Kaassis M, Oberti E, Burtin P, Boyer J
Gastroenterology Unit, University Hospital, Angers, France.
Endoscopy. 2000 Sep;32(9):673-6. doi: 10.1055/s-2000-9023.
Chronic radiation proctitis is a complication of radiotherapy for malignant pelvic diseases. Rectal bleeding caused by radiation proctitis is difficult to manage. Argon plasma coagulation (APC) is an electrocoagulation technique that appears to be an effective and low-cost alternative to the use of lasers in gastrointestinal endoscopy. The aim of this study was to evaluate the efficacy of APC, as well as patients' tolerance of the procedure, in the treatment of bleeding radiation-induced proctitis.
The charts of 16 patients with chronic radiation proctitis were analyzed retrospectively. Their average age was 73.5 (range 62-80). Fifteen patients had prostate cancer, and one had uterine cancer. The average time to onset of symptoms after radiotherapy was 15 months (range 6-36 months). All patients had intermittent or daily rectal bleeding, and three patients needed blood transfusions. The severity of bleeding was graded from 0 to 4. APC treatment was administered every month; the argon gas flow was set at 0.6 l/min with an electrical power setting of 40 W.
All patients were improved with APC treatment. A mean of 3.7 sessions was necessary to relieve symptoms. APC therapy resulted in a reduction in the mean severity score from 2.4 to 0.6. Seven patients had no recurrent rectal bleeding, and the bleeding was significantly reduced to occasional and negligible spotting (less than one bleeding episode per week) in nine patients. None of the patients required transfusions after treatment. During the follow-up period (average 10.7 months, range 8-28 months), one patient had a recurrence of rectal bleeding that required two repeat sessions. The tolerance was good, with no long-term treatment-related complications.
APC is an effective, safe and well-tolerated treatment for rectal bleeding caused by chronic radiation proctitis. It should be considered as a first-line therapy for radiation proctitis.
慢性放射性直肠炎是盆腔恶性疾病放射治疗的一种并发症。放射性直肠炎所致的直肠出血难以处理。氩等离子体凝固术（APC）是一种电凝技术，在胃肠内镜检查中似乎是一种有效且低成本的替代激光的方法。本研究的目的是评估APC治疗放射性直肠炎出血的疗效以及患者对该操作的耐受性。
回顾性分析16例慢性放射性直肠炎患者的病历。他们的平均年龄为73.5岁（范围62 - 80岁）。15例患者患有前列腺癌，1例患有子宫癌。放疗后出现症状的平均时间为15个月（范围6 - 36个月）。所有患者均有间歇性或每日直肠出血，3例患者需要输血。出血严重程度从0到4分级。每月进行一次APC治疗；氩气流量设定为0.6升/分钟，电功率设定为40瓦。
所有患者经APC治疗后均有改善。平均需要3.7次治疗来缓解症状。APC治疗使平均严重程度评分从2.4降至0.6。7例患者直肠出血未复发，9例患者出血明显减少至偶尔出现且可忽略不计的点状出血（每周少于一次出血发作）。治疗后无患者需要输血。在随访期（平均10.7个月，范围8 - 28个月），1例患者直肠出血复发，需要再次进行两次治疗。耐受性良好，无长期治疗相关并发症。
APC是治疗慢性放射性直肠炎所致直肠出血的一种有效、安全且耐受性良好的治疗方法。它应被视为放射性直肠炎的一线治疗方法。
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