Luna-Pérez Pedro, Rodríguez-Ramírez Saúl E
Colorectal Service, Surgical Oncology Department, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., Mexico.
J Surg Oncol. 2002 May;80(1):41-4. doi: 10.1002/jso.10095.
Radiation proctitis is a common complication after pelvic irradiation. One to five percent of these patients will develop intractable or massive hemorrhagic radiation proctitis that will require repeated hospital admissions and blood transfusions. We evaluated the benefits of instillation of 4% formalin in the management of refractory hemorrhagic radiation-induced proctitis.
From January 1998 to May 1999, 20 female patients who failed with administration of topical steroids and/or mesalazine were treated with 500 ml of 4% formalin instilled into the rectum in 50-ml aliquots.
Median age was 58 years. Eighteen patients had cervical cancer and two, endometrial cancer. These patients received a mean of 7,500 rads to the pelvis. The symptoms began at a mean of 8 months after termination of radiotherapy. Median time of symptomatic rectal hemorrhage was 8 months. Median of blood units previously transfused was six (range: 2-11). Hemorrhage immediately ceased after the 4% formalin instillation in 17 patients. Three patients required formalin instillation repetition with success in one. Overall success was 90%. Median follow-up was 20 months. Five patients had moderate pelvic pain after instillation and one developed rectosigmoideal necrosis that required resection plus Hartmann procedure. Two patients developed rectovaginal fistula and required colostomy, and one thereafter, required abdominoperineal resection en bloc with the posterior wall of the vagina due to pelvis sepsis.
Rectal instillation of 4% formalin is a simple, inexpensive, and efficient treatment for refractory hemorrhagic radiation proctitis.
放射性直肠炎是盆腔放疗后的常见并发症。这些患者中有1%至5%会发展为难治性或大量出血性放射性直肠炎，需要反复住院和输血。我们评估了4%福尔马林灌肠在难治性出血性放射性直肠炎治疗中的益处。
1998年1月至1999年5月，20例局部使用类固醇和/或美沙拉嗪治疗失败的女性患者接受了直肠灌注500毫升4%福尔马林治疗，每次50毫升。
中位年龄为58岁。18例患有宫颈癌，2例患有子宫内膜癌。这些患者盆腔平均接受了7500拉德的辐射。症状平均在放疗结束后8个月开始出现。有症状的直肠出血中位时间为8个月。先前输血的中位单位数为6个（范围：2至11个）。17例患者在灌注4%福尔马林后出血立即停止。3例患者需要重复灌注福尔马林，其中1例成功。总体成功率为90%。中位随访时间为20个月。5例患者灌注后出现中度盆腔疼痛，1例发生直肠乙状结肠坏死，需要进行切除加哈特曼手术。2例患者发生直肠阴道瘘，需要进行结肠造口术，1例此后因盆腔感染需要连同阴道后壁进行腹会阴联合整块切除。
直肠灌注4%福尔马林是治疗难治性出血性放射性直肠炎的一种简单、廉价且有效的方法。
