The diagnosis of acute radiation enteritis is generally not difficult. A history of radiotherapy combined with clinical manifestations and relevant examinations can determine the nature and location of the lesion, and a clear diagnosis can be made. However, other underlying diseases such as non-specific ulcerative colitis, intestinal tuberculosis, and intestinal lipid metabolism disorder syndrome should be considered.
General treatment: Psychological treatment and dietary guidance, detailed explanation to patients that acute radiation proctitis is a common radiation therapy toxic side effects, there is no need to be overly nervous, should maintain a good attitude and actively cooperate with treatment, and will soon be cured. During the acute period, attention should be paid to rest. The diet should be non-irritating, easy to digest, nutritious, and with many small meals. Limit fiber intake.
Drug treatment: 1, astringent and antispasmodic treatment: oral Huang Lianxin, haloperidol, belladonna combination, Simethicone, etc. Aspirin can effectively control the early diarrhea of radiation enteritis, which may be related to the inhibition of prostaglandin synthesis.
2. Retention enema therapy: Simethicone – goldin peptide mixture (Simethicone 6mg + goldin peptide 2ml + dexamethasone 5mg + gentamicin 80,000 U + saline 40ml). Yunnan Baiyao, Methotrexate, Simethicone + vitamin B12 + dexamethasone, etc. Retain the enema, firstly, after the stool is emptied, take the left side position, firstly, fully coat the catheter with paraffin oil (14#/16#) then slowly insert the catheter into the anus about 10cm.
Then draw the mixture of Similac-Kinin peptide into a 60ml syringe and slowly inject it into the rectum and then pull out the catheter and gently rub the anus for 4-5 minutes. Ask the patient to pad the buttocks, prone, left and right lateral and supine positions respectively, let the mixture fully adhere to the rectal mucosa and prolong the time of drug in the rectum as much as possible, once a day; 10-20 days/course, 2 courses of treatment, and start to evaluate the efficacy after the end of 2 courses of treatment.
3, local hemostasis: low intestinal bleeding can be compressed under direct endoscopic view to stop bleeding or use hemostatic agents. However, cautery can not be used to stop the sedan. Higher bleeding points can be retained in enemas with thrombin 100-1000 units plus 200 ml of warm saline, which can generally stop bleeding within 1 to 3 minutes. Or use Yunnan Baiyao to retain the enema to stop bleeding treatment. Large amounts of uncontrollable high bleeding need to be surgical treatment.
4.Anti-infection treatment: antibiotics are needed when there is secondary infection.
5.Intravenous high nutrition support. As the occurrence and development of radiation proctitis is prone to inadequate intake and malnutrition, intravenous high nutrition support such as energy combination, amino acids, fat emulsion, human albumin and multivitamins can be given according to the specific situation. Surgery: late lesions such as intestinal stenosis, obstruction and fistula require surgical treatment. For distal colon lesions, a transverse colostomy can be performed to achieve permanent or temporary stool diversion, and the results are often better than simply cutting the distal colon lesions. Generally, colostomy needs to be closed after 6 to 12 months or more, when the function of the colon is restored.
Chinese medicine treatment Chinese medicine believes that early gastrointestinal reactions are caused by the depletion of fluids and heat in the stomach and intestines after radiation exposure. The symptoms include nausea, vomiting and reduced food intake. The treatment is to nourish Yin and harmonize the stomach. In addition, it can be combined with acupuncture of Neiguan and Sansili.
The prognosis of radiation small bowel infection is worse than that of radiation colitis and proctitis. 2/3 of patients with mild disease can be improved or cured within 4 to 18 months. It is believed that extensive pelvic surgery followed by radiotherapy results in even poorer blood supply to the diseased tissue and its prognosis is often worse. According to foreign reports, the mortality rate of severe intestinal radiation injury is 22%.