氩等离子体凝固治疗放射性直肠出血：最佳应用参数和长期疗效。
Argon plasma coagulation treatment of hemorrhagic radiation proctopathy: the optimal settings for application and long-term outcome.
机构信息
Fourth Department of Internal Medicine, Sapporo Medical University, School of Medicine, South 1 West 16, Chuo-ku, 060-8543 Sapporo, Japan.
出版信息
Gastrointest Endosc. 2011 Mar;73(3):543-9. doi: 10.1016/j.gie.2010.11.015. Epub 2011 Jan 22.
BACKGROUND
No standard treatment exists for hemorrhagic radiation proctopathy (HRP). Recently it was reported that argon plasma coagulation (APC) is effective for HRP. However, previous studies documented complications such as ulcers, strictures, and perforations in as many as 20% of APC-treated patients.
OBJECTIVE
The aim of this study was to determine the optimal parameters for APC by using swine rectum and to assess the safety and effectiveness of APC in HRP patients.
DESIGN
Prospective case series.
SETTING
University teaching hospital.
PATIENTS
Sixty-five patients with HRP were prospectively enrolled between 2000 and 2010.
INTERVENTIONS
APC for HRP.
MAIN OUTCOME MEASUREMENTS
Optimal APC parameters, number of treatments, success rate, complications, clinical remissions.
RESULTS
APC in swine rectal wall ex vivo was optimal with a 40-W current, 1.2-L/min gas flow rate, and 2-second application, which was sufficient to treat the submucosal telangiectasia but did not adversely affect the muscle layer. Sixty-five patients (46 men, 19 women; median age 72 years) with HRP occurring at a mean of 20 months after radiotherapy were studied. Proctopathy was classified as grade A (mild) in 7 patients (10.8%), grade B (moderate) in 41 (63.1%), and grade C (severe) in 17 (26.2%). The treatment success rate was 98.5% after a median of 2 (range 1-5) APC sessions. The median clinical score for rectal bleeding was significantly decreased after APC (P < .0001), and the hemoglobin level was significantly increased (P < .0001). APC was well tolerated, and no significant side effects or complications occurred. During a mean follow-up of 34.6 months (range 3.6 -121.1 months), 4 patients (6.3%) had minor recurrent rectal bleeding and 60 (93.8%) remained in remission.
LIMITATIONS
Nonrandomized study.
CONCLUSIONS
HRP treatment with optimal APC settings yields a high success rate and long-lasting clinical remission with no significant complications.
背景
目前尚无针对放射性直肠出血（HRP）的标准治疗方法。最近有报道称，氩等离子体凝固（APC）对 HRP 有效。然而，既往研究显示，多达 20%的 APC 治疗患者会出现溃疡、狭窄和穿孔等并发症。
目的
本研究旨在通过猪直肠确定 APC 的最佳参数，并评估 APC 在 HRP 患者中的安全性和有效性。
设计
前瞻性病例系列研究。
设置
大学教学医院。
患者
2000 年至 2010 年间，前瞻性纳入 65 例 HRP 患者。
干预措施
APC 治疗 HRP。
主要观察指标
APC 的最佳参数、治疗次数、成功率、并发症、临床缓解情况。
结果
APC 治疗猪直肠壁的最佳参数为电流 40 W、气体流量 1.2 L/min、作用时间 2 秒，既能充分治疗黏膜下毛细血管扩张，又不会对肌肉层造成不良影响。65 例 HRP 患者（男 46 例，女 19 例；中位年龄 72 岁）均在放疗后 20 个月左右发病。直肠病变分级为：轻度（A 级）7 例（10.8%），中度（B 级）41 例（63.1%），重度（C 级）17 例（26.2%）。中位 2（15）次 APC 治疗后，治疗成功率为 98.5%。APC 治疗后，直肠出血的临床评分中位数显著降低（P<.0001），血红蛋白水平显著升高（P<.0001）。APC 治疗耐受性良好，未发生明显不良反应或并发症。中位随访 34.6 个月（3.6121.1 个月）期间，4 例（6.3%）患者出现轻微复发性直肠出血，60 例（93.8%）患者仍处于缓解状态。
局限性
非随机研究。
结论
采用最佳 APC 参数治疗 HRP 可获得较高的成功率和持久的临床缓解，且无明显并发症。
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