Dray Xavier, Battaglia Gorgio, Wengrower Dov, Gonzalez Pedro, Carlino Alessandra, Camus Marine, Adar Tomer, Pérez-Roldán Francisco, Marteau Philippe, Repici Alessandro
APHP Lariboisière Hospital and Sorbonne Paris Cité Paris 7 University, Paris, France.
Endoscopy Unit, Istituto Oncologico Veneto I.R.C.C.S., Padova, Italy.
Endoscopy. 2014 Nov;46(11):970-6. doi: 10.1055/s-0034-1377756. Epub 2014 Oct 7.
The main endoscopic therapy for radiation proctitis is argon plasma coagulation (APC); however treatment is not always successful. Radiofrequency ablation (RFA) is a possible treatment for radiation proctitis but data are scarce. The aim of this study was to report on the safety and efficacy of RFA in the treatment of radiation proctitis.
This study was an open-label, retrospective, multicenter study of patients with chronic hemorrhagic radiation proctitis who were treated with RFA. Data included a three-item symptom score, the number of packed red blood cell transfusions, the lowest hemoglobin concentration, and complications, during the 6 months prior to and after RFA. Clinical success was defined as a decrease in the symptom score. Biological success was defined as an increase in the hemoglobin rate with equal or decreased number of transfusions required.
A total of 17 patients underwent a median of 2 RFA sessions (range 1 - 4), without perioperative complications. Symptom scores decreased in 16 patients (clinical success 94 %), from a mean score of 3.6 (median 4) to 1.4 (median 1) (P < 0.01). Two patients developed rectal ulceration, with no local symptoms. During the 6 months after RFA, hemoglobin concentration increased in all 17 patients (from mean 8.3 ± 2.8 g/dL [median 7.5] to 11.3 ± 2.2 g/dL [median 11.0]; P < 0.01). Among 13 patients who were transfusion dependent prior to RFA (mean 7.2 ± 7.7 transfusions [median 4]), 9 patients (69 %) were weaned off transfusions after RFA. A significant increase in the hemoglobin level was observed in this subgroup of patients (from mean 7.2 ± 1.4 g/dL [median 7.3] to 10.7 ± 1.5 g/dL [median 10.5]; P < 0.001). Biological success was 100 %.
RFA seems to significantly decrease clinical symptoms and increase the hemoglobin concentration, thus reducing the need for transfusions.
氩离子凝固术（APC）是放射性直肠炎的主要内镜治疗方法；然而，治疗并非总是成功的。射频消融术（RFA）是一种治疗放射性直肠炎的可能方法，但相关数据较少。本研究的目的是报告RFA治疗放射性直肠炎的安全性和有效性。
本研究是一项对接受RFA治疗的慢性出血性放射性直肠炎患者进行的开放标签、回顾性、多中心研究。数据包括RFA前后6个月内的三项症状评分、红细胞输注量、最低血红蛋白浓度及并发症情况。临床成功定义为症状评分降低。生物学成功定义为血红蛋白水平升高且所需输注次数相同或减少。
共有17例患者接受了中位数为2次的RFA治疗（范围1 - 4次），无围手术期并发症。16例患者症状评分降低（临床成功率94%），平均评分从3.6（中位数4）降至1.4（中位数1）（P < 0.01）。2例患者出现直肠溃疡，无局部症状。在RFA后的6个月内，所有17例患者的血红蛋白浓度均升高（从平均8.3±2.8 g/dL[中位数7.5]升至11.3±2.2 g/dL[中位数11.0]；P < 0.01）。在RFA前依赖输血的13例患者中（平均输血7.2±7.7次[中位数4次]），9例（69%）在RFA后不再需要输血。该亚组患者的血红蛋白水平显著升高（从平均7.2±1.4 g/dL[中位数7.3]升至10.7±1.5 g/dL[中位数10.5]；P < 0.001）。生物学成功率为100%。
RFA似乎能显著减轻临床症状并提高血红蛋白浓度，从而减少输血需求。
