Department of General Surgery, Nanjing Jinling Hospital, Nanjing, P.R. China.
J Surg Oncol. 2012 Jun 1;105(7):632-6. doi: 10.1002/jso.22099. Epub 2011 Sep 19.
We assessed the role of surgery in the management of patients with intestinal obstruction or enterocutaneous fistula after chronic radiation enteritis (CRE) referred to our department, a specialist gastrointestinal surgical center, and analysis was made for the success of surgery.
A retrospective analysis was made of 156 patients receiving radiation therapy for malignancy from Jan 2000 to Nov 2010, among which 134 received surgery for intestinal or urinary complications. The demographic data, nutritional status, previous surgery, disease location and clinical manifestations, concomitant urinary complications, and surgical procedures were analyzed.
Although malnutrition was prevalent (84/156, 53.9%) in this group of patients, the majority of them (101/134, 75.4%) recovered uneventfully after surgery following nutrition therapy, and resection and anastomosis (102/134) was the predominant surgical procedure for radiation injury to the ileocecal region. Sixteen patients received surgery for radiation-induced urinary complications. There were 36 postoperative morbidities (26.87%), mainly wound complications (21/134), intestinal obstruction (5/134), and anastomotic dehiscence (3/134).
Surgery is justified for patients with bowel obstruction or fistula after CRE. A comprehensive perioperative management, especially perioperative nutrition therapy was important for the success of the surgery.
我们评估了 156 例慢性放射性肠炎（CRE）患者的肠道或肠外瘘的治疗策略，这些患者因恶性肿瘤接受放疗后被转诊至我院（一个专业的胃肠外科中心），并对手术的成功率进行了分析。
回顾性分析了 2000 年 1 月至 2010 年 11 月期间因恶性肿瘤接受放疗的 156 例患者，其中 134 例因肠道或泌尿道并发症接受了手术治疗。分析了这些患者的人口统计学数据、营养状况、既往手术史、疾病部位和临床表现、并存的泌尿道并发症以及手术方式。
尽管该组患者普遍存在营养不良（84/156，53.9%），但大多数患者（101/134，75.4%）在营养治疗后手术恢复顺利，回盲部放射性损伤的主要手术方式是切除吻合术（102/134）。16 例患者因放射性泌尿道并发症接受手术治疗。术后有 36 例出现并发症（26.87%），主要是伤口并发症（21/134）、肠梗阻（5/134）和吻合口裂开（3/134）。
对于 CRE 后出现肠梗阻或肠瘘的患者，手术是合理的。综合围手术期管理，特别是围手术期营养治疗，对手术的成功至关重要。
