Kellum J M, Jaffe B M, Calhoun T R, Ballinger W F
Am J Surg. 1977 Sep;134(3):314-7. doi: 10.1016/0002-9610(77)90395-6.
Six patients who originally received radiotherapy for Hodgkin's disease or primary gastric lymphoma developed radiation injury of the stomach requiring surgical management. Only two of these patients had evidence of gastric neoplastic involvement at the time of treatment. Experience with these patients leads us to draw the following conclusions: (1) Symptoms of radiation injury mimic those of recurrent neoplastic disease. (2) The effects of radiation are progressive and may be resistant to medical management. (3) The indications for surgical management include perforation, hemorrhage, obstruction, intractable pain, fistula formation, and inability to rule out recurrence. (4) Parenteral hyperalimentation can be an important adjunct in preparing debilitated patients for operation. (5) Gastric resection with gastrojejunostomy is the preferred operation. (6) Frozen section examination can be useful in determining the proper level of resection.
6例最初因霍奇金病或原发性胃淋巴瘤接受放射治疗的患者发生了胃部放射性损伤，需要手术处理。这些患者中只有2例在治疗时存在胃肿瘤累及的证据。对这些患者的治疗经验使我们得出以下结论：（1）放射性损伤的症状与肿瘤复发的症状相似。（2）放射效应是渐进性的，可能对内科治疗有抵抗。（3）手术处理的指征包括穿孔、出血、梗阻、顽固性疼痛、瘘管形成以及无法排除复发。（4）胃肠外高营养在使虚弱患者为手术做好准备方面可作为一项重要的辅助措施。（5）胃切除加胃空肠吻合术是首选的手术方式。（6）冰冻切片检查有助于确定合适的切除范围。
