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

摘要： 放射治疗是盆腔恶性肿瘤常用的治疗方法，但放射剂量的积累可能导致放射性肠损伤（RII）。肠瘘是RII的严重并发症，显著影响病人的生活质量。由于RII在急性期和慢性期的病理生理差异，针对不同阶段的肠瘘应采取不同的治疗策略。对于急性RII合并肠瘘，应以“损伤控制”为主要指导原则，采用创伤较小的治疗方法尽可能迅速地控制感染。对于慢性RII合并肠瘘，应力争进行放射性损伤“责任病灶”的确定性切除。RII合并肠瘘常累及盆腔邻近器官，因此，应树立整体盆腔观念，结合多学科协作进行病情的综合评估，从而制定个体化的治疗方案。肠造口转流术是重要的过渡性治疗手段，合理应用可为病情危重的病人创造二期手术的机会。对于存在多器官瘘或复杂瘘的病人，联合器官切除或全盆腔器官切除是最终的治疗选择。

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