不同诊断分型的慢性放射性直肠损伤临床治疗转归:85例回顾性分析

Clinical outcomes of chronic radiation rectal injury with different diagnostic types:a retrospective analysis of 85 cases

目的以放射性直肠损伤专家共识(2021版)为依据,描述慢性放射性直肠损伤(RLRI)患者不同临床分型的临床特征,分析不同临床分型患者并发症差异,并对比不同分型患者的临床治疗方法及治疗效果。方法选取2020年1月至2020年12月于中山大学附属第六医院结直肠肛门外科住院治疗的85例RLRI患者的临床资料进行回顾性总结,分析不同临床分型之间的临床资料特点、治疗方式、治疗效果及并发症(包括瘘、狭窄、梗阻、穿孔等)之间的差异。结果在85例RLRI患者中,毛细血管扩张型占29例,溃疡型占12例,狭窄型占4例,混合型占40例;RLRI不同临床分型患者的年龄、BMI、RTOG/EORTC评分、VRS评分、血清白蛋白差异存在统计学意义(P<0.05);不同临床分型患者的并发症差异有统计学意义(Z=-5.066,P<0.001);不同临床分型患者的治疗方式及治疗效果差异无统计学意义(χ^(2)=3.021,P=0.388;χ^(2)=0.299,P=0.861)。结论不同分型的RLRI患者年龄、BMI、血清白蛋白、RTOG/EORTC评分、VRS评分等临床资料差异存在统计学意义,且临床分型为毛细血管扩张型的患者发生并发症的概率更高,提示早期干预及个性化升阶梯("step-up")治疗的重要性,值得临床医师在诊疗过程中参考。

Objective According to the expert consensus of the radioactive rectal injury(2021 edition),the clinical characteristics of different clinical types of patients with radiation-induced late rectal injury(RLRI)were described,the differences in complications among different clinical types were analyzed,and the clinical treatment methods and therapeutic effects of different types of patients were compared.Methods The clinical data of 85 patients with RLRI who were hospitalized in the Department of Colorectal and Anal Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University from January 2020 to December 2020 were retrospectively summarized.The differences of clinical data characteristics,treatment methods,treatment effects,complications(including fistula,stenosis,obstruction,perforation,etc.)among different clinical types were analyzed.Results Among 85 patients with RLRI,there were 29 cases of telangiectasia,twelve cases of ulceration,four cases of stenosis and 40 cases of mixed.There were statistical differences in age,BMI,RTOG/EORTC score,VRS score and serum albumin in patients with different clinical types of RLRI(P<0.05).The complications of different clinical types were significantly different(Z=-5.066,P<0.001).There was no significant difference in treatments and therapeutic effect among different clinical types(χ^(2)=3.021,P=0.388;χ^(2)=0.299,P=0.861).Conclusion Clinical data such as age,BMI,albumin,RTOG/EORTC score and VRS score were different in patients with RLRI of different types,and patients with clinical classification of telangiectasia had a higher probability of complications,suggesting the importance of early intervention and personalized step-up treatment,which is worthy of reference by clinicians in the diagnosis and treatment process.