复方血竭灌肠与庆大霉素联合地塞米松灌肠对放射性直肠炎的疗效比较

[目的]比较复方血竭与庆大霉素联合地塞米松灌肠对放射性直肠炎的疗效。[方法]采用完全随机、三盲方法将187例放射性肠炎患者分为治疗组与对照组;治疗组99例采用复方血竭灌肠液灌肠,对照组88例采用庆大霉素联合地塞米松灌肠,疗程均为20d;观察2组治疗后临床疗效及内镜评价疗效。[结果]治疗组临床总有效率为88.7%,内镜评价总有效率为88.6%;对照组临床总有效率为75.9%;内镜评价总有效率为72.4%。2组在临床、内镜评价上均差异有统计学意义(P0.05)。[结论]用复方血竭和庆大霉素联合地塞米松灌肠方法治疗放射性直肠炎均有良好疗效,但复方血竭优于庆大霉素联合地塞米松。     

太宁栓对放射性直肠炎临床症状改善的作用

[目的]探讨应用太宁栓(复方角菜酸酯栓)治疗放射性直肠炎的效果。[方法]将30例宫颈癌根治性放疗后出现放射性直肠炎患者随机分为观察组、对照组,每组15例。对照组行常规静脉用药治疗;观察组在此基础上使用太宁栓1枚每12h直肠给药1次,嘱直肠给药后呈俯卧位,臀部抬高10cm,持续10min。治疗1周后比较2组近期临床症状改善情况。[结果]观察组总有效率93.3%,对照组总有效率53.3%,2组患者近期疗效比较差异有统计学意义(P0.05);2组均未见不良反应。[结论]放射性直肠炎加用太宁栓可显著提高疗效,并且有见效快、使用方便、不良反应小、依从性好等优点。     

中西医结合治疗宫颈癌放疗患者放射性直肠炎的疗效观察

目的：评价中西医结合治疗宫颈癌放疗患者放射性直肠炎的疗效。方法将46例放疗后出现放射性直肠炎的宫颈癌患者随机均分为两组,对照组给予常规西药止血、消炎治疗,观察组在此基础上给予中药十全大补汤加味口服。治疗前后采用国际放疗远期并发症评分标准LENT-SOMA分级标准和积分法疗效评定标准分别对两组的放射性直肠炎进行评价。结果观察组临床症状明显改善,治疗总有效率为82．6％,对照组为69．6％,两组比较有统计学差异（ P＜0．05）。结论中西医结合治疗宫颈癌放疗患者的放射性直肠炎疗效显著,优于单纯西药治疗。     

康复新液保留灌肠治疗急性放射性直肠炎38例

[目的]观察康复新液保留灌肠治疗急性放射性直肠炎的疗效。[方法]将75例急性放射性直肠炎患者随机分为2组:治疗组38例和对照组37例。2组患者均采用抗感染、补液、营养支持及少渣饮食等治疗,在此基础上,治疗组用0.9%氯化钠加康复新液保留灌肠,每晚1次;对照组给予0.9%氯化钠、地塞米松、庆大霉素、锡类散混合溶液保留灌肠,每晚1次;10d为1个疗程,经2个疗程治疗后,比较2组总有效率、结肠镜肠黏膜改变及复发率情况。[结果]治疗组总有效率(94.7%)与对照组(89.2%)比较差异无统计学意义(P>0.05)。治疗组在肠黏膜改善及总复发率方面均明显优于对照组(P<0.05)。[结论]康复新液保留灌肠治疗放射性直肠炎简便易行,疗效确切,复发率低于对照组。     

中医治疗放射性直肠炎31例临床观察

[目的]分别观察中药口服配合中药灌肠和针刺配合中药口服及中药灌肠治疗放射性直肠炎的临床疗效。[方法]选取临床中符合放射性直肠炎的患者31例,随机分为2组,其中第1组15例患者,采用中药口服配合中药灌肠治疗,第2组16例患者,采用针刺配合中药口服及中药灌肠治疗,治疗后分别观察2组的临床疗效,并对比2组疗效。[结果]2组治疗方法治疗放射性直肠炎均有明显的疗效,其中中药口服配合中药灌肠组治疗放射性直肠炎治愈为40.0%,针刺配合中药口服及中药灌肠组治疗有效率为56.3%。[结论]中药口服、中药灌肠、针刺对放射性直肠炎的治疗均有明显的疗效,而将三种方法配合使用能更加显著的提高临床疗效。     

复方血竭对放射性直肠炎的疗效观察

目的 观察复方血竭灌肠剂对放射性直肠炎的临床疗效.方法 对符合条件的34例病人分为对照组与治疗组,分别予以常规消炎、止血、止泻药物及本医院制剂室制备的复方血竭灌肠,对比治疗前后的肠镜下直肠黏膜表现及活检组织病理改变.结果 治疗组有效率94%,对照组有效率95%,2组有效率有统计学差异.结论 在放射性直肠炎的治疗中,复方血竭灌肠可以有效减轻炎症的发生.     

中药灌肠治疗直肠炎1009例的疗效观察

[目的]观察中药灌肠液在治疗直肠炎中的疗效.[方法]回顾性分析武汉市第八医院2004年1月～2014年5月以中药灌肠液灌肠一号治疗直肠炎患者的临床资料,分析其治疗效果.[结果]运用中药灌肠液治疗直肠炎1 009例,治愈928例,治愈率为91.97％;好转74例,好转率为7.33％;无效7例,无效率为0.7％.总有效率99.3％.[结论]中药灌肠液治疗直肠炎,方法简单,效果明显,不良反应少,值得进一步推广.     

西瓜霜喷剂灌肠治疗放射性直肠炎32例疗效观察

放射性直肠炎是放疗常见的并发症，2006—2008年，我们应用西瓜霜喷剂灌肠治疗放射性直肠炎患者32例，取得满意效果。现报告如下。     

复方谷氨酰胺对重度放射性直肠炎的疗效及对炎性细胞因子水平的影响

[目的]探讨复方谷氨酰胺对重度放射性直肠炎的治疗效果及对患者炎性细胞因子水平的影响。[方法]78例重度放射性直肠炎患者随机分为观察组(41例)和对照组(37例)。对照组采用5mg地塞米松加100mg利多卡因配100ml的0.9%氯化钠溶液每晚灌肠1次;观察组在对照组基础上加用复方谷氨酰胺口服,3次/d,每次3粒。治疗3周后评价2组疗效及血液中炎性细胞因子(TNF-α及IL-8)的变化。[结果]观察组临床有效率为78.0%(32/41),结肠镜检查缓解率为82.9%(34/41);对照组临床有效率为48.6%(18/37),结肠镜检查缓解率为56.8%(21/37);2组在临床有效率及结肠镜检查缓解率上比较均差异有统计学意义(P0.05)。治疗后2组血液中TNF-α及IL-8均下降,但观察组较对照组下降更明显(P0.05)。[结论]在用地塞米松加利多卡因灌肠治疗重度放射性直肠炎的基础上加用复方谷氨酰胺口服,可以显著提高临床有效率及结肠镜检查缓解率,并能显著降低血液中炎性细胞因子的水平。     

内镜下喷洒中药凝胶剂治疗溃疡性结肠炎52例

[目的]观察内镜下喷洒中药凝胶剂治疗溃疡性结肠炎(UC)的临床效果。[方法]100例UC患者随机分为治疗组52例,运用中药凝胶剂内镜下喷洒治疗;对照组48例,用柳氮磺胺吡啶栓肛门塞入治疗,2组间进行疗效对比观察。[结果]治疗组近期治愈率及总有效率为65.38%及92.31%;对照组分别为37.48%及72.29%;2组间比较差异均有统计学意义(均P<0.01)。[结论]中药凝胶剂内镜下喷洒治疗UC疗效可靠,且不良反应少。     

Formalin instillation for refractory radiation-induced hemorrhagic proctitis

PURPOSE: Our goal was to evaluate use of topical (4 percent) formalin in management of radiation-induced hemorrhagic proctitis, refractory to other methods of treatment. Specifically, we wished to determine its safely, ability to stop bleeding, and complications associated with therapy. METHODS: Sixteen patients with radiation-induced hemorrhagic proctitis were treated with topical (4 percent) formalin. All had been previously treated with conservative regimens such as cautery, topical steroids, or laser, but these had failed. Five-hundred milliliters (ml) of a 4 percent formalin solution was instilled into the rectum in 50-ml aliquots. Each aliquot was kept in contact with rectal mucosa for approximately 30 seconds. Treatments were performed under local anesthesia in nine patients, sedation only in four, spinal in two, and general in one patient. RESULTS: In 12 patients, bleeding stopped after a single formalin instillation; in 3, bleeding was considerably reduced but continued sporadically. One patient required three treatments before bleeding stopped. Four patients developed postoperative anal pain, of which one also had significant tenesmus and reduced capacity. Of these four patients, only two had significant anal pain and fissures that lasted longer than one month. CONCLUSIONS: Topical (4 percent) formalin is safe and effective in treatment of radiation-induced hemorrhagic proctitis. A single treatment will stop bleeding in 75 percent of patients.Supported in part by the Bowman Research Fund.Read at the meeting of The American Society of Colon and Rectal Surgeons, Montreal, Quebec, Canada, May 7 to 12, 1995.     

Application of 10 Percent Formalin for the Treatment of Radiation-Induced Hemorrhagic Proctitis

Purpose Rectal instillation of 4 percent formalin solution has been described as a successful treatment for hemorrhagic radiation proctitis recalcitrant to medical treatment. We present our experience with a new method of treatment involving the topical application of 10 percent buffered formalin, which is well tolerated and suitable for office use. Methods Patients with marked or refractory rectal bleeding and clinical features consistent with radiation proctitis were reviewed. Treatment involved direct application of a 10 percent buffered formalin solution to the affected mucosa using a 16-inch cotton tip applicator applied through a proctoscope in the office setting. Results A total of 100 patients with a mean age of 75 (range, 49–91) years were followed for 18 (range, 1–79) months. The interval from radiation exposure to formalin treatment was 21 months. Overall, 93 percent of patients had cessation of bleeding after an average of 3.5 formalin applications at two-week to four-week intervals. Patients with severe (Grade 3) proctitis and those taking aspirin required an average of 1.5 additional treatments. A total of eight patients rebled at a mean of 24 months from treatment; however, all responded to further applications of formalin. Three patients complained of anal pain and one experienced dizziness postprocedure for a complication rate of 1.1 percent. Conclusions We present a simple, cost-effective, and well-tolerated method of controlling hemorrhagic radiation proctitis. It is performed by using materials readily available in the office of a colon and rectal surgeon, eliminating the need for bowel preparation, anesthesia, or a surgical suite. Poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, New Orleans, Louisiana, June 21 to 26, 2003.     

Two Percent Formalin Retention Enemas for Hemorrhagic Radiation Proctitis: A Preliminary Report

Purpose The short-term safety and efficacy of 2 percent formalin administered as a retention enema for hemorrhagic radiation proctitis was studied. Methods A group of 24 patients with hemorrhagic radiation proctitis who received radical radiotherapy were administered 2 percent formalin as a retention enema and the treatment was followed up from 1 to 29 (mean, 15.34) weeks. The enema was performed on an outpatient basis under sedation with pentazocine and promethazine with a retention time of two minutes. The symptoms and proctoscope findings were graded and converted into a numeric score, ranging from 1 to 4. The mean improvements in scores before treatment and after the last follow-up were analyzed for statistical significance by using the paired t-test. Results There was complete cessation of bleeding in 47.8 percent of patients and very negligible bleeding in 30.4 percent. A total of 78.2 percent responded positively to treatment with 2 percent formalin retention enema. More than one application was required in 34.7 percent of the patients. The procedure was well tolerated and most of the side effects were mild. Side effects were diarrhea in 23.5 percent, abdominal pain and tenesmus in 8.8 percent, and fever with vomiting in 2.9 percent of patients. There was a statistically significant reduction in bleeding and proctoscopy scores (P < 0.01). None of the patients in this study required surgery to palliate their symptoms. Conclusions Two percent formalin when given as a retention enema is a safe, inexpensive, and effective intervention for hemorrhagic radiation proctitis. Any trained health worker using simple precautions can perform this procedure. The long-term efficacy and safety of 2 percent formalin retention enemas need further assessment with randomized, controlled trials. Poster presentation at meeting of the Association of Radiation Oncologists of India, Ahmedabad, India, December 1 to 4, 2005.     

Argon plasma coagulation is an effective treatment for refractory hemorrhagic radiation proctitis

INTRODUCTION: Chronic radiation proctitis complicating pelvic radiotherapy can be debilitating. It commonly presents with rectal bleeding, which can be difficult to control. Medical management of hemorrhagic radiation proctitis is not very successful, although surgery carries high risks. Thus, endoscopic treatments are preferred. The aim of this study is to assess the efficacy of argon plasma coagulation applied endoscopically to treat hemorrhagic radiation proctitis that has been refractory to topical formalin therapy. METHODS: Twelve patients who had ongoing bleeding from radiation proctitis, after previously failed formalin therapy, underwent endoscopic treatment using argon plasma coagulation. The efficacy of treatment was assessed by grading the frequency and severity of bleeding (0–4, 0 being no bleeding), hemoglobin level, and transfusion requirements. RESULTS: At a median follow-up of 11 months, ten patients (83 percent) had a significant reduction in the severity and frequency of bleeding, with complete cessation in six (50 percent). The presence of coexistent radiation-induced sigmoiditis in two patients was associated with reduced but persistent bleeding, because of difficulty in targeting the bleeding sites in the sigmoid colon. The median number of treatment sessions per patient was two (range, 1–3), with the number of sessions correlated with the extent of the proctitis. All patients had an improvement in their hemoglobin level, with the mean increasing from 11.2 to 12.3 g/dl. In the six months before starting therapy, all patients had been taking iron supplements, and four had required blood transfusions (median 3 units, range, 2–6). Iron supplements were ceased four weeks after the completion of therapy in all cases, and no further transfusions were required during the study period. None of the patients experienced any significant side effects or complications. CONCLUSIONS: Argon plasma coagulation is an effective and safe treatment for hemorrhagic radiation proctitis that has been refractory to topical formalin therapy.     

Formalin Application in the Treatment of Chronic Radiation-Induced Hemorrhagic Proctitis—An Effective But Not Risk-Free Procedure: A Prospective Study of 33 Patients

PURPOSE This prospective study evaluated the efficacy and safety of local formalin application in chronic refractory radiation-induced hemorrhagic proctitis.METHODS All patients were treated under anesthesia by direct application of 4 percent formalin to the affected rectal areas.RESULTS The study included 33 patients (17 women) and was conducted between January 1994 and December 2001. There were 11 anal cancers (33 percent), 11 prostate cancers, 9 cervical or endometrial cancers, 1 bladder cancer, and 1 rectal cancer. The mean number of daily rectal bleeds was 2.7 (range, 0.5–15). Nineteen patients (58 percent) were blood transfusion dependent. Twenty-three patients had only one formalin application and 10 patients required a second application because of the persistent bleeding. The treatment was effective in 23 cases (70 percent): 13 patients had complete cessation of bleeding and 10 patients had only minor bleeding. Six anal or rectal strictures occurred: 4 patients had been treated for anal cancer (36 percent) and 2 patients had been treated for other cancers (9 percent). None of the strictures was malignant. Anal incontinence worsened in 5 patients of the 11 who had been treated for anal cancer (45 percent) and occurred in 4 of the 22 other patients (18 percent).CONCLUSION Formalin application is an effective treatment for chronic radiation-induced hemorrhagic proctitis. However, local morbidity is not negligible. This result may be related to the high proportion of anal cancers in the series. In our opinion, therefore, formalin application should be reserved for severe hemorrhagic proctitis refractory to medical treatment and should be thoroughly discussed in cases of anorectal radiation-induced stricture, prior anal incontinence, or treated anal cancer.Presented at the Journées Francophones de Pathologie Digestive, Paris, France, March 31 to April 2, 2003, and at Digestive Disease Week, New Orleans, Louisiana, May 15 to 20, 2004.     

Chronic radiation-induced proctitis: the 4 % formalin application as non-surgical treatment

Purpose

Radiation proctitis is a known complication following radiation therapy for pelvic malignancy. The majority of cases are treated nonsurgically. Rectal instillation of formalin solution has been described as a successful treatment for chronic radiation-induced hemorrhagic proctitis resistant to medical treatment. We present our results in patients undergoing treatment with application of 4 % formalin for radiation-induced injury to the rectum.

Methods

All patients were treated under anesthesia by direct application of 4 % formalin solution to the affected rectal areas. Patient gender, initial malignancy, grade of proctitis, need for blood transfusion, previous therapy, number of applications and response to treatment with formalin, complications, and length of follow-up were reviewed.

Results

A total of 15 patients with a mean age of 68.9 (range, 48–77) years were followed for 31.3 (range, 18–51) months. The mean interval from the conclusion of radiotherapy and the onset of symptoms was 6.9 months. The mean duration of hemorrhagic proctitis before formalin application was 7.9 months. Ten patients had only one formalin application and five patients required a second application because of the persistent bleeding. Thirteen patients (87 %) had complete cessation of bleeding. No complications related to the formalin treatment were observed.

Conclusions

According to a revision of the literature and our experience, despite the small number of patients in our trial, we can state that the application of 4 % formalin solution is an effective, safe, and well-tolerated treatment for chronic radiation-induced hemorrhagic proctitis with minimal discomfort and no severe complications.     

Endoscopic treatments for chronic radiation proctitis

Chronic radiation proctitis is a complication that occurs in patients who receive radiation therapy for pelvic malignancies. The common presentation is with rectal bleeding, but also rectal pain, diarrhea, tenesmus and even passage of mucus can occur. The optimal treatment of bleeding due to radiation proctitis remains unclear. Among various therapeutic options, medical management is generally ineffective and surgical intervention has a high incidence of morbidity. Promising advances have been made in endoscopic therapy, including argon plasma coagulation (APC), formalin application as well as new techniques such as radio-frequency ablation and cryoablation. APC is a safe, highly effective and long-lasting therapy in patients with rectal bleeding associated with radiation proctitis. It has been shown that several sessions of APC reduce the rate of bleeding and therefore the blood transfusion requirements. Moreover, the effect of treatment is long lasting. However, best results are achieved in patients with mild to moderate radiation proctitis, leaving space for alternative treatments for patients with more severe disease. In patients with severe or refractoryradiation proctitis intra rectal formalin application is an appropriate treatment option. Radiofrequency ablation and cryoablation have shown efficacy as alternative methods in a limited number of patients with refractory chronic radiation proctitis.     

Argon plasma coagulation in the treatment of hemorrhagic radiation proctitis.

Hemorrhagic radiation proctosigmoiditis is a serious complication of pelvic radiation therapy. Pharmacotherapy is generally ineffective in the treatment of chronic radiation proctitis. Argon plasma coagulation is an effective, safe and well-tolerated therapy option for radiation proctitis. We report a case of hemorrhagic radiation proctosigmoiditis treated successfully with Argon plasma coagulation. We used argon plasma coagulation for mucosal coagulation in painting pattern set at 1.5 L/min and 60 W. After five therapy sessions with argon plasma coagulation, the patient's rectal bleeding and anemia resolved. After four months of argon plasma coagulation therapy, the patient is well and her endoscopic examination showed remarkable improvement of the vascular lesions. Blood transfusion requirement was resolved after therapy, and hemoglobin level increased from 8.2 g/dl to 11.5 g/dl. Argon plasma coagulation therapy may be useful as alternative treatment for hemorrhagic radiation proctitis. Future prospective controlled trials are necessary to confirm the efficacy of argon plasma coagulation in the treatment of radiation proctitis.     

Surgical management of intestinal radiation injury

The management of 14 cases of radiation injury to the intestinal tract over a 4-year period is evaluated. The longest latent interval between radiation treatment and symptoms was 30 years. Eight patients were treated surgically; six were treated conservatively by laser therapy or application of formalin to the affected mucosa. The indications for surgery were rectovaginal fistula (four), rectal stricture (one), radiation proctitis (eight), and small bowel obstruction (one). Seven patients underwent large bowel resection. These consisted of four anastomoses with coloanal J-reservoirs, two low anterior resections, and one coloanal anastomosis without reservoir. There was no perioperative mortality. Morbidity occurred in one of the eight surgical cases. Radical resection of the radiation-damaged rectum has been shown to be a safe and reliable treatment for rectovaginal fistulas, rectal strictures, and proctitis unresponsive to medical measures. Coloanal J-reservoir is the procedure of choice to avoid urgency and frequency symptoms associated with coloanal sleeve anastomosis. Laser therapy for hemorrhagic proctitis can achieve an important place in the management of this problem without recourse to surgery.     

光动力治疗上消化道较早期肿瘤的初探

目的观察光动力疗法治疗上消化道早期肿瘤的近期疗效。方法中期食管癌患者3例,胃底早癌1例。静脉注射光敏剂photosan 2 mg/kg,44～48 h后应用波长630 nm的半导体激光进行光动力治疗。术后1个月、3个月、6个月、1年复查胃镜并进行病理学检查,复查胸腹部CT,评价近期疗效,并记录术中和术后不良反应发生情况。结果术后1周肿瘤组织坏死,尚未脱落。术后1个月左右,胃镜示原病灶几乎完全消退,病理检查未发现肿瘤细胞。术中及术后无出血、穿孔等不良反应发生。主要的不良反应是照射部位的轻微疼痛、反酸及低热,经对症处理均可缓解。1例食管癌患者治疗后2个月左右出现食管瘢痕狭窄,经胃镜下扩张治疗并放置食管支架后症状缓解。该患者已随访近1年,连续5次胃镜病理未见肿瘤复发及残留。结论光动力疗法治疗上消化道早期肿瘤安全、有效、损伤小,术后恢复快。尤其适用于长期服用抗凝药、合并心脑血管等基础病而不能耐受手术及放化疗,以及胃镜下EMR、ESD切除肿瘤存在高度出血风险的患者。