中国实用外科杂志

中国实用外科杂志

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放射性肠炎继发肠梗阻特点及处理要点

黄雨桦，李幼生   

  1. 上海交通大学医学院附属第九人民医院普外科，上海200011
  • 出版日期:2019-12-01 发布日期:2019-12-23

  • Online:2019-12-01 Published:2019-12-23

摘要： 放射性肠炎是腹、盆腔恶性肿瘤经放射性治疗后引起的常见消化道并发症，随着放疗病人的增多及生存时间的延长，放射性肠炎的发病率也有所增加。依据组织病理学和临床表现的差异，放射性肠炎可分为急性放射性肠炎和慢性放射性肠炎，其中约 1/3 的慢性放射性肠炎病人需要手术治疗，放射性肠炎继发肠梗阻的手术目的是解除梗阻、恢复肠道功能、防止复发。目前，放射性肠炎合并肠梗阻治疗的总体原则是行确定性的病变肠管切除和消化道重建手术。对于并发急性肠梗阻的病人，应积极采取非手术措施将急诊手术转化为择期或限期手术，降低手术风险、减少术后并发症。此外，由于慢性放射性肠炎病人出现营养不良风险较高，围手术期应进行合理的营养支持。

关键词: 放射性肠炎, 肠梗阻

Abstract: Characteristics and treatment of intestinal obstruction resulting from radiation enteritis        HUANG Yu-hua，LI You-sheng.  Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011,China
Corresponding author：LI You-sheng，E-mail：liys@medmail.com.cn
Abstract    Radiation enteritis (RE) is a common complication caused by radiotherapy of abdominal and pelvic malignant tumor. As the increase of radiotherapy and the prolongation of survival time, the incidence of RE is growing. Based on the different pathological and clinical features, RE can be divided into acute and chronic RE, and about one third chronic RE patients require surgical treatment. The aims of surgery for intestinal obstruction resulting from RE are to relieve obstruction, restore intestinal function and prevent recurrence. The general principle of surgery is to definitely remove the damaged intestine and reconstruct the continuity of digestive tract. However, for the RE patients with acute intestinal obstruction, surgeons prefer to take non-surgical measures to transform emergency surgery into elective or limited-time surgery, in order to reduce the risk of operation and postoperative complications. Moreover, because the patients with chronic RE are at high risk of malnutrition, proper nutritional support should be considered in the perioperative period.

Key words: radiation enteritis, intestinal obstruction