Yuan Zi-Xu, Ma Teng-Hui, Zhong Qing-Hua, Wang Huai-Ming, Yu Xi-Hu, Qin Qi-Yuan, Chu Li-Li, Wang Lei, Wang Jian-Ping
Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China E-mail :
Asian Pac J Cancer Prev. 2016;17(2):631-8. doi: 10.7314/apjcp.2016.17.2.631.
Radiation proctitis is a common complication after radiotherapy for pelvic malignant tumors. This study was conducted to assess the efficacy of novel almagate enemas in hemorrhagic chronic radiation proctitis (CRP) and evaluate risk factors related to rectal deep ulcer or fistula secondary to CRP. All patients underwent a colonoscopy to confirm the diagnosis of CRP and symptoms were graded. Typical endoscopic and pathological images, risk factors, and quality of life were also recorded. A total of 59 patients were enrolled. Gynecological cancers composed 93.1% of the primary malignancies. Complete or obvious reduction of bleeding was observed in 90% (53/59) patients after almagate enema. The mean score of bleeding improved from 2.17 to 0.83 (P<0.001) after the enemas. The mean response time was 12 days. No adverse effects were found. Moreover, long-term successful rate in controlling bleeding was 69% and the quality of life was dramatically improved (P=0.001). The efficacy was equivalent to rectal sucralfate, but the almagate with its antacid properties acted more rapidly than sucralfate. Furthermore, we firstly found that moderate to severe anemia was the risk factor of CRP patients who developed rectal deep ulcer or fistulas (P= 0.015). We also found abnormal hyaline-like thick wall vessels, which revealed endarteritis obliterans and the fibrosis underlying this disease. These findings indicate that almagate enema is a novel effective, rapid and well-tolerated method for hemorrhagic CRP. Moderate to severe anemia is a risk factor for deep ulceration or fistula.
放射性直肠炎是盆腔恶性肿瘤放疗后的常见并发症。本研究旨在评估新型铝镁加灌肠剂治疗出血性慢性放射性直肠炎（CRP）的疗效，并评估与CRP继发直肠深部溃疡或瘘管相关的危险因素。所有患者均接受结肠镜检查以确诊CRP，并对症状进行分级。还记录了典型的内镜和病理图像、危险因素及生活质量。共纳入59例患者。原发性恶性肿瘤中妇科癌症占93.1%。铝镁加灌肠后，90%（53/59）的患者出血完全或明显减少。灌肠后出血平均评分从2.17降至0.83（P<0.001）。平均起效时间为12天。未发现不良反应。此外，控制出血的长期成功率为69%，生活质量显著改善（P=0.001）。其疗效与直肠用硫糖铝相当，但铝镁加因其抗酸特性起效比硫糖铝更快。此外，我们首次发现中重度贫血是发生直肠深部溃疡或瘘管的CRP患者的危险因素（P=0.015）。我们还发现了异常的透明样厚壁血管，提示闭塞性动脉内膜炎及该病潜在的纤维化。这些发现表明，铝镁加灌肠是治疗出血性CRP的一种新型有效、快速且耐受性良好的方法。中重度贫血是深部溃疡或瘘管的危险因素。
