摘要
慢性放射性肠损伤是指盆腔恶性肿瘤患者,接受放射治疗3个月后出现的迁延反复的肠道损伤。慢性放射性肠损伤出现肠道大出血、梗阻、穿孔、肠瘘等晚期并发症后,均需手术治疗。目前国内外尚没有标准的慢性放射性肠损伤手术方式。本文将从慢性放射性肠损伤的病理机制和损伤范围角度,阐述慢性放射性肠损伤的手术难点,并结合文献资料及本中心诊治经验,探讨相应手术对策。慢性放射性肠损伤的病理机制主要为进行性闭塞性动脉内膜炎和间质纤维化;损伤范围包括小肠、末端回肠、乙状结肠及直肠。慢性放射性损伤患者组织愈合能力差、盆腔纤维化和多器官受累以及机体条件差,并发症发生率及病死率较高。确定性的病变肠管切除是常规的手术方式,扩大切除放射性损伤肠管,以保证吻合口一端没有放射性损伤,是减少吻合口并发症的关键。
Chronic radiation intestinal injury denotes the repeated and prolonged damage of intestine caused by radiotherapy to pelvic malignancy,which usually occurs after three months of radiotherapy.Surgical intervention is indicated when the progressive intestinal injury leads to the development of massive intestinal hemorrhage,obstruction,perforation,fistula and other late complications.However,there is no consensus on the surgical procedures.We illustrate the dilemma in surgical treatment from the points of pathological mechanism and the frequent sites of radiation intestinal injury.Meanwhile,we discuss the surgical alternatives of radiation intestinal injury based on the literature and our experience.The pathological mechanism of chronic radiation injury is progressive occlusive arteritis and parenchymal fibrosis.The frequently involved sites are distal ileum,sigmoid colon and rectum based on the radiotherapy region.The morbidity and mortality are high in surgery of chronic radiation injury due to poor ability of tissue healing,pelvic fibrosis,multiple organ damage,and poor physical condition.Definitive intestinal resection is one of the most common surgical procedures.Extended resection of diseased bowel to ensure that there is no radiation damage in at least one end of the anastomotic bowels is the key to decrease the risk of complications related to anastomotic sites.
作者
马腾辉
王辉
汪建平
Ma Tenghui;Wang Hui;Wang Jianping(Department of Colorectal Surgery,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases,Guangdong Institute of Gastroenterology,Guangzhou,Guangdong 510655,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2020年第8期728-733,共6页
Chinese Journal of Gastrointestinal Surgery
基金
国家自然科学基金(81803163)
广东省自然科学基金(2018A030310319)。
关键词
放射性肠损伤
慢性
并发症
晚期
手术治疗
Radiation intestinal injury,chronic
Complications,late
Surgical treatment
