放射性胃、十二指肠黏膜损伤内镜下分级与病理变化相关性研究

发布时间：2018-04-21 08:41

本文选题：胰腺癌 + 放疗　；参考：《河北北方学院》2017年硕士论文

【摘要】：放射性胃、十二指肠黏膜损伤是上腹部肿瘤放射治疗时常见并发症,多见于胰腺癌、肝癌、胆管癌等上腹部肿瘤的放疗。轻者内镜下可见黏膜充血、水肿、糜烂,严重者出现溃疡、穿孔、梗阻、胃潴留等,临床则出现上腹部疼痛,吞咽困难,腹胀,恶心呕吐,呕血等。胰腺位于腹膜后,毗邻胃和十二指肠,其黏膜组织是人体内除骨髓外对射线最为敏感的组织,易受到放射性损伤,严重影响患者的生活质量。本课题搜集从2010年7月至2016年7月在空军总医院行胰腺癌放疗患者,搜集整理放疗后胃、十二指肠损伤内镜下表现并进行分级,分析放疗后胃、十二指肠黏膜损伤胃镜下分级与病理变化相关性,探讨影响放射性胃、十二指肠损伤发生的风险因素。放疗前后均有胃镜和病理检查的有103例患者,收集患者基本临床资料,包括性别、年龄、肿瘤部位、腹部手术史、放疗后临床症状等。放疗后胃镜诊断放射性损伤,在损伤部位活检进行病理分析。病理分析主要包括单核细胞、中性粒细胞、嗜酸性粒细胞浸润和黏膜腺体萎缩程度。所有数据使用SPSS22.0统计软件分析。放射性损伤胃镜下分级与病理采用Speraman相关性分析,单因素分析采用卡方检验,组间比较采用Mann-Whitney U检验,P0.05有统计学意义。胰腺癌放疗后内镜观察,0级胃、十二指肠黏膜光滑,无变形,绒毛正常13例,Ⅰ级黏膜充血、肿胀,组织脆性增加13例,Ⅱ级黏膜点片状出血8例,Ⅲ级黏膜点片状糜烂9例,Ⅳ级黏膜形成溃疡36例,Ⅴ级病变包括:溃疡合并狭窄6例,狭窄后导致十二指肠梗阻5例,单纯十二指肠狭窄5例,溃疡合并出血8例。Ⅰ级以上总发生率为87.4%(90/103),其中胃和十二指肠共同损伤53.4%(55/103),单纯胃黏膜损伤34.0%(35/103),单纯十二指肠损伤为10.7%(11/103)。损伤部位活检后观察单核细胞浸润程度(4例VS29例VS34例VS36例)、中性粒细胞浸润程度(48例VS24例VS20例VS11例)、嗜酸性粒细胞浸润程度(68例VS24例VS8例VS3例)及胃、十二指肠黏膜萎缩程度(24例VS33例VS29例VS17例)。胃镜下黏膜损伤分级与慢性炎症、中性粒细胞、嗜酸性粒细胞浸润及黏膜腺体萎缩均呈正相关(r=0.466,p=0.000;r=0.434,p=0.000;r=0.274,p=0.05;r=0.480,p=0.000),内镜损伤分级与放疗后临床症状呈正相关(r=0.421,p=0.000)。影响胃镜下损伤分级因素为年龄(P=0.023),其余无影响。放疗同步替吉奥、吉西他滨化疗对胃和十二指肠损伤有影响(p=0.036),不同放疗方法对胃和十二指肠损伤无影响。结论:⒈胃镜下损伤分级与病理表现呈正相关,随着分级加重,病理表现也逐渐加重,表现在单核细胞、中性粒细胞、嗜酸性粒细胞浸润加深,黏膜腺体萎缩加重。⒉胃镜下损伤分级与临床症状呈正相关,随着分级加重,临床症状也越严重。根据患者临床症状,可适当给予消化酶和促进胃肠动力药物,改善消化不良症状。⒊同步化疗对放射性胃、十二指肠损伤及损伤分级无影响,医师可根据患者情况选择同步放化疗,增加疗效。⒋氨磷汀与抑酸剂对放射损伤及损伤分级无影响,但质子泵抑制剂对放射性溃疡有一定的效果。⒌不同放疗方法均能导致放射性胃肠损伤,根据肿瘤位置、临床分期及患者经济条件选择适宜的放疗方法。⒍胰腺癌放疗患者,应定期行胃镜检查,避免发生溃疡、穿孔、梗阻、出血等并发症,提高患者生活质量。
[Abstract]:Radionuclide, duodenal mucosa injury is a common complication of radiation therapy for upper abdominal tumor. It is often seen in the radiotherapy of upper abdominal tumors such as pancreatic cancer, liver cancer, bile duct cancer and other upper abdominal tumors. The pancreas is located in the retroperitoneum, adjacent to the stomach and duodenum, and its mucosa is the most sensitive tissue in the human body except the bone marrow. It is easily damaged by radioactivity and seriously affects the quality of life of the patients. The collection of pancreatic cancer patients from July 2010 to July 2016 was collected and collated. The findings and classification of gastric and duodenal injuries after radiotherapy were classified, and the correlation between gastroscope and duodenal mucosa injury gastroscopy was analyzed with pathological changes. The risk factors affecting the occurrence of radioactive stomach and duodenal injury were discussed. There were 103 patients with gastroscopy and pathological examination before and after radiotherapy, and collected the basic clinical data of the patients. Including sex, age, tumor site, history of abdominal surgery, clinical symptoms after radiotherapy. After radiotherapy, gastroscopy was used to diagnose radioactive damage and pathological analysis at the lesion site. Pathological analysis included mononuclear cells, neutrophils, eosinophil infiltration and atrophy of mucous glands. All data were divided by SPSS22.0 software. Analysis. Speraman correlation analysis was used in the classification and pathology of radioactivity damage gastroscope. Single factor analysis was examined by chi square test, Mann-Whitney U test was used in the group, and P0.05 had statistical significance. After radiotherapy of pancreatic cancer, endoscopic observation, 0 grade stomach, smooth duodenal mucosa, no deformation, 13 cases of normal villi, grade I mucous congestion, swelling and tissue crisp There were 13 cases of sex increase, 8 cases of stage II mucosa bleed, 9 cases of stage III mucosa erosion and 36 cases of ulceration in grade IV mucosa, 6 cases of ulcer combined with stenosis, 5 cases of duodenal obstruction after stenosis, 5 cases of duodenal stenosis and 8 cases of ulcer combined with bleeding. The total incidence rate above grade I was 87.4% (90/103), of which stomach and ten Two common injury of the fingers (55/103), simple gastric mucosal injury 34% (35/103), and simple duodenal injury 10.7% (11/103). After biopsy, the infiltration degree of mononuclear cells (4 cases VS29 cases VS34 VS36 cases), neutrophilic granulocyte infiltration degree (48 cases VS24 case VS20 cases VS11 cases), eosinophil infiltration degree (68 VS24 VS8 case VS3) The degree of atrophy of gastric and duodenal mucosa (24 cases of VS33 VS29 cases VS17 cases). The classification of mucosal damage under gastroscope was positively correlated with chronic inflammation, neutrophils, eosinophil infiltration and atrophy of mucous glands (r=0.466, p=0.000; r=0.434, p=0.000; r=0.274, P =0.05; r=0.480, p=0.000), and the clinical symptoms of endoscopy injury classification and radiotherapy Positive correlation (r=0.421, p=0.000). The factors affecting the classification of gastroscopy damage were age (P=0.023), and the rest had no effect. Radiotherapy combined with gemcitabine, gemcitabine chemotherapy had an effect on gastric and duodenal injury (p=0.036), and there was no effect on gastric and duodenal injury by different radiotherapy methods. The histopathological manifestations were aggravated and the pathological manifestations were gradually aggravated. The infiltration of neutrophils, neutrophils, eosinophils increased and the atrophy of the mucous glands became worse. The classification of the lesion was positively correlated with the clinical symptoms, and the more severe the clinical symptoms were. Synchronous chemotherapy has no effect on radioactive gastric, duodenal injury and damage classification. Physicians can choose concurrent chemoradiotherapy according to the patient's condition to increase the curative effect. Different radiotherapy methods can lead to radioactive gastrointestinal damage. According to the location of the tumor, the clinical stage and the patient's economic conditions, a suitable radiotherapy method is selected.

【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.55

【参考文献】