香榆祛瘀合剂灌肠防治放射性直肠炎临床观察
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摘要
目的放射性直肠炎是直肠或骨盆内脏器进行放疗时或放疗后引起的直肠炎,目前尚无公认有效的治疗药物和治疗方式。香榆祛瘀合剂是山东大学附属山东省肿瘤医院自主研制的中药合剂,具有活血化瘀、收敛止血、抗菌消炎等作用。本研究分析香榆祛瘀合剂防治直肠癌保肛术后放疗致急性放射性直肠炎的临床疗效。方法选取2017-03-01-2018-02-28就诊于山东大学附属山东省肿瘤医院需行直肠癌术后放疗的患者60例,按照随机数字表法分为对照组和试验组,每组30例。试验组给予香榆祛瘀合剂灌肠,对照组给予无菌注射用水灌肠,两组均灌注至放疗结束。比较患者放疗后急性放射性直肠炎出现时间、放射性直肠炎分级、体质量变化和肠道疼痛分级等。结果试验组出现放射性直肠炎时间为(17.21±3.1)d,明显晚于对照组(11.53±2.662)d,差异有统计学意义,t=8.73,P<0.001。放疗后试验组患者发生Ⅰ~Ⅳ级放射性直肠炎分别为17、8、5和0例,对照组分别为6、13、9和2例,差异有统计学意义,χ2=17.933,P=0.006。放疗后试验组患者体质量减轻(1.78±0.88)kg,明显小于对照组(3.21±1.00)kg,差异有统计学意义,t=5.91,P<0.001。放疗后试验组患者疼痛评分为2.93±2.23,明显低于对照组5.53±1.83,差异有统计学意义,t=4.94,P<0.001。结论香榆祛瘀合剂灌肠预防直肠癌术后放疗致急性放射性直肠炎的临床疗效较好,可明显延缓放射性直肠炎出现时间,有效减轻患者放射性直肠炎严重程度,防止因放射性直肠炎所致体质量降低及疼痛,提高患者生活质量,使患者顺利完成放疗。
OBJECTIVE Radiation proctitis is the inflammation of the rectum,which is caused by the radiotherapy of rectum or pelvic viscera.There is no recognized effective treatment so far.Xiangyuquyu mixture is a traditional Chinese medicine mixture developed by the Shandong Cancer Hospital Affiliated to Shandong University.It has the function of activating blood and removing blood stasis,astringency hemostasis and anti-inflammatory.This study was to investigate the clinical efficacy of Xiangyuquyu mixture in the prevention and treatment of acute radiation proctitis which is caused by the postoperative radiotherapy of rectal cancer.METHODS Totally 60 patients who visited Shandong Cancer Hospital Affiliated to Shandong University from March 1,2017 to February 28,2018 and had radiotherapy after operation for rectal carcinoma according to the random number table method,the patients were divided into control group and study group with30 cases in each group.The study group was retention enema with Xiangyuquyu mixture,and the control group was retention enema with aseptic injection water.The patients in both groups were perfused until the end of radiotherapy.The time of occurrence of acute radiation proctitis,the grade of radiation proctitis and the change of body weight were compared after radiotherapy.RESULTS The time of radiation proctitis in the study group was significantly later than that in the control group[(17.21±3.1)d,(11.53±2.662)d,respectively,t=8.73,P<0.001].After radiotherapy,the radiation proctitis in the study group was significantly lighter than that in the control group(gradeⅠ-Ⅳ:17,8,5,0;6,13,9,2,respectively,χ2=17.933,P=0.006).The weight loss of the patients in the study group was significantly lower than that in the control group[(1.78±0.88)kg,(3.21±1.00)kg,respectively,t=5.91,P<0.001].After radiotherapy,the pain score of the patients in the study group was significantly lower than that in the control group(2.93±2.23,5.53±1.83,respectively,t=4.94,P<0.001).CONCLUSIONS Xiangyuquyu mixture is effective in the prevention of acute radiation proctitis caused by the radiotherapy of rectal cancer.It can effectively lighten the severity of radiation proctitis,obviously delay the occurrence of radioactive proctitis,effectively reduce the grade of radiation proctitis,prevent the body weight loss caused by radioactive proctitis and alleviate the pain caused by radiation proctitis as well as improve the quality of patients' life,so that patients can successfully complete treatment.
OBJECTIVE Radiation proctitis is the inflammation of the rectum,which is caused by the radiotherapy of rectum or pelvic viscera.There is no recognized effective treatment so far.Xiangyuquyu mixture is a traditional Chinese medicine mixture developed by the Shandong Cancer Hospital Affiliated to Shandong University.It has the function of activating blood and removing blood stasis,astringency hemostasis and anti-inflammatory.This study was to investigate the clinical efficacy of Xiangyuquyu mixture in the prevention and treatment of acute radiation proctitis which is caused by the postoperative radiotherapy of rectal cancer.METHODS Totally 60 patients who visited Shandong Cancer Hospital Affiliated to Shandong University from March 1,2017 to February 28,2018 and had radiotherapy after operation for rectal carcinoma according to the random number table method,the patients were divided into control group and study group with30 cases in each group.The study group was retention enema with Xiangyuquyu mixture,and the control group was retention enema with aseptic injection water.The patients in both groups were perfused until the end of radiotherapy.The time of occurrence of acute radiation proctitis,the grade of radiation proctitis and the change of body weight were compared after radiotherapy.RESULTS The time of radiation proctitis in the study group was significantly later than that in the control group[(17.21±3.1)d,(11.53±2.662)d,respectively,t=8.73,P<0.001].After radiotherapy,the radiation proctitis in the study group was significantly lighter than that in the control group(gradeⅠ-Ⅳ:17,8,5,0;6,13,9,2,respectively,χ2=17.933,P=0.006).The weight loss of the patients in the study group was significantly lower than that in the control group[(1.78±0.88)kg,(3.21±1.00)kg,respectively,t=5.91,P<0.001].After radiotherapy,the pain score of the patients in the study group was significantly lower than that in the control group(2.93±2.23,5.53±1.83,respectively,t=4.94,P<0.001).CONCLUSIONS Xiangyuquyu mixture is effective in the prevention of acute radiation proctitis caused by the radiotherapy of rectal cancer.It can effectively lighten the severity of radiation proctitis,obviously delay the occurrence of radioactive proctitis,effectively reduce the grade of radiation proctitis,prevent the body weight loss caused by radioactive proctitis and alleviate the pain caused by radiation proctitis as well as improve the quality of patients' life,so that patients can successfully complete treatment.
引文
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[9]陈炬辉,潘丁龙,王春梅.小牛血清去蛋白肠灌注用于治疗放射性肠炎的临床观察[J].中国医药科学,2013,3(16):15-17.
[10]邓小琳,张瑞桢.康复新液联合金因肽保留灌肠治疗放射性直肠炎的效果观察[J].当代护士(中旬刊),2018,25(1):83-84.
[11]Vanneste BG,Van De Voorde L,de Ridder RJ,et al.Chronic radiation proctitis:tricks to prevent and treat[J].Int J Colorectal Dis,2015,30(10):1293-1303.
[12]Cunha TR,Colaiacovo W,Oliveira CZ,et al.Comparison between two different parameters of argon plasma coagulation in the treatment of chronic radiation proctopathy[J].Int J Colorectal Dis,2016,31(9):1657-1658.
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[14]Goldner G,Tomicek B,Becker G,et al.Proctitis after externalbeam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity:results of a prospective multicenter study of 166patients[J].Int J Radiat Oncol Biol Phys,2007,67(1):78-83.
[15]Leadon SA.Repair of DNA damage produced by ionizing radiation:a minireview[J].Semin Radiat Oncol,1996,6(4):295-305.
[16]邱云芳,叶赟,张曦霞,等.低温药物灌肠对大鼠急性放射性直肠损伤的防治效果研究[J].护士进修杂志,2012,27(24):2217-2219.
[17]彭政,廖小方,郑勤红,等.IL-11治疗重度放射性直肠炎的临床研究[J].浙江医学,2014,36(1):75-76.
[18]Wong MT,Lim JF,Ho KS,et al.Radiation proctitis:a decade’s experience[J].Singapore Med J,2010,51(4):315-319.
[19]吴华,陈莉,沈颖洲,等.小剂量地塞米松联合L-谷氨酰胺颗粒灌肠治疗溃疡性结肠炎72例疗效观察[J].实用医技杂志,2013,20(7):774-775.
[20]陆清昀.中药口服加灌肠治疗放射性肠炎43例疗效观察[J].四川中医,2017,35(1):71-73.
[21]祝云鹤,李仁廷.穴位贴敷联合中药保留灌肠治疗放射性肠炎23例疗效观察[J].云南中医中药杂志,2015,36(3):40-41.
[22]王馨曼,安颂歌,张磊,等.中药保留灌肠治疗放射性直肠炎疗效的系统评价[J].护理研究,2016,30(1):59-62.
[23]夏桂萍.中药保留灌肠治疗放射性直肠炎的疗效观察[J].中医临床研究,2016,8(8):114-115.
[24]高碧燕,卢玉波,俞晶,等.思密达-金因肽混合液保留灌肠治疗急性放射性直肠炎(附34例分析)[J].现代肿瘤医学,2006,14(3):334-336.
[2]Manojlovic N,Babic D.Radiation-induced rectal ulcer--prognostic factors and medical treatment[J].Hepatogastroenterology,2004,51(56):447-450.
[3]Hille A,Herrmann MK,Kertesz T,et al.Sodium butyrate enemas in the treatment of acute radiation-induced proctitis in patients with prostate cancer and the impact on late proctitis.A prospective evaluation[J].Strahlenther Onkol,2008,184(12):686-692.
[4]Aj M,Cdm FH,Pj L.Perceived school and neighborhood safety,neighborhood violence and academic achievement in urban school children[J].Urban Rev,2010,42(5):458-467.
[5]王晓珊,梁良,罗树春.小牛血清去蛋白注射液对食管癌急性放射性食管炎的预防效果[J].癌症进展,2014,12(2):167-171.
[6]Nascimento M,Aguilar-Nascimento JE,Caporossi C,et al.Efficacy of synbiotics to reduce acute radiation proctitis symptoms and improve quality of life:a randomized,double-blind,placebo-controlled pilot trial[J].Int J Radiat Oncol Biol Phys,2014,90(2):289-295.
[7]Grodsky MB,Sidani SM.Radiation proctopathy[J].Clin Colon Rectal Surg,2015,28(2):103-111.
[8]Tang Y,Huang Y,Mo X,et al.Efficacy and safety of Yunxiangjing derived from Chinese herbal medicine administered as an enema in the management of acute radiation-induced proctitis in patients with pelvic malignancy[J].J Tradit Chin Med,2016,36(1):45-50.
[9]陈炬辉,潘丁龙,王春梅.小牛血清去蛋白肠灌注用于治疗放射性肠炎的临床观察[J].中国医药科学,2013,3(16):15-17.
[10]邓小琳,张瑞桢.康复新液联合金因肽保留灌肠治疗放射性直肠炎的效果观察[J].当代护士(中旬刊),2018,25(1):83-84.
[11]Vanneste BG,Van De Voorde L,de Ridder RJ,et al.Chronic radiation proctitis:tricks to prevent and treat[J].Int J Colorectal Dis,2015,30(10):1293-1303.
[12]Cunha TR,Colaiacovo W,Oliveira CZ,et al.Comparison between two different parameters of argon plasma coagulation in the treatment of chronic radiation proctopathy[J].Int J Colorectal Dis,2016,31(9):1657-1658.
[13]Lenz L,Rohr R,Nakao F,et al.Chronic radiation proctopathy:A practical review of endoscopic treatment[J].World J Gastrointest Surg,2016,8(2):151-160.
[14]Goldner G,Tomicek B,Becker G,et al.Proctitis after externalbeam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity:results of a prospective multicenter study of 166patients[J].Int J Radiat Oncol Biol Phys,2007,67(1):78-83.
[15]Leadon SA.Repair of DNA damage produced by ionizing radiation:a minireview[J].Semin Radiat Oncol,1996,6(4):295-305.
[16]邱云芳,叶赟,张曦霞,等.低温药物灌肠对大鼠急性放射性直肠损伤的防治效果研究[J].护士进修杂志,2012,27(24):2217-2219.
[17]彭政,廖小方,郑勤红,等.IL-11治疗重度放射性直肠炎的临床研究[J].浙江医学,2014,36(1):75-76.
[18]Wong MT,Lim JF,Ho KS,et al.Radiation proctitis:a decade’s experience[J].Singapore Med J,2010,51(4):315-319.
[19]吴华,陈莉,沈颖洲,等.小剂量地塞米松联合L-谷氨酰胺颗粒灌肠治疗溃疡性结肠炎72例疗效观察[J].实用医技杂志,2013,20(7):774-775.
[20]陆清昀.中药口服加灌肠治疗放射性肠炎43例疗效观察[J].四川中医,2017,35(1):71-73.
[21]祝云鹤,李仁廷.穴位贴敷联合中药保留灌肠治疗放射性肠炎23例疗效观察[J].云南中医中药杂志,2015,36(3):40-41.
[22]王馨曼,安颂歌,张磊,等.中药保留灌肠治疗放射性直肠炎疗效的系统评价[J].护理研究,2016,30(1):59-62.
[23]夏桂萍.中药保留灌肠治疗放射性直肠炎的疗效观察[J].中医临床研究,2016,8(8):114-115.
[24]高碧燕,卢玉波,俞晶,等.思密达-金因肽混合液保留灌肠治疗急性放射性直肠炎(附34例分析)[J].现代肿瘤医学,2006,14(3):334-336.