放射性肠炎继发肠梗阻特点及处理要点

Characteristics and treatment of intestinal obstruction resulting from radiation enteritis

放射性肠炎是腹、盆腔恶性肿瘤经放射性治疗后引起的常见消化道并发症,随着放疗病人的增多及生存时间的延长,放射性肠炎的发病率也有所增加。依据组织病理学和临床表现的差异,放射性肠炎可分为急性放射性肠炎和慢性放射性肠炎,其中约1/3的慢性放射性肠炎病人需要手术治疗,放射性肠炎继发肠梗阻的手术目的是解除梗阻、恢复肠道功能、防止复发。目前,放射性肠炎合并肠梗阻治疗的总体原则是行确定性的病变肠管切除和消化道重建手术。对于并发急性肠梗阻的病人,应积极采取非手术措施将急诊手术转化为择期或限期手术,降低手术风险、减少术后并发症。此外,由于慢性放射性肠炎病人出现营养不良风险较高,围手术期应进行合理的营养支持。

Radiation enteritis(RE) is a common complicationcaused by radiotherapy of abdominal and pelvic malignanttumor. As the increase of radiotherapy and the prolongation ofsurvival time, the incidence of RE is growing. Based on thedifferent pathological and clinical features, RE can be dividedinto acute and chronic RE, and about one third chronic REpatients require surgical treatment. The aims of surgery forintestinal obstruction resulting from RE are to relieve obstruction, restore intestinal function and prevent recurrence.The general principle of surgery is to definitely remove thedamaged intestine and reconstruct the continuity of digestivetract. However, for the RE patients with acute intestinalobstruction, surgeons prefer to take non-surgical measures totransform emergency surgery into elective or limited-timesurgery, in order to reduce the risk of operation andpostoperative complications. Moreover, because the patientswith chronic RE are at high risk of malnutrition, propernutritional support should be considered in the perioperativeperiod.