Formalin irrigation for hemorrhagic chronic radiation proctitis
Formalin irrigation for hemorrhagic chronic radiation proctitis
复制标题
福尔马林冲洗治疗出血性慢性放射性直肠炎
DOI：
10.3748/wjg.v21.i12.3593
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发表时间：
2015-03-28
影响因子：
4.3
通讯作者：
Wang, Lei
中科院分区：
文献类型：
--
作者：
Ma, Teng-Hui;Yuan, Zi-Xu;Wang, Lei
目的：评估改良局部福尔马林冲洗法治疗难治性出血性慢性放射性直肠炎（CRP）的有效性和安全性。方法：CRP患者对既往药物治疗无反应，根据不良事件通用术语标准出现II-III级直肠出血。排除了肛门直肠狭窄、深部溃疡和瘘管患者。所有患者在治疗前均接受了柔性内镜评估。收集患者人口统计学和临床数据，包括原发肿瘤、放疗和既往治疗选择。患者在手术室接受了硬膜外麻醉下的4%福尔马林局部冲洗。记录直肠出血的缓解情况和相关并发症。在随访时调查排便、出血缓解和其他症状。直肠阴道瘘患者的内镜检查结果进行了分析。结果：24例患者（19名女性，5名男性），平均年龄为61.5 ± 9.5岁。从放疗结束至出血发作的平均时间为11.1 ± 9.0个月（范围：2-24个月）。6例患者（25.0%）输血依赖。术前维也纳直肠镜检查评分（VRS）中位数为3分。19例患者（79.2%）仅接受了一个疗程的局部福尔马林冲洗，5例（20.8%）需要第二个疗程。未观察到副作用。治疗后1个月，5例完全止血，14例明显止血，有效率为79.1%（19/24）。对于长期疗效，5/16、1/9和0/6例患者分别在治疗后1年、2年和5年主诉持续出血。治疗后1个月、3个月和2年分别发现3例直肠阴道瘘。单变量分析显示，较高的内镜VRS和溃疡评分与直肠阴道瘘的发生风险相关。结论：改良福尔马林冲洗是治疗出血性CRP的有效和安全的方法，但在内镜下VRS高的患者中应谨慎进行。
AIM: To assess the efficacy and safety of a modified topical formalin irrigation method in refractory hemorrhagic chronic radiation proctitis (CRP).METHODS: Patients with CRP who did not respond to previous medical treatments and presented with grade II-III rectal bleeding according to the Common Terminology Criteria for Adverse Events were enrolled. Patients with anorectal strictures, deep ulcerations, and fistulas were excluded. All patients underwent flexible endoscopic evaluation before treatment. Patient demographics and clinical data, including primary tumor, radiotherapy and previous treatment options, were collected. Patients received topical 4% formalin irrigation in a clasp-knife position under spinal epidural anesthesia in the operating room. Remission of rectal bleeding and related complications were recorded. Defecation, remission of bleeding, and other symptoms were investigated at follow-up. Endoscopic findings in patients with rectovaginal fistulas were analyzed.RESULTS: Twenty-four patients (19 female, 5 male) with a mean age of 61.5 +/- 9.5 years were enrolled. The mean time from the end of radiotherapy to the onset of bleeding was 11.1 +/- 9.0 mo (range: 2-24 mo). Six patients (25.0%) were blood transfusion dependent. The median preoperative Vienna Rectoscopy Score (VRS) was 3 points. Nineteen patients (79.2%) received only one course of topical formalin irrigation, and five (20.8%) required a second course. No side effects were observed. One month after treatment, bleeding cessation was complete in five patients and obvious in 14; the effectiveness rate was 79.1% (19/24). For long-term efficacy, 5/16, 1/9 and 0/6 patients complained of persistent bleeding at 1, 2 and 5 years after treatment, respectively. Three rectovaginal fistulas were found at 1 mo, 3 mo and 2 years after treatment. Univariate analysis showed associations of higher endoscopic VRS and ulceration score with risk of developing rectovaginal fistula. CONCLUSION: Modified formalin irrigation is an effective and safe method for hemorrhagic CRP, but should be performed cautiously in patients with a high endoscopic VRS.