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

doi:10.3760/cma.j.issn.1004-4221.2020.01.008

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摘要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。

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	卢冠霖
	方诗琳
	彭亚楠
	赵秋
	施先艳
	刘静

关键词 ：放射性肠炎/氩离子凝固术, 放射性肠炎/联合治疗, 治疗结果

Abstract：Objective To preliminarily evaluate the clinical efficacy of endoscopic argon plasma coagulation (APC) combined with sub-mucosal injection of norepinephrine saline in the treatment of radiation proctitis (RP), especially for refractory RP. Methods Clinical data of 22 RP patients were retrospectively analyzed. The severity of RP was evaluated by a modified endoscopy scoring system (A) or Sherman′s classification (B). The criteria of successful treatment are the improvement of clinical symptoms or the cessation of bleeding (or only occasional traces of blood on the stools that do not need further treatment). Results All 22 patients were successfully treated. Among them, 18 patients (82%) had no bleeding. According to the classification of A, 15 patients (68%) had mild proctitis and 7(32%) experienced severe proctitis. Based on B classification, 9 patients (41%) were categorized as mild proctitis and 13(59%) as severe proctitis. Using the classification of A, the number of treatment sessions was significantly correlated with the endoscopic grade (or endoscopic total score)(Spearman’s r=0.86,P<0.001). Conclusion sPreliminary evidence demonstrates that endoscopic APC combined with sub-mucosal injection of norepinephrine saline is not only effective for mild and moderate RP, but also maintains long-term efficacy for refractory RP. Modified endoscopy scoring system (A) assessment is more suitable for clinical application compared with B assessment.

Key words： Radiation proctitis/argon plasma coagulation Radiation proctitis/combined therapy Treatment outcome

收稿日期: 2018-10-24

通讯作者: 刘静,Email:liujing_GI@whu.edu.cn;施先艳,Email:xianyan.shi@163.com

引用本文:

卢冠霖,方诗琳,彭亚楠等. 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[J]. 中华放射肿瘤学杂志, 2020, 29(1): 35-38.

Lu Guanlin,Fang Shilin,Peng Yanan et al. Preliminary clinical analysis of radiation proctitis treated with argon plasma coagulation combined with submucosal injection[J]. Chinese Journal of Radiation Oncology, 2020, 29(1): 35-38.

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