慢性放射性肠炎的外科治疗

目的探讨慢性放射性肠炎外科治疗的方法及临床效果。方法对49例慢性放射性肠炎并发肠梗阻、肠瘘、肠狭窄、肠出血、严重结肠直肠炎及肠穿孔的患者进行治疗,其中47例平均施行(2·8±2·1)次手术。26例行病变肠段切除、一期肠吻合术;14例行病变肠段切除、近端肠造口术,其中6例为永久性肠造口,8例二期手术肠造口还纳;7例行病变肠段旷置术。结果本组无一例发生吻合口瘘,47例(96%)临床治愈,死亡2例。结论慢性放射性肠炎出现外科并发症需及时手术治疗,应根据患者全身及腹腔情况选择正确术式,围手术期处理及吻合口解剖部位的选择是手术成功的关键。

Surgical management of chronic radiation enteritis

OBJECTIVE: To explore the surgical methods and the clinical results of chronic radiation enteritis. METHODS: Treatments were applied to forty-nine cases of chronic radiation enteritis complicated with intestinal obstruction, enterocutaneous fistula, intestinal stenosis, intestinal bleeding, severe proctocolitis and intestinal perforation, among whom 47 cases received an average of 2.8 +/- 2.1 operations. Twenty-six cases received resection of the injured segment with primary anastomosis, fourteen cases received intestinal resection and proximal enterostomy, among whom 6 ostomies were permanent, and another 8 cases received secondary ostomy closure. The injured intestinal segments were spared in 7 cases. RESULTS: Forty-seven among 49 cases were cured (success rate, 96%) with no anastomotic leakage. Two patients died. CONCLUSIONS: Surgical complications of chronic radiation enteritis should be managed operatively. The operative method should be chosen according to the general condition of the patients and the complexity of the abdomen. Perioperative management and proper selection of intestinal segments for anastomosis are essential for the success.