66例急性放射性食管炎的临床研究

The clinical research on acute radiation-induced esophagitis of 66 patients

探讨了胸部肿瘤放射治疗时所引起的急性放射性食管炎的临床症状特点、内镜发现、病理改变,以为急性放射性食管炎的诊断提供依据。对66例X射线照射治疗的胸部肿瘤病人,用RTOG临床评分和内镜评分评价急性放射性食管炎,同时分析了临床症状、内镜改变、病理改变与累积剂量之间的关系。发现急性放射性食管炎的临床症状主要为吞咽困难、吞咽疼痛、胸骨后烧灼感,尤其在进食时和放疗第2—3周内。累积剂量为20—30Gy时,根据美国放射肿瘤学协作组(RadiationTherapyOncologyGroup,RTOG)对急性放射性食管炎的分级标准,66例肺癌及食管癌病人放射治疗后48例(72.7%)发生急性放射性食管炎,其中1级34例(51.5%)、2级12例(18.1%)、3级2例(3.0%),无4级损伤。根据Kuwahata’s内镜评分标准,18例病人在放疗中行镜检,0级为2例(11%)、1级为9例(50%)、2级为5例(27.8%),3级为2例(11.2%)。内镜检查见粘膜糜烂、脱落,可有溃疡形成,病理改变多表现为鳞状上皮内有炎细胞侵润、基底层崩解、深染、细胞坏死。急性放射性食管炎的诊断应有明确的射线接触史,并超过剂量阈值,出现典型的临床症状。但因照射条件和个人敏感性不同,剂量域值仅为参考。内镜检查是主要的诊断手段。病理检查在区别溃疡良恶性上可发挥重要作用。

The work is to study radiotherapy-induced clinical symptoms of endoscopic findings, pathological changes and evaluation of esophagitis in the thorax. The clinical symptoms of 66 patients under radiotherapy were evaluated with the accumulated dose, endoscopic findings of esophagus and pathological changes. Typical symptoms in 2-3 weeks included moderate dysphagia or odynophagia and requiring narcotic analgesics with 20-30Gy of the accumulated dose. Endoscopic findings of esophagus were with erosion of mucosa or without sloughing, pathological changes of esophagus were the infiltration of inflammatory cells in squamous epithelium, disintegration of basic layer, deeply stained necrosis of cells. The grade≥2 acute esophagifis using RTOG criteria was observed 21.2%, and the grade 3 is 3.0%. The grade 2 and 3 acute esophagifis using Kuwaht＇s criteria was observed 38.5%. The diagnosis of acute esophagifis should include history of exposure to radiation, with doses exceeding the dose threshold, and typical clinical characteristics. Endoscopic examination is very useful for diagnosis, since such examination can provide accurate information. RTOG scores correlate closely with endoscopic grading, and is convenient and precise. Pathology can distinguish between benign and malignant changes of ulcer.