放射性直肠炎的预后危险因素分析

Risk factors associated with prognosis in patients with radiation proctitis

目的探讨与放射性直肠炎预后相关的危险因素。方法对2007年8月至2010年2月期间收治的33例放射性直肠炎患者的临床疗效及生活质量进行随访以评价预后，并进一步通过回顾性分析不同预后患者临床资料的差异．寻找与预后相关的危险因素。结果33例患者的原发肿瘤包括宫颈癌22例、前列腺癌3例、卵巢癌2例、直肠癌2例、子宫内膜癌2例、宫颈癌合并卵巢癌1例、阴道癌1例。在收集到放疗资料的18例患者中，照射剂量为（61．3±12．9）Gy。接受放疗至出现放射性直肠炎症状的时间为（11．7±12．8）个月，均通过临床症状及结肠镜检查确诊。治疗方法包括药物保留灌肠11例．甲醛局部烧灼止血9例，手术治疗12例（为直肠阴道瘘、大出血、肠梗阻等严重并发症者．其中行病变肠管切除9例，单纯造瘘3例），1例未行任何治疗。患者总的临床有效率75％，总体生活质量（63．79±20．92）分，预后良好者占75％；手术治疗的有效率为91．7％。性别为与预后相关的危险因素（P〈0．05），而病变程度、治疗方法并非预后的危险因素（均P〉0．05）。结论性别是放射性直肠炎预后的危险因素：病变程度不同并不意味着预后不同：对出现严重并发症的患者采取手术治疗可明显改善其近期生活质量。

Objective To investigate risk factors associated with prognosis in patients with radiation proetitis （RP）. Methods Between August 2007 and February 2010, 33 patients diagnosed with radiation proctitis were identified. Data pertaining to treatments and quality of life （QOL） were analyzed retrospectively. Results Indication for radiation included cervical cancer （n=22）, prostate cancer （n=3）, ovary cancer （n=2）, rectal cancer （n=2）, endometrical cancer（n=2）, cervical cancer （n=1）, and vaginal cancer（n=1）. Data regarding radiation were available in 18 patients, and the mean dose was （61.3±12.9） Gy with a median dose of 61 Gy. Eleven were treated with enema therapy, 9 formalin dab, 12 surgical operations. Clinical improvement was noticed in 75% of the patients with a mean QOL score of 63.79±20.92. Prognosis was favorable in 75% of the patients. Surgical treatment was effective in 91.7% of ihe patients with severe complications. Univariate analysis showed that gender was associated with the prognosis of RP, while the severity of RP and treatment method were not predictive for RP prognosis. Conclusions Gender but not disease severity is associated with the prognosis of radiation proctitis. Surgery may be beneficial to RP patients with severe complications.