选取我院2015年7月至2017年7月收治宫颈癌放疗后放射性肠炎患者共100例,以随机数字表法分为对照组（50例）和中西医组（50例）,分别给予西药单用和在此基础上加用益肠促愈方辅助治疗,比较两组综合疗效,内镜疗效,治疗前后主要证候评分、日常生活质量评分、转化生长因子β1（transforming growth factor β1,TGF-β1）水平及药物毒副反应发生率。结果:中西医组综合疗效和内镜疗效均显著优于对照组（P<0.05）;中西医组治疗后主要证候评分显著低于对照组、治疗前（P<0.05）;中西医组治疗后EORTC QOL-C30量表评分均显著高于对照组、治疗前（P<0.05）;中西医组治疗后TGF-β1水平显著低于对照组、治疗前（P<0.05）;同时两组药物毒副反应发生率比较差异无统计学意义（P>0.05）。结论:益肠促愈方辅助西药治疗宫颈癌放疗后放射性肠炎可有效减轻消化道和全身症状,促进肠黏膜损伤修复,调节TGF-β1水平。     

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。      

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。     

局部中晚期鼻咽癌IMRT同步化疗后急性放射性口腔黏膜炎的预测因素分析

目的 通过前瞻性分析资料齐全的同期放化疗局部晚期鼻咽癌患者的剂量学及临床相关因素,寻找急性放射性口腔黏膜炎的预测因子。方法 对2015—2016年间连续入组的92例局部晚期鼻咽癌IMRT同步化疗患者采用RTOG评分标准进行急性放射性黏膜炎评分,定义评分≥3为重度放射性黏膜炎。获取临床资料,从IMRT计划系统获取患者的DVH剂量学参数信息。对可能预测重度黏膜炎的因素进行统计分析。结果 全组患者重度急性放射性口腔黏膜炎的发生率为21%(19/92),体重下降、口腔黏膜V₃₀是重度黏膜炎的相关因素(P=0.017、0.003)。ROC曲线分析显示口腔黏膜V₃₀诊断重度放射性口腔黏膜炎的阈值为73.16%(敏感性0.842,特异性0.671),ROC的AUC值0.753(P=0.001)。结论 体重下降和口腔黏膜V₃₀是重度黏膜炎的预测因素。     

纤维结肠镜诊治放射性肠炎6例临床体会

纤维结肠镜诊治放射性肠炎６例临床体会吴秋珍，陈国芬大同市第三医院（大同市０３７００８）１９９１年以来，我们采用纤维结肠镜（下称纤结镜）诊治放射性肠炎６例，疗效满意，现报告如下。１临床资料６例均为女性，平均年龄５６．５岁（４１～７２岁）。本组病例均为宫...     

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。     

系统口咽处理防治急性放射性黏膜反应的临床观察

为了观察系统口咽处理防治急性放射性黏膜反应的疗效,对60例初治头颈部肿瘤放疗患者,随机分成治疗组(30例)和对照组(30例).治疗组常规口腔护理,同时联合用药(口泰、康复新、金因泰和利多卡因)系统口咽处理;对照组常规口腔护理,出现黏膜反应后静脉滴入维生素、激素等.观察急性口咽黏膜反应出现时间、程度及药物不良反应.结果两组间急性放射性黏膜反应的发生率比较差异无统计学意义,P>0.05;两组间黏膜反应出现的时间比较差异有统计学意义,P<0.05,治疗组以Ⅰ、Ⅱ级口咽黏膜反应为主(70.0%),对照组以Ⅲ、Ⅳ级为主(60.0%),两组间比较差异均有统计学意义,P<0.05,治疗组以轻度疼痛为主(VAS评分0～3分,63.3%),对照组以中、重度疼痛为主(VAS评分4～6分,7～10分,66.6%),两组间比较差异均有统计学意义,P<0.05;未见药物不良反应.初步研究结果提示,系统口咽处理可推迟放射性黏膜反应的发生,并降低Ⅲ、Ⅳ级黏膜反应的发生率,治疗操作简单易行,值得临床推广应用.     

凝血酶混合液治疗晚期放射性直肠炎疗效观察

目的：观察凝血酶混合液保留灌肠治疗妇科恶性肿瘤放疗后晚期放射性直肠炎的疗效。方法：对161例妇科恶性肿瘤放疗后的晚期放射性直肠炎患者,以凝血酶冻干粉、庆大霉素、地塞米松、维生素B12、生理盐水或温米汤等混合液保留灌肠,每天1-2次。结果：161例患者经保留灌肠治疗1周-2月后,41例轻度患者均痊愈,112例中度患者中,痊愈32例,好转80例,8例重度放射性肠炎无效,治疗总有效率为95.03%。结论：凝血酶冻干粉、庆大霉素、地塞米松、维生素B12等混合液治疗妇科恶性肿瘤放疗后晚期放射性直肠炎疗效确切,值得临床推广应用。     

盆腔肿瘤放疗致放射性直肠炎的临床观察

目的探讨盆腔肿瘤放疗导致的放射性直肠炎的影响因素及临床处治方法。方法回顾性分析1998年4月至2006年10月106例在我院经过放射治疗的盆腔恶性肿瘤患者的临床资料。结果接受盆腔放射治疗的患者发生Ⅰ度放射性直肠炎37例,占34．9％;Ⅱ度11例,占10．4％;Ⅲ度9例,占8．5％,总发生率53．8％（57／106）。结论盆腔接受放射治疗后,放射性直肠炎为重要并发症之一,一般经过对症治疗多能治愈。     

A phase III randomized, placebo-controlled, double-blind study of misoprostol rectal suppositories to prevent acute radiation proctitis in patients with prostate cancer

PURPOSE: Acute radiation proctitis is the most relevant complication of pelvic radiation and is still mainly treated supportively. Considering the negative impact of acute proctitis symptoms on patients' daily activities and the potential relationship between the severity of acute radiation injury and late damage, misoprostol was tested in the prevention of acute radiation-induced proctitis. METHODS AND MATERIALS: A total of 100 patients who underwent radiotherapy for prostate cancer were entered into this phase III randomized, placebo-controlled, double-blind study with misoprostol or placebo suppositories. Radiation-induced toxicity was evaluated weekly during radiotherapy using the Common Toxicity Criteria. RESULTS: Between the placebo and the misoprostol groups, no significant differences in proctitis symptoms occurred: 76% of patients in each group had Grade 1 toxicity, and 26% in the placebo group and 36% in the misoprostol group had Grade 2 toxicity. No differences were found in onset or symptom duration. Comparing the peak incidence of patients' toxicity symptoms, significantly more patients experienced rectal bleeding in the misoprostol group (p = 0.03). CONCLUSION: Misoprostol given as a once-daily suppository did not decrease the incidence and severity of radiation-induced acute proctitis and may increase the incidence of acute bleeding.     

Novel and Effective Almagate Enema for Hemorrhagic Chronic Radiation Proctitis and Risk Factors for Fistula Development

Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.     

Formalin instillation for refractory radiation-induced hemorrhagic proctitis

BACKGROUND AND OBJECTIVES: Radiation proctitis is a common complication after pelvic irradiation. One to five percent of these patients will develop intractable or massive hemorrhagic radiation proctitis that will require repeated hospital admissions and blood transfusions. We evaluated the benefits of instillation of 4% formalin in the management of refractory hemorrhagic radiation-induced proctitis. METHODS: From January 1998 to May 1999, 20 female patients who failed with administration of topical steroids and/or mesalazine were treated with 500 ml of 4% formalin instilled into the rectum in 50-ml aliquots. RESULTS: Median age was 58 years. Eighteen patients had cervical cancer and two, endometrial cancer. These patients received a mean of 7,500 rads to the pelvis. The symptoms began at a mean of 8 months after termination of radiotherapy. Median time of symptomatic rectal hemorrhage was 8 months. Median of blood units previously transfused was six (range: 2-11). Hemorrhage immediately ceased after the 4% formalin instillation in 17 patients. Three patients required formalin instillation repetition with success in one. Overall success was 90%. Median follow-up was 20 months. Five patients had moderate pelvic pain after instillation and one developed rectosigmoideal necrosis that required resection plus Hartmann procedure. Two patients developed rectovaginal fistula and required colostomy, and one thereafter, required abdominoperineal resection en bloc with the posterior wall of the vagina due to pelvis sepsis. CONCLUSIONS: Rectal instillation of 4% formalin is a simple, inexpensive, and efficient treatment for refractory hemorrhagic radiation proctitis.     

腔内后装治疗子宫颈癌时机对早期直肠反应的影响

目的探索进一步降低放射治疗子宫颈癌所致早期放射性直肠炎并发症的可能性。方法1997年5月～1998年4月，我们对晚期子宫颈癌患者36例采用体外照射十高剂量率近距离后装腔内治疗（HDR－ICR）同期交替进行（观察组）与同期随机分组另36例常规放疗法（对照组）进行临床治疗观察。结果早期放射性直肠炎反应的发生率观察组19．44％，对照组41．67％两组差别统计学有显著意义（P＜0.05），而两组并发早期放射性直肠炎的轻重程度和时间早晚无统计学意义（P＞0．05）。结论子宫颈癌患者，行体外照射时较早加用后装腔内照射，可降低早期直肠炎并发症的发生率，有助于改善其放疗后的生存质量。     

内镜下黏膜切除术联合氩离子血浆凝固术治疗早期食管癌及其癌前病变

[目的]探讨内镜下黏膜切除术（endoscopic mucosal resection,EMR）联合氩离子血浆凝固术（Argon plasma coagulation,APC）在食管癌高发区治疗早期食管癌及其癌前病变的意义。[方法]应用透明帽法对食管癌高发区普查中发现的84例早期食管癌及食管癌前病变行EMR治疗,并联合应用APC治疗残留及复发病灶。术后2、6个月进行内镜复查。[结果]2004～2008年间共有84例患者成功行EMR,治疗成功率为100%。并发症：术中出血3例,术后出血2例,经内镜下治疗或保守治疗均成功止血;无一例穿孔、狭窄等并发症发生。随访：84例中,5例早期食管癌,49例原位癌/重度不典型增生术后半年随访时对原切除部位行内镜下活检,病理诊断5例重度不典型增生、8例中度不典型增生和19例轻度不典型增生,均内镜下APC治疗。平均随访21个月,无一例复发。[结论]应用透明帽法内镜下黏膜切除联合氩离子凝固术治疗早期食管癌及其癌前病变是食管癌二级预防的有效方法。