Department of digestive surgery, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
Department of radiotherapy, centre François-Baclesse, avenue du Général-Harris, 14045 Caen cedex, France.
J Visc Surg. 2020 Dec;157(6):475-485. doi: 10.1016/j.jviscsurg.2020.08.012. Epub 2020 Sep 1.
Abdominal pelvic radiation therapy can induce acute or chronic lesions in the small bowel wall, called radiation enteritis. Treatment of acute radiation enteritis is essentially symptomatic; symptoms regress when radiation is discontinued. Conversely, late toxicity can occur up to 30 years after discontinuation of radiation therapy, posing diagnostic problems. Approximately one out of five patients treated by radiation therapy will present clinical signs of radiation enteritis, including obstruction, malabsorption, malnutrition and/or other complications. Management should be multidisciplinary, centered mainly on correction of malnutrition. Surgery is indicated in case of complications (i.e., abscess, perforation, fistula) and/or resistance to medical treatment; intestinal resection should be preferred over internal bypass. The main risk in case of iterative resections is the short bowel syndrome and the need for definitive nutritional assistance.
腹部骨盆放射治疗可导致小肠壁的急性或慢性损伤，称为放射性肠炎。急性放射性肠炎的治疗主要是对症治疗；当停止放射治疗时，症状会消退。相反，迟发性毒性可能在放射治疗停止后 30 年内发生，从而带来诊断问题。大约五分之一接受放射治疗的患者会出现放射性肠炎的临床症状，包括梗阻、吸收不良、营养不良和/或其他并发症。治疗应采用多学科方法，主要集中在纠正营养不良上。如果出现并发症（即脓肿、穿孔、瘘管）和/或对药物治疗有抵抗力，应进行手术；如果可能，应优先选择肠切除术，而不是肠内旁路术。在反复切除的情况下，主要风险是短肠综合征和需要进行确定性营养支持。
