Yeoh E, Horowitz M, Russo A, Muecke T, Robb T, Maddox A, Chatterton B
Department of Radiation Oncology, Royal Adelaide Hospital, Australia.
Am J Med. 1993 Oct;95(4):397-406. doi: 10.1016/0002-9343(93)90309-d.
Although radiation enteritis is a well-recognized sequel of therapeutic irradiation, the effects of abdominal and/or pelvic irradiation on gastrointestinal function are poorly defined and treatment is often unsuccessful. To determine both the short- and long-term effects of therapeutic irradiation on gastrointestinal function, we performed a prospective study.
Various aspects of gastrointestinal function were evaluated in 27 patients with potentially curable malignant disease (23 female, 4 male) before the commencement of, during, and 6 to 8 weeks, 12 to 16 weeks, and 1 to 2 years following completion of radiation therapy. Seventeen patients received pelvic irradiation alone and 10 patients received both abdominal and pelvic irradiation. Gastrointestinal symptoms, absorption of bile acid, vitamin B12, lactose, and fat, gastric emptying, small-intestinal and whole-gut transit, stool weight, and intestinal permeability were measured. Results were compared with those obtained in 18 normal volunteers.
All 27 patients completed at least 2 series of measurements and 18 patients completed all 5 series of experiments. During radiation treatment, increased stool frequency (p < 0.001) was associated with decreased bile acid and vitamin B12 absorption (p < 0.001 for both), increased fecal fat excretion (p < 0.05), an increased prevalence of lactose malabsorption (p < 0.01), and more rapid small-intestinal (p < 0.01) and whole-gut (p < 0.05) transit. Although there was improvement in most of these changes with time, at 1 to 2 years after the completion of irradiation, the frequency of bowel actions was greater (p < 0.001), bile acid absorption was less (p < 0.05), and small-intestinal transit was more rapid (p < 0.01) when compared with that of baseline and the normal subjects. At this time, at least 1 parameter of gastrointestinal function was abnormal in 16 of the 18 patients. Stool weight was greater (p < 0.05) and whole-gut transit faster (p < 0.01) in patients who received both pelvic and abdominal irradiation, when compared with those who received pelvic irradiation alone. Stool frequency (p < 0.001) and fecal fat excretion (p < 0.05) were greater in those patients who had surgery before radiation therapy.
Pelvic irradiation is usually associated with widespread, persistent effects on gastrointestinal function.
尽管放射性肠炎是治疗性放射公认的后遗症，但腹部和/或盆腔放射对胃肠功能的影响尚不明确，治疗往往效果不佳。为了确定治疗性放射对胃肠功能的短期和长期影响，我们进行了一项前瞻性研究。
在27例可能治愈的恶性疾病患者（23例女性，4例男性）放疗开始前、放疗期间以及放疗结束后6至8周、12至16周和1至2年，对胃肠功能的各个方面进行评估。17例患者仅接受盆腔放疗，10例患者接受腹部和盆腔联合放疗。测量胃肠症状、胆汁酸、维生素B12、乳糖和脂肪的吸收、胃排空、小肠和全肠道转运、粪便重量以及肠道通透性。将结果与18名正常志愿者的结果进行比较。
所有27例患者至少完成了2组测量，18例患者完成了所有5组实验。放疗期间，排便频率增加（p<0.001）与胆汁酸和维生素B12吸收减少（两者均p<0.001）、粪便脂肪排泄增加（p<0.05）、乳糖吸收不良患病率增加（p<0.01）以及小肠（p<0.01）和全肠道（p<0.05）转运加快有关。尽管随着时间的推移，这些变化大多有所改善，但在放疗结束后1至2年，与基线和正常受试者相比，排便频率更高（p<0.001）、胆汁酸吸收更少（p<0.05）且小肠转运更快（p<0.01）。此时，18例患者中有16例至少有1项胃肠功能参数异常。与仅接受盆腔放疗的患者相比，接受盆腔和腹部联合放疗的患者粪便重量更大（p<0.05），全肠道转运更快（p<0.01）。放疗前接受手术的患者排便频率（p<0.001）和粪便脂肪排泄（p<0.05）更高。
盆腔放疗通常会对胃肠功能产生广泛、持续的影响。
