中国放射性直肠炎诊治专家共识(2018版)

Chinese consensus on diagnosis and treatment of radiation proctitis (2018)

放射性直肠炎是指因盆腔恶性肿瘤接受放疗后引起的直肠放射性损伤。放射性直肠炎的临床诊疗实践应从诊断、治疗及预防去充分考量。放射性直肠炎的诊断应综合临床、内镜、影像学及组织病理学,运用各项评分标准表现对症状和病变严重程度及病情所处阶段作出评估,以确定治疗策略及治疗方案。在治疗决策上,应尽可能通过非手术治疗缓解主要症状,避免严重并发症的发生;针对病情反复、病情进展的患者,转流性肠造口术及病变肠管切除是主要的外科治疗手段。在预防上,针对放射性直肠炎的高危患者,应通过放疗技术的改进、物理防护及药物预防等方法进行综合预防。本指南旨在为我国放射性直肠炎临床诊疗实践提供指导意见。

Radiation proctitis denotes the radiation damage of rectum caused by radiotherapy to pelvic malignancy.The clinical practices of radiation proctitis should be fully considered from diagnosis,treatment and prevention. In order to determine appropriate treatment strategies,the diagnosis of radiation proctitis should be based on clinical symptoms,endoscopic findings,imaging and histopathology to assess severity of symptoms and stage of disease.In terms of treatment decisions,non-surgical interventions are generally applied to relieve major symptoms and avoid serious complications.Diverting colostomy and restorative resection are the main surgical treatments for patients with recurrent symptoms.In terms of prevention,radiation proctitis should be prevented by improvement of radiotherapy technology,physical protection and prophylactic medication.This guide aims to provide guidance for the clinical practices of radiation proctitis in China.