Yeoh E, Holloway R H, Russo A, Tippett M, Bermingham H, Chatterton B, Horowitz M
Department of Radiation Oncology, Royal Adelaide Hospital, South Australia.
Gut. 1996 Feb;38(2):166-70. doi: 10.1136/gut.38.2.166.
Although it is well recognised that oesophageal symptoms are common during therapeutic mediastinal irradiation of intrathoracic malignant diseases, the effects of mediastinal irradiation on oesophageal function are poorly defined. To clarify the pathogenesis of these sequelae a prospective study was performed to document comprehensively the effects of mediastinal irradiation on oesophageal function. Oesophageal symptoms, barium swallow, endoscopy, and combined radionuclide scintigraphy and oesophageal manometry were evaluated in eight patients with potentially curable intrathoracic malignant disease before treatment, during the last week of mediastinal irradiation, and six to eight weeks after its completion. Before irradiation, structural abnormalities were excluded by barium swallow and endoscopy. All but one patient experienced odynophagia or dysphagia, or both, during mediastinal irradiation (p < 0.001) but endoscopic abnormalities were observed in only three patients and there was no correlation between oesophageal symptoms and endoscopic changes. Irradiation, however, had no significant effect on oesophageal motility or transit. It is concluded that oesophageal symptoms which develop during mediastinal irradiation are not a result of altered oesophageal motility or transit and may reflect increased mucosal sensitivity.
尽管人们普遍认识到，在对胸内恶性疾病进行纵隔放射治疗期间，食管症状很常见，但纵隔放射对食管功能的影响却知之甚少。为了阐明这些后遗症的发病机制，我们进行了一项前瞻性研究，全面记录纵隔放射对食管功能的影响。在8例有可能治愈的胸内恶性疾病患者中，分别在治疗前、纵隔放射治疗的最后一周以及放疗结束后的6至8周，对其食管症状、吞钡检查、内镜检查以及放射性核素闪烁扫描与食管测压相结合的检查进行了评估。在放疗前，通过吞钡检查和内镜检查排除了结构异常。除1例患者外，所有患者在纵隔放射治疗期间均出现了吞咽痛或吞咽困难，或两者皆有（p < 0.001），但仅3例患者观察到内镜异常，且食管症状与内镜改变之间无相关性。然而，放射治疗对食管动力或传输没有显著影响。得出的结论是，纵隔放射治疗期间出现的食管症状并非食管动力或传输改变所致，可能反映了黏膜敏感性增加。
