Dilemma and strategy in surgery of chronic radiation intestinal injury
10.3760/cma.j.cn.441530-20200521-00296
- VernacularTitle:慢性放射性肠损伤的手术难点与对策
- Author:
Tenghui MA
1
;
Hui WANG
;
Jianping WANG
Author Information
1. 中山大学附属第六医院结直肠肛门外科 放射性肠病专科 广东省结直肠盆底疾病研究重点实验室 广东省胃肠病学研究所，广州 510655
- Keywords:
Radiation intestinal injury, chronic;
Complications, late;
Surgical treatment
- From:
Chinese Journal of Gastrointestinal Surgery
2020;23(8):728-733
- CountryChina
- Language:Chinese
-
Abstract:
Chronic radiation intestinal injury denotes the repeated and prolonged damage of intestine caused by radiotherapy to pelvic malignancy, which usually occurs after three months of radiotherapy. Surgical intervention is indicated when the progressive intestinal injury leads to the development of massive intestinal hemorrhage, obstruction, perforation, fistula and other late complications. However, there is no consensus on the surgical procedures. We illustrate the dilemma in surgical treatment from the points of pathological mechanism and the frequent sites of radiation intestinal injury. Meanwhile, we discuss the surgical alternatives of radiation intestinal injury based on the literature and our experience. The pathological mechanism of chronic radiation injury is progressive occlusive arteritis and parenchymal fibrosis. The frequently involved sites are distal ileum, sigmoid colon and rectum based on the radiotherapy region. The morbidity and mortality are high in surgery of chronic radiation injury due to poor ability of tissue healing, pelvic fibrosis, multiple organ damage, and poor physical condition. Definitive intestinal resection is one of the most common surgical procedures. Extended resection of diseased bowel to ensure that there is no radiation damage in at least one end of the anastomotic bowels is the key to decrease the risk of complications related to anastomotic sites.
