Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis - An effective but not risk-free procedure: A prospective study of 33 patients
Formalin application in the treatment of chronic radiation-induced hemorrhagic proctitis - An effective but not risk-free procedure: A prospective study of 33 patients
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DOI：
10.1007/s10350-005-0030-z
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发表时间：
2005-08-01
影响因子：
3.9
通讯作者：
Atienza, P
中科院分区：
文献类型：
--
作者：
de Parades, V;Etienney, I;Atienza, P
目的：这项前瞻性研究评估了局部福尔马林应用治疗慢性难治性放射性出血性直肠炎的有效性和安全性。方法：所有患者均在麻醉下进行治疗，将 4% 福尔马林直接涂抹于受影响的直肠区域。结果：该研究包括 33 名患者（17 名女性），于 1994 年 1 月至 2001 年 12 月期间进行。其中有 11 名肛门癌（3.3%）、11 名前列腺癌、9 名宫颈癌或子宫内膜癌、1 名膀胱癌和 1 名直肠癌。每日直肠出血的平均次数为 2.7 次（范围为 0.5-15 次）。十九名患者（58%）依赖输血。 23名患者仅使用了一次福尔马林，10名患者因持续出血需要第二次使用。治疗有效23例（70%）：13例完全停止出血，10例仅有轻微出血。发生 6 例肛门或直肠狭窄：4 名患者接受过肛门癌治疗（36%），2 名患者接受过其他癌症治疗（9%）。所有狭窄都不是恶性的。 11 名接受肛门癌治疗的患者中，有 5 名患者的肛门失禁情况恶化（45%），而其他 22 名患者中，有 4 名患者的肛门失禁情况恶化（18%）。结论：福尔马林应用是治疗慢性放射性出血性直肠炎的有效方法。然而，当地的发病率也不容忽视。这一结果可能与该系列中肛门癌比例较高有关。因此，我们认为，福尔马林的应用应保留用于药物治疗难治的严重出血性直肠炎，并且应在肛门直肠辐射引起的狭窄、既往肛门失禁或接受治疗的肛门癌的病例中进行彻底讨论。
PURPOSE: This prospective study evaluated the efficacy and safety of local formalin application in chronic refractory radiation-induced hemorrhagic proctitis. METHODS: All patients were treated under anesthesia by direct application of 4 percent formalin to the affected rectal areas. RESULTS: The study included 33 patients (17 women) and was conducted between January 1994 and December 2001. There were 11 anal cancers (3 3 percent), 11 prostate cancers, 9 cervical or endometrial cancers, 1 bladder cancer, and 1 rectal cancer. The mean number of daily rectal bleeds was 2.7 (range, 0.5-15). Nineteen patients (58 percent) were blood transfusion dependent. Twenty-three patients had only one formalin application and 10 patients required a second application because of the persistent bleeding. The treatment was effective in 23 cases (70 percent): 13 patients had complete cessation of bleeding and 10 patients had only minor bleeding. Six anal or rectal strictures occurred: 4 patients had been treated for anal cancer (36 percent) and 2 patients had been treated for other cancers (9 percent). None of the strictures was malignant. Anal incontinence worsened in 5 patients of the 11 who had been treated for anal cancer (45 percent) and occurred in 4 of the 22 other patients (18 percent). CONCLUSION: Formalin application is an effective treatment for chronic radiation-induced hemorrhagic proctitis. However, local morbidity is not negligible. This result may be related to the high proportion of anal cancers in the series. In our opinion, therefore, formalin application should be reserved for severe hemorrhagic proctitis refractory to medical treatment and should be thoroughly discussed in cases of anorectal radiation-induced stricture, prior anal incontinence, or treated anal cancer.