中国放射性直肠损伤多学科诊治专家共识(2021版)要点解读

Interpretation of Chinese expert consensus on multidisciplinary diagnosis and treatment of radiation rectal injury(2021 edition)

盆腔放疗在恶性肿瘤治疗过程中发挥了重要作用,但仍难以避免造成放射性损伤。2021年,在中华医学会外科学分会结直肠外科学组、中国医师协会外科医师分会结直肠外科医师委员会和中国抗癌协会大肠癌专业委员会的共同推动下,放射性肠损伤诊治专家组更新制订了2021版《中国放射性直肠损伤多学科诊治专家共识》(以下简称"共识")。与《中国放射性直肠炎诊治专家共识(2018版)》相比,该版本有较大的改动,更新主要体现在以下几个方面:(1)调整放射性直肠损伤名称:将"放射性直肠炎"这一称谓调整为"放射性直肠损伤";(2)倡导盆腔整体性损伤概念和多学科诊治模式;(3)提出疾病临床分型:慢性期损伤分型包括毛细血管扩张型、溃疡型、狭窄型和混合型;(4)根据上述疾病分型特点进行个体化治疗,并调整非手术治疗的推荐等级;(5)提出手术治疗的具体指导原则与细节:"损伤控制"原则和"扩大切除"原则等方面。新版"共识"对疾病分析及治疗策略等进一步细化,提高了临床实践指导价值,为我国放射性直肠损伤的规范化诊治提供了重要参考依据。

Although pelvic radiotherapy has played an important role in the treatment of malignant tumors,it is still difficult to avoid radiation damage within a certain period of time.In 2021,under the joint promotion of Colorectal Surgery Group of Chinese Medical Association Surgery Branch,Colorectal Surgeons Committee of Chinese Medical Doctor Association Surgeons Branch,Colorectal Surgeons Committee of Chinese Medical Doctor Association,and Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association,Expert Group on Diagnosis and Treatment of Radiation Intestinal Injury has updated and formulated the 2021 edition of the"Chinese expert consensus on the multidisciplinary diagnosis and treatment of radiation rectal injury"(hereinafter referred to as"Consensus").This Consensus edition has major changes compared with the"Chinese consensus on the diagnosis and treatment of radiation proctitis(2018)",which mainly updates in the following aspects:(1)adjusting the name of radiation rectal injury:the term"radiation proctitis"was adjusted to"radiation rectal injury";(2)advocating the concept of pelvic integral injury and the multidisciplinary diagnosis and treatment model;(3)putting forward the clinical classification of diseases:the classification of the chronic rectal injury includes telangiectasia,ulcer,stenosis and mixed type;(4)carrying out individualized treatment based on the characteristics of the above-mentioned disease classification,and adjusting the recommended level of non-surgical treatment;(5)proposing specific guiding principles and details of surgical treatment:"damage control"and"expanded resection"principles,etc.This new edition(2021)of Consensus further refines the disease analysis and treatment strategies,which not only improves the guiding value of clinical practice,but also provides an important reference for the standardized diagnosis and treatment of radiation rectal injury in China.