During radium therapy for cervical cancer, the radium device should be adequately fixed to avoid displacement and not to be tilted towards the posterior vaginal wall. The spacing between pelvic irradiation and external irradiation should be not less than 4-6 cm, and the number of radium treatments should be changed from 3-4 times to 2 times. There is the use of rear-loading treatment machine, designed with special rectal dumping brace, which can separate the anterior rectal wall and vaginal container by 1, 5 cm to reduce the amount of rectal radiation exposure. Those who have manifestations of radiation proctitis should suspend radiotherapy and perform other treatments.
The prognosis of radiation small bowel infection is worse than that of radiation colitis and proctitis. 2/3 of patients with mild disease may improve or recover within 4 to 18 months. It is believed that extensive pelvic surgery followed by radiotherapy will result in 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%.
When radioactive proctitis occurs, avoid eating foods that are fibrous or irritating to the intestinal wall, and it is advisable to eat foods with less residue, low fat and less gas production. Such as carrots, spinach, etc., not only lax intestines and supplement vitamins. Attention should also be paid to keeping the anus and perineum clean and wearing loose underwear. For those with obvious symptoms, hot compresses can be applied to the anus and perineum to reduce symptoms, and anti-inflammatory drugs can be taken orally or applied via the anus. For those who have bleeding, use Yunnan Baiyao, etc. For obvious diarrhea, use antidiarrheal drugs. For obvious pain, use anti-inflammatory pain suppositories. For severe symptoms, radiotherapy can be suspended, and high doses of vitamins, infusion of various intravenous nutrition and application of adrenocorticotropic hormones and antibiotics can be used to reduce local inflammatory reactions and promote recovery.
General treatment
Bed rest should be given in the acute stage. Diet should be non-irritating, easily digestible, nutritious, with many small meals. Limit fiber intake. Intravenous high nutrition therapy can be used for severe diarrhea.
Drug treatment
1, astringent and antispasmodic: available topical eggplant compound, compound camphor tincture, pomegranate peel decoction (pomegranate peel 30g with water 200-300ml decoction of 50ml, taken orally once a day). Aspirin can effectively control the early diarrhea of radiation enteritis, which may be related to the inhibition of prostaglandin synthesis.
2, local analgesics and stool softeners: those with significant post-rash and pain can use 2% benzocaine cottonseed oil retention enemas. Use warm paraffin oil retention enema or warm water sitz bath.
3.Hormone enema: Succinyl hydrocortisone 50mg plus 200ml warm saline retention enema, especially effective for those with post-acute.
4, presacral closed therapy: 0, 5% procaine 40ml, vitamin B6100mg, vitamin B1200mg, α-chymotrypsin 2-5mg, streptomycin 0, 5g, closed once every 5-7 days, treatment 1 to 3 times, can make the pain significantly reduced.
5, hemostasis: low intestinal bleeding can be hemostatic under direct endoscopic pressure or use of hemostatic agents or bleeding points for “8” suture hemostasis. However, cautery can not be used to stop the sedan. Higher bleeding point can be made by norepinephrine 4~6mg or neofolin 10~20mg diluted in 200ml of warm saline to retain the enema, or thrombin 100~1000 units plus 200ml of warm saline to retain the enema, generally within 1~3 minutes to stop bleeding. Large amounts of uncontrollable high bleeding need to be surgical treatment.
6.Anti-infection: antibiotics are needed when there is secondary infection.
7.α2 macroglobulin: α2 macroglobulin has been tried in China for the treatment of radiation enteritis, with good results. 6ml of α2 macroglobulin is injected into the muscle every other day or 3ml is injected into the muscle every day, and the technique is 1 course of treatment for 2 months. The mucosal bleeding and pain improved significantly after the administration of the drug. The ulcer tended to heal. The principle may be by making plasma kinin-releasing enzyme, so that it is reduced, thus reducing capillary exudation and pain. Also α2-macroglobulin binds to a variety of protein hydrolases to inhibit the latter’s action on the intestinal wall.
Surgical treatment
Advanced lesions such as intestinal strictures, obstructions, and fistulas mostly require surgical treatment. For distal colonic lesions, a transverse colostomy can be performed to achieve permanent or temporary diversion of stool, and the results are often better than simply incising the distal colonic lesion. Generally, colostomy needs to be closed after 6 to 12 months or more, once the function of the colon is restored.
Traditional Chinese medicine treatment
According to Chinese medicine, the early gastrointestinal reaction is the result of radiation exposure, which can lead to depletion of fluids and heat in the stomach and intestines. The symptoms include nausea, vomiting and reduced food intake. Treatment is to nourish Yin and harmonize the stomach. The medicine is based on the use of Fritillaria and ochre to lower the rebellion and stop vomiting; Sha Shen, Yu Zhu and Lu Gen to nourish Yin and clear heat; Orange Peel, Bamboo Roo and Coix Seed to harmonize the stomach. In addition, it can be combined with acupuncture of Neiguan and Foot San Li.
In proctitis, it is considered to be heat in the intestinal tract. The symptoms are abdominal pain, downward spiral, and stool with pus and blood. Treatment butt nourish Yin and clear heat. The medicine is used to detoxify and clear heat with Sophora japonica, Diyu, Stachybotrys sinensis, Paeonia lactiflora, Ocimum sanctum, Hawthorn sour and sweet; Qin Pi collects astringency and stops diarrhea. In addition, it can be combined with acupuncture treatment.
For those with radiation complications of leukopenia, TCM considers yin deficiency and blood deficiency. The symptoms are fatigue and weakness, and pale face. The treatment is to benefit the qi and nourish the blood. The medicine uses Astragalus and Huang Jing to benefit the Qi; Angelica and Chicken Blood Vine to invigorate the Blood; Semen Cuscutae, Fructus Lycii and Zi He Che to tonify the kidney and generate marrow. In addition, 50% Lingzhi injection can be used for intramuscular injection, 4ml each time, once a day, 10 days for a course of treatment.
Concurrent thrombocytopenia is considered by TCM to be a deficiency of both qi and yin, with blood-heat delusion. The symptoms include fatigue and weakness, and bleeding in the skin and mucous membranes. Treatment is to benefit Qi and nourish Yin, cool the blood and stop the force. The medicine uses Astragalus membranaceus, turtle shell gum, tortoise shell gum and jujube to benefit Qi and nourish Yin; Bai Mao Root, Dan Pi, Xian He Cao and Xiao Ji to clear heat and stop bleeding. Chinese medicine was used to retain the enema with 60g of Bletilla, 20g of ground elm charcoal, 3g of Panax ginseng powder, add 1000ml of water, decoct to 500ml, and retain the enema with 50ml each time, 10 times for a course. The authors have used 3g of Qing Dai, 0.5g of furacilin powder, 20ml of 10% calcium gluconate injection, add water to 500ml, once a day, 50ml each time, retain the enema, 10 days as a course of treatment, can receive satisfactory effect on hemostasis.