关键词: 放射性肠损伤, 肠瘘, 损伤控制, 确定性切除, 多学科协作

Abstract: Radiotherapy is a common treatment for pelvic malignancies, but cumulative radiation doses may lead to radiation-induced intestinal injury (RII). Enteric fistula, a severe complication of RII, significantly impacts patients’ quality of life. Due to the distinct pathophysiological mechanisms of acute and chronic RII, stage-specific therapeutic strategies should be adopted for enteric fistula. For acute RII with enteric fistula, the guiding principle should be “damage control”, prioritizing rapid infection management through minimally invasive interventions. In chronic RII with enteric fistula, definitive resection of the radiation-injured “culprit lesions” is the primary goal. Since RII-associated enteric fistula often involves adjacent pelvic organs, a holistic pelvic perspective combined with multidisciplinary collaboration is essential for comprehensive evaluation and individualized treatment planning. Enterostomy diversion plays a pivotal role in staged surgical management and its reasonable application can provide a window for secondary definitive resection. For patients with multi-visceral fistulas or complex fistulas, multi-visceral resection or total pelvic exenteration may ultimately be required.

Key words: radiation-induced intestinal injury, intestinal fistula, damage control, definitive resection, multidisciplinary collaboration