内镜下氩离子凝固术与光动力疗法治疗2例放射性肠炎出血

Endoscopic argon plasma coagulation and photodynamic therapy for 2 cases of hemorrhagic radiation enteritis

目的探讨放射性肠炎出血的有效治疗方法。方法对临床确诊的放射性肠炎出血患者予以内镜下氩离子凝固术与光动力疗法。结果58岁男性患者,因前列腺癌接受放射治疗,放疗术后半年出现便血。结肠镜检查：距肛门4-6cm直肠见弥漫扩张的毛细血管网伴新鲜渗血,确诊为放射性肠炎出血。予以内镜下氩离子凝固术（APC）,随访半年无复发出血。52岁女性患者,宫颈癌放射治疗术后1年余,便血5个月。结肠镜检查：距肛门4-8cm直肠见弥漫扩张的畸形毛细血管网伴新鲜渗血,确诊为放射性肠炎出血。予以内镜下光动力疗法（PDT）,随访2年无复发出血。结论内镜下APC与PDT治疗放射性肠炎出血安全有效,能否作为放射性肠炎出血的一线治疗手段尚需临床进一步研究。

Objective To find out the effective therapy for hemorrhagic radiation enteritis. Methods Patients with clinically diagnosed hemorrhagic radiation enteritis were treated with endoscopic argon plasma coagulation and photodynamic therapy. Results Patient one, a 58-years old male, had hematochezia 6 months after radiotherapy for prostatic carcinoma. Endoscopy showed diffuse telangiectacia with fresh bleeding in the rectum 4-6cm beyond the anus, which was diagnosed as hemorrhagic radiation enteritis and treated with argon plasma coagulation. No relapse was observed during the 6-month follow-up. Patient two, a 52-yearsold female, had hematochezia for 5 months, one year after radiotherapy for cervical cancer. Endoscopy showed diffuse telangiectacia with fresh bleeding in the rectum 4-8cm beyond the anus, which was diagnosed as hemorrhagic radiation enteritis and treated with photodynamic therapy. No recurrence was found during the 2-year follow-up. Conclusion Endoscopic argon plasma coagulation and photodynamic therapy are safe, effective for hemorrhagic radiation enteritis. However, further study is needed to determine whether they can be used as the first-line therapy for hemorrhagic radiation enteritis.