Joyeux H, Matias J, Gouttebel M C, Vedrenne J B, Guillaume A, Martella L, Saint-Aubert B
Institut Curie, Paris.
Chirurgie. 1994;120(12):129-33.
Our expérience in the treatment of 46 cases with radiation enteritis (RE) permitted to summarize 5 key points in the Surgical Strategy: laparotomy incision, enterolysis technique, small bowel and colon preservation, anastomosis technic and parenteral nutritional support. Surgery is imposed most of the time in digestive and nutritional Insufficiencies due to radiation enteritis. 46 patients aged to 33-81 years (mean age = 59) were included for possible surgery. The first clinical digestive symptoms were occlusion (n = 39) and/or digestive fistula (n = 7) and/or perforation (n = 3). These abnormalities were often associated with severe malnutrition (weight loss > or = 20% of usual weight) inducing surgery preparation with pre-operative parenteral nutrition (8 to 350 days). 3 patients were not operated because of general problems and lived 1 to 7 months after the beginning of parenteral nutrition. For operated patients (n = 43), 12 underwent 2 operations (resection and/or enteral liberation) and one patient underwent 4 surgical interventions because of digestive fistula. In 35 cases, small bowel resection was performed leaving 135.4 +/- 62.6 cm of intestine (0 to 225 cm of jejunum and/or ileum) and in 13 cases, complete enterolysis was achieved. All the patients received a post-operative parenteral nutrition during 1 to 23 months (median = 6.2 +/- 5.3 months). 31 patients received home parenteral nutrition during the pre and/or post-operative phase for a median duration of 6.3 +/- 3.2 months (range: 1-23 months). 4 patients died during the immediate post-operative phase and among them, 3 died after the second surgery. 12 deaths were observed due to the primary cancer and 6 due to the evolution of radiation lesions. Median survival of patients without cancer evolution reach 180 months with a 5-year survival rate of 94% (Kaplan-Meier method). In patients with radiation enteritis, the pre and post-operative nutritional support associated with radical surgery allows to obtain prolonged survival in non cancer patients.
我们对46例放射性肠炎（RE）患者的治疗经验，总结出手术策略的5个要点：剖腹切口、肠粘连松解技术、小肠和结肠保留、吻合技术及肠外营养支持。由于放射性肠炎导致消化和营养功能不全，多数情况下需要进行手术。纳入46例年龄在33至81岁（平均年龄59岁）可能需要手术的患者。首发临床消化症状为肠梗阻（n = 39）和/或消化瘘（n = 7）和/或穿孔（n = 3）。这些异常常伴有严重营养不良（体重减轻≥正常体重的20%），需通过术前肠外营养（8至350天）进行手术准备。3例因全身问题未手术，在开始肠外营养后存活1至7个月。对于接受手术的患者（n = 43），12例接受了2次手术（切除和/或肠粘连松解），1例因消化瘘接受了4次手术干预。35例进行了小肠切除，剩余肠管长度为135.4±62.6 cm（空肠和/或回肠0至225 cm），13例实现了完全肠粘连松解。所有患者术后接受了1至23个月（中位数 = 6.2±5.3个月）的肠外营养。31例患者在术前和/或术后阶段接受家庭肠外营养，中位持续时间为6.3±3.2个月（范围：1至23个月）。4例患者在术后即刻死亡，其中3例在第二次手术后死亡。观察到12例死于原发性癌症，6例死于放射性病变进展。无癌症进展患者的中位生存期达180个月，5年生存率为94%（Kaplan-Meier法）。对于放射性肠炎患者，术前和术后营养支持联合根治性手术可使非癌症患者获得延长生存期。
