急性放射性皮炎外喷3%注射用重组人白介素-11的疗效观察

目的观察放射性皮炎外用3%注射用重组人白介素-11(recombinant human interleukin-11,rh IL-11)的临床疗效。方法将2013年1-9月在我科行放疗并发放射性皮炎患者140例随机分两组,试验组70例使用3%rh IL-11外喷皮炎创面,对照组70例使用康复新液外敷。结果用药48 h后试验组疼痛缓解效果、皮炎康复效果均优于对照组(P<0.05)。尤其体现在Ⅲ度放射性皮炎中,疼痛治疗效果试验组优于对照组(χ2=4.792,P=0.041)。实验组3 d康复效果显效率明显高于对照组(80%vs 32%,P=0.008)。试验组7 d康复效果有效率明显高于对照组(80%vs 30%,P=0.004)。结论放疗后≥Ⅱ度放射性皮炎局部外喷3%rh IL-11溶液,可减轻急性放射性皮炎症状,促进康复。     

An ultrasonographic monitoring of skin condition in patients receiving radiotherapy for head and neck cancers

Radiodermatitis is one of the commonest side effects of radiotherapy. They are usually assessed by semi‐quantitative clinical scores, which are not validated and may be subject to inter‐observer variability. A few previous studies suggested that high‐frequency ultrasonography (HF‐USG) is useful in the assessment of the acute phase of radiation dermatitis in breast cancer patients. (a) To monitor skin changes by HF‐USG during the course of radiotherapy due to head and neck cancers, and (b) to determine whether there is any connection between skin sonograms and the skin scoring criteria. This prospective, observational study includes patients diagnosed with head and neck cancers, treated with radiotherapy or concomitant chemoradiation. The final analysis includes six patients. In every patient, the HF‐USG as well as dermatological assessment (target lesion score—TLS and CACE v. 4.0) were performed 4×: before, in the middle, day after, and 3 months after radiotherapy. There were significant differences between non‐irradiated skin thickness and thickness of skin with clinically obvious radiodermatitis (TLS grade 1‐4; P < .0001), as well as between irradiated, unchanged skin thickness (TLS grade 0) and thickness of skin with clinically obvious radiodermatitis (TLS grade 1‐4; P = .0002). There was no significant difference between non‐irradiated and irradiated, unchanged skin thickness (TLS grade 0; P = .9318). In four patients, we demonstrated subepidermal low echogenic band (SLEB). HF‐USG can be useful tool to noninvasive and objective assessment of skin changes during radiotherapy.     

放射性皮炎软膏的皮肤刺激性及临床疗效观察

目的观察放射性皮炎软膏对家兔的皮肤刺激性,临床治疗放射性皮炎疗效。方法采用家兔完整性皮肤和破损性皮肤进行皮肤刺激性实验。放射性皮炎治疗,采用研究组57例,对照组40例(湿润烧伤膏),并将治疗结果进行对比。结果放射性皮炎软膏在72h内完整性皮肤刺激性积分为"0",破损性皮肤刺激性积分为"1",平均分值为"0.33"。临床治疗放射性皮炎结果为:放射性皮炎软膏总好转率为93%,湿润烧伤膏总好转率为80%。统计学处理无显著性差异(P>0.05),且临床应用中均未发现不良反应。结论放射性皮炎软膏对皮肤无刺激性,且临床治疗放射性皮炎疗效显著。     

光敏拮抗剂类皮肤保护剂预防头颈部放射性皮炎疗效观察

目的：观察光敏拮抗剂类皮肤保护剂预防头颈部放射性皮炎的疗效。方法：将66例头颈部肿瘤病人随机分为两组,观察组33例,放疗期间使用光敏拮抗剂类皮肤保护剂;对照组33例,按常规皮肤护理。比较两组放射性皮炎的发生程度。结果：观察组病人发生Ⅰ级、Ⅱ级、Ⅲ级皮炎分别为72.7%、27.3%、0;对照组病人发生Ⅰ级、Ⅱ级、Ⅲ级皮炎分别为24.2%、66.6%、9.1%。观察组病人发生放射性皮炎程度明显轻于对照组（P〈0.05）。结论：光敏拮抗剂类皮肤保护剂能提高皮肤的耐受能力,降低头颈部放射性皮炎的发生程度。     

Chronic radiodermatitis following percutaneous coronary interventions: a report of two cases

We describe two patients in whom chronic radiodermatitis with therapy-resistant ulceration of the right scapular region developed, following percutaneous coronary intervention with fluoroscopic imaging. Contrary to most reported cases in the literature, which involve numerous cardiac catheterization procedures, in both patients described here the total radiation dose was given during two successive procedures, involving difficult and prolonged coronary intervention with stent implantation. In both cases, local treatment of the ulcerative lesions was insufficient, necessitating excision of the radiodermatitis area and replacement with a skin graft, with good therapeutic result. The incidence of radiodermatitis after percutaneous coronary interventions is rising with the increasing number and complexity of these procedures. The main risk factor is a long duration of fluoroscopy using the same incidence. The skin lesions encompass a wide spectrum, ranging from erythema, telangiectasia, atrophy, hyperpigmentation and hypopigmentation to necrosis, chronic ulceration and squamous cell carcinoma. The lesions can appear from 15 days to 10 years after the procedure. To prevent radiation-induced injury, the radiation dose has to be limited and monitored. Also, careful inspection of the skin at the site of exposure is necessary and the radiographic beam has to be restricted to the smallest field size. A good clinical follow-up at regular intervals is important after long and complicated procedures.     

七味烧伤酊治疗老年喉癌气管造瘘周围放射性皮炎临床研究

目的:评价老年喉癌患者气管造瘘口周围放射性皮炎的处理效果。方法:将53例老年喉癌(年龄在60岁以上)气管造瘘口周围放射性皮炎患者,随机分成对照组20例,烧伤酊组33例,对照组患者采用常规外科换药治疗。烧伤酊组用七味烧伤酊治疗,两组均进行多元护理干预。结果:烧伤酊组患者造瘘口周围放射性皮炎的预后明显优于对照组,两者比较有显著差异性(P<0.05)。结论:正确涂用七味烧伤酊可明显改善老年气管造瘘口周围放射皮炎患者的预后,减轻患者痛苦,保证放射治疗的顺利进行。     

Cutaneous mastocytosis extending beyond a radiotherapy site: A form of radiodermatitis or a neoplastic phenomenon?

Ionising radiation is often used as an adjuvant in the management of breast cancer. Acute and chronic skin changes are well recognised complications associated with its use. We demonstrate a rare clinical presentation of cutaneous mastocytosis that occurred at the site of radiotherapy and then extended beyond this boundary, and ask whether this can be treated as a localised side effect of radiotherapy or whether the potential for systemic mastocytosis needs to be excluded.     

连柏液防治放射性皮肤损伤的临床分析

目的:观察连柏液在预防和治疗急性放射性皮肤损伤中的作用.方法:2000-05/ 2005-12治疗的126例恶性肿瘤患者随机分为2个组,75例在第1次放射治疗后给予连柏液外涂为预防组,51例只做常规放射治疗宣教和健康教育为对照1组. 将同期出现3级急性放射性皮肤损伤的92例患者随机分成治疗组54例,对照2组常规治疗38例. 根据NCI制定的CTC.V2.0急性放射性皮肤损伤的分级标准进行临床评价.结果:皮肤反应发生率预防组和对照1组分别为32.0%, 92.2%,差异有统计学意义(u=6.769, P＜0.01). 轻度放射反应(1 2级)预防组为28.0%(21/75),对照1组为70.6%(36/51),两组比较差异有统计学意义(χ2=22.226, P＜0.01). 3级急性放射性皮肤损伤患者治疗组和对照2组的有效率分别为92.6%(50/54)和65.9%(25/38),两组比较差异有统计学意义(χ2= 6.018, P=0.024). 治疗组创面愈合时间(11.07±2.21) d;对照2组愈合时间(18.08±1.76) d,二者差异有统计学意义(u=16.932, P＜0.01).结论:连柏液能有效地预防放射性皮炎的发生, 治疗3级急性放射性皮肤损伤疗效明显. 连柏液疗效安全可靠,经济,使用方便,对患者能减轻痛苦、提高生活质量、保证放射治疗的顺利进行.