Piccolomini Alessandro, Francioli Niccolò, Verre Luigi, Guarnieri Alfredo, Vuolo Giuseppe, Di Cosmo Leonardo, Tirone Andrea, Chieca Raffaele, Tucci Enrico, Carli Anton Ferdinando
U O C Chirurgia 2, Dipartimento di Chirurgia e Bioingegneria, Azienda Ospedaliera Universitaria Senese, Siena.
Chir Ital. 2009 May-Jun;61(3):341-6.
Radiation proctitis, is a relatively frequent complication resulting from the direct or collateral irradiation of the rectum in radiotherapy treatment for genito-urinary or anorectal malignancies. The main symptoms are diarrhoea, tenesmus, proctorrhagia, anal pain, mucorrhoea and faecal incontinence. The evolution of chronic radiation proctitis requires treatment for related anaemia, anal incontinence and micturition disorders. The approach and type of treatment depend on the severity of the symptoms and on the endoscopic aspect, in relation to the response to previous medical therapy performed. In our experience, endoscopic treatment is the best choice in the presence of ongoing bleeding and the possible development of severe anaemia. The surgical option is mandatory in patients at high risk of sepsis, requiring a faecal diversion constructed using the Hartmann technique. We report two cases, observed during the last two years, one treated with endoscopic bipolar coagulation and the other with a double urinary and faecal diversion.
放射性直肠炎是泌尿生殖系统或肛肠恶性肿瘤放射治疗中直肠直接或间接照射引起的一种较为常见的并发症。主要症状为腹泻、里急后重、直肠出血、肛门疼痛、黏液便和大便失禁。慢性放射性直肠炎的进展需要针对相关贫血、肛门失禁和排尿障碍进行治疗。治疗方法和类型取决于症状的严重程度以及内镜表现，并与先前进行的药物治疗反应相关。根据我们的经验，在内镜下持续出血以及可能发展为严重贫血的情况下，内镜治疗是最佳选择。对于有败血症高风险的患者，手术选择是必要的，需要采用哈特曼技术构建粪便转流。我们报告了近两年观察到的两例病例，一例采用内镜下双极电凝治疗，另一例采用尿路和粪便双转流治疗。
