氩离子凝固术治疗出血性慢性放射性直肠炎的效果  

Efficacy of argon plasma coagulation for hemorrhagic chronic radiation proctitis

作　　者：郑焱华 卢俊会 陈星[1] Zheng Yanhua;Lu Junhui;Chen Xing(Endoscopy Center,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China;Shanxi Medical University,Taiyuan 030001;Department of Gastroenterology,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西省肿瘤医院、中国医学科学院肿瘤医院山西医院、山西医科大学附属肿瘤医院内镜中心,太原030013 [2]山西医科大学第一医院消化内科,太原030001

出　　处：《肿瘤研究与临床》2023年第5期376-379,共4页Cancer Research and Clinic

基　　金：国家重点研发计划(2016YFC1303601);山西省重点研发计划(201903D321140)。

摘　　要：目的探讨氩离子凝固术(APC)治疗出血性慢性放射性直肠炎(HCRP)患者的有效性和安全性。方法回顾性分析2017年1月至2021年6月山西省肿瘤医院36例接受APC治疗的HCRP患者的临床资料。使用Zinicola内镜评分和维也纳直肠镜评分对HCRP严重程度进行分级。治疗成功定义为最后一次APC治疗后6个月内直肠出血停止或偶尔出现不需要治疗的便血。结果中位随访时间为1.63年(0.85~2.68年)。依据Zinicola内镜评分,20例(55.6%)患者为重度HCRP。32例HCRP患者在APC治疗后直肠成功止血,4例重度HCRP患者在进行多次APC治疗后仍有直肠出血的症状。患者使用APC治疗(2.7±1.0)次,APC治疗前后HCRP患者的Zinicola内镜评分分别为(3.6±0.8)分和(1.4±1.1)分,维也纳直肠镜评分分别为(3.8±0.8)分和(1.2±1.1)分,差异均有统计学意义(t值分别为22.37、18.96,均P<0.001)。HCRP患者经APC治疗前后血红蛋白水平分别为(85±15)g/L和(100±17)g/L,差异有统计学意义(t=17.86,P<0.001)。未见APC治疗相关的狭窄、穿孔或瘘管等严重并发症。结论APC可能是HCRP患者有效且安全的治疗选择。Objective To investigate the efficacy and safety of argon plasma coagulation(APC)in the treatment of patients with hemorrhagic chronic radiation proctitis(HCRP).Methods The clinical data of 36 HCRP patients who received APC treatment in Shanxi Province Cancer Hospital between January 2017 and June 2021 were retrospectively analyzed.The severity of HCRP was assessed by using the Zinicola endoscopic score and the Vienna proctoscopy score.The elimination of rectal bleeding or occasional bloody stools that did not require further treatment within 6 months of the last APC treatment was considered to be the therapy success.Results The median follow-up time was 1.63 years(0.85-2.68 years).There were 20(55.6%)patients with severe HCRP according to the Zinicola endoscopic score.After APC treatment,32 patients with HCRP obtained adequate rectal hemostasis,whereas 4 patients with severe HCRP still experienced rectal bleeding symptoms after APC treatment for several times.All patients received APC treatment for(2.7±1.0)times in total.The endoscopic scores of HCRP patients before and after APC treatment were(3.6±0.8)scores,(1.4±1.1)scores,respectively;Vienna proctoscopy scores were(3.8±0.8)scores,(1.2±1.1)scores,respectively;and the differences were statistically significant(t values were 22.37,18.96;all P<0.001).The hemoglobin levels of HCRP patients before and after APC treatment were(85±15)g/L,(100±17)g/L,respectively,and the difference was statistically significant(t=17.86,P<0.001).Serious side effects including strictures,perforations,or fistulas and other severe complications related to APC therapy were not found.Conclusions APC may be an effective and safe treatment option for patients with HCRP.

关 键 词：辐射损伤 直肠炎 氩离子凝固术 治疗结果 安全性 

分 类 号：R730.55[医药卫生—肿瘤]