直肠癌新辅助放化疗后放射性直肠肛管损伤的认识与思考

Understanding and considerations of radiation-induced rectal and anal injury after neoadju-vant chemoradiotherapy for rectal cancer

放射性直肠损伤是盆腔恶性肿瘤接受放射治疗后出现的一种放射性肠损伤,主要表现为直肠黏膜炎症、腹痛、腹泻、里急后重、直肠出血、直肠狭窄和肠瘘等。由于其临床表现缺乏特异性,诊断多依赖于影像学、电子结肠镜等辅助检查。随着新辅助放化疗在直肠癌治疗中的广泛应用,放射性直肠损伤日益多见并严重影响患者的生活质量。放射线除直接损伤直肠黏膜外,还可对肛门括约肌造成损伤,影响肛门功能。吻合口漏是直肠癌患者接受新辅助放化疗后的主要术后并发症。合理选择手术时机及手术方法能够在一定程度上减少术后并发症。本文就直肠癌新辅助放化疗过程中可能出现的放射性直肠肛管损伤作一综述,以期为该类患者的诊治提供新的思路。

Radiation-induced rectal injury,a form of radiation-induced intestine injury occurring after post-pelvic malignancies radiotherapy,primarily presents as inflammation of the rectal mucosa,accompanied by symptoms such as abdominal pain,diar-rhea,tenesmus,rectal bleeding,rectal stricture,and enterocutaneous fistula.Diagnosis,often hindered by the lack of specific clini-cal manifestations,relies on auxiliary examinations such as imaging and electronic colonoscopy.As neoadjuvant radiotherapy and chemotherapy become increasingly prevalent in rectal cancer treatment,radiation-induced rectal injury emerges as a common is-sue significantly impacting patients’quality of life.Beyond the direct impact on the rectal mucosa,radiation can also damage the anal sphincter,affecting anal function.Anastomotic leakage stands out as the primary postoperative complication for rectal cancer patients undergoing neoadjuvant radiotherapy and chemotherapy.Reasonable selection of surgical timing and methods can reduce postoperative complications to a certain extent.This article provides a comprehensive review of radiation-induced rectal and anal injury associated with neoadjuvant chemoradiotherapy for rectal cancer,aiming to offer new ideas for the diagnosis and treatment for such patients.