Silvain C, Besson I, Ingrand P, Beau P, Fort E, Matuchansky C, Carretier M, Morichau-Beauchant M
Service d'Hépato-gastroentérologie et d'Assistance Nutritive, Hôpital Jean Bernard, Poitiers, France.
Dig Dis Sci. 1992 Jul;37(7):1065-71. doi: 10.1007/BF01300288.
The outcome of 31 patients with severe radiation enteritis treated by total parenteral nutrition (TPN) was analyzed. Before initiation of parenteral nutrition, 18 of the patients had not had abdominal surgery, while 13 had either a resection or an intestinal bypass for radiation enteritis. Median follow-up was 2 1/2 years (range: 1 month to 12 years) from the time of initiation of parenteral nutrition. Surgery was required in 15 cases because parenteral alimentation could not be continued. Only eight of these 15 were able to resume a normal oral intake. Total parenteral nutrition allowed oral feeding to be resumed in 11 (36%) after a median follow-up of 40 months (range: 6-142 months). In general, total parenteral nutrition was well tolerated and was associated with low morbidity. Eighteen patients died, 13 of complications due to radiation therapy, four of cancer recurrence, and one of an unrelated cause. Survival probability was 58% at one year and 36% at five years. When possible, prognostic factors present either before or at initiation of total parenteral nutrition were analyzed. Age, predisposing vascular factors (hypertension, diabetes mellitus, or vascular disease), and enteric fistula and/or perforation were found to have prognostic value. The probability of clinical radiation enteritis recurrence was 34% at one year and 47% at two years. A clinical recurrence of symptoms was more frequent but not significantly so after parenteral nutrition as compared to surgical therapy of radiation enteritis. Although TPN corrected denutrition and allowed deferred surgery in some patients, severe radiation enteritis remains a poorly predictable progressive disease with numerous relapses.
分析了31例接受全胃肠外营养（TPN）治疗的严重放射性肠炎患者的治疗结果。在开始肠外营养之前，18例患者未接受过腹部手术，而13例因放射性肠炎接受过切除术或肠旁路手术。从开始肠外营养起，中位随访时间为2.5年（范围：1个月至12年）。15例患者因无法继续肠外营养支持而需要手术治疗。这15例患者中只有8例能够恢复正常经口进食。在中位随访40个月（范围：6 - 142个月）后，全胃肠外营养使11例（36%）患者恢复了经口进食。总体而言，全胃肠外营养耐受性良好，且并发症发生率较低。18例患者死亡，13例死于放疗相关并发症，4例死于癌症复发，1例死于无关原因。1年生存率为58%，5年生存率为36%。在可能的情况下，分析了全胃肠外营养开始前或开始时存在的预后因素。发现年龄、血管相关易感因素（高血压、糖尿病或血管疾病）以及肠瘘和/或穿孔具有预后价值。临床放射性肠炎复发的概率1年时为34%，2年时为47%。与放射性肠炎的手术治疗相比，肠外营养支持后症状的临床复发更为频繁，但差异无统计学意义。尽管全胃肠外营养纠正了营养不良，并使一些患者能够推迟手术，但严重放射性肠炎仍然是一种难以预测的进行性疾病，复发频繁。
