黏膜下注射联合氩离子凝固治疗慢性放射性肠病出血  

Efficacy and Safety of Submucosal Injection Combined with Argon Plasma Coagualtion for Patients with Hemorrhagic Chronic Radiation Enteropathy

作　　者：施先艳[1] 黄星[1] 刘静[1] 周瑞[1] 韩洁[1] 

机构地区：[1]武汉大学中南医院消化内科,湖北武汉430071

出　　处：《武汉大学学报（医学版）》2017年第5期808-811,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨黏膜下药物注射联合氩离子凝固治疗慢性放射性肠病出血的有效性和安全性。方法:对42例均经过药物灌肠或口服,其中3例加用高压氧治疗仍有顽固性出血者,应用结肠镜黏膜下注射联合氩离子凝固并随访,观察治疗前后便血情况、血红蛋白水平、病变面积和黏膜脆性,以及治疗后的并发症。结果:治疗后便血次数和量明显减少(P<0.005和P<0.000 1),血红蛋白水平明显上升(P<0.01),病变面积缩小和黏膜脆性减少(P<0.000 2或0.000 01)。除2例合并溃疡出血,40例经过1次或2次治疗,1次有效率87.5%(35/40),总有效率达100%(40/40)。40例随访期间(平均68.5个月)维持缓解。无严重的并发症。结论:内镜黏膜下药物注射联合氩离子凝固治疗慢性放射性肠病出血安全有效。Objective：To assess the efficacy and toxicity of submucosal injection combined with argon plasma coagulation（APC）in the endoscopic treatment for patients with bleeding chronic radiation enteropathy（CRE）.Methods：42patients（median age 56.5years）with CRE after pelvic radiotherapy for gynecologic tumors were treated with APC following submucosal injection with 1%norepinephrine solution,and followed up for a mean time of 68.5months（ranging 3-94months）between Jun 2008 and October 2016,one month after the end of endoscopic therapy.All presented with enterotitis-related anemia and refractory bleeding despite medical management before endoscopic treatment,and 34 cases of them necessitated freguently blood transfusions.Blood testing,hematochezia,endoscopic scores,and complication were recorded before and after the therapy to evaluate improvement.Results：For 35patients（83.3%,35/42）,bleeding was controlled after 1treatment.Added to 5cases after 2sessions,bleeding control was obtained in 40patients（95.2%,40/42）.Except for 2cases companied with bleeding resulting from radiation-related ulcer,eventual treatment success rates were 87.5%（35/40）and 100%（40/40）after 1and 2sessions respectively.The median clinical scores for bleeding were significantly decreased after the endoscopic therapy（P0.005 or 0.000 1）,and the hemoglobin levels were significantly increased（P〈0.01）.Also,there was improvement in friability as well as in involved surface area（P0.000 2or 0.000 01）one month after the end of treatment.The therapy was well tolerated,and no significant side effects or complications occurred.During a mean follow-up of 68.5months,all remained in remisson.Conclusion：The nonrandomized study showed that hemorragic CRE treatment with endoscopic submucosal injection combined with APC may yield a high success rate and long-term clinical remisson with no significant complications.

关 键 词：慢性放射性肠病 内镜 黏膜下注射 氩离子凝固 

分 类 号：R574.6[医药卫生—消化系统]