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宫颈癌放疗后肠穿孔并难治性放射性肠炎1例A Case of Intestinal Perforation, Refractory Radiation Enteritis after Pelvic Cavity Radiotherapy for Cervical Cancer
宫颈癌, 肠穿孔, 放射性肠炎 Cervical Cancer; Intestinal Perforation; Radiation Enteritis
《Asian Case Reports in Emergency Medicine》, Vol.1 No.1, 2013-02-20
本文报告1例宫颈癌盆腔放疗后并发肠穿孔并难治性放射性肠炎患者。1位59岁女性患者，因宫颈癌接受盆腔放疗(4000 cGy)后3月出现慢性腹痛，并突然出现腹痛而诊断为“小肠穿孔”行手术，术中发现放射野约60 cm长回肠壁坏死、穿孔。病理检查证实切除的肠段为严重的慢性放射性肠炎。对曾受过腹部放疗的患者，如出现腹痛等急腹症表现，急诊应警惕放射性肠炎继发肠坏死穿孔的可能，腹部平片或CT检查有助于明确诊断。放射性肠炎引起的出血和腹泻症状顽固，难于治疗，目前主要治疗方法为对症支持治疗。
A rare case of intestinal perforation, refractory radiation enteritis after pelvic cavity radiotherapy for cervical cancer is reported. A 59-year-old woman with a past history cervical cancer and received tumor bed irradiation (4000 cGy) three months previously suffered chronic abdominal pain for one month and sudden onset of peritonitis caused by perforation of the small intestine. She underwent laparotomy and was found to have perforation of the jejunum in the radiation field. Histopathological examination of resected intestine revealed evidence of severe chronic radiation enteritis. A diagnosis of chronic radiation enteritis and intestinal perforation should be considered in patients who had received abdominal irradiation and who manifest abdominal pain after irradiation. The symptom of diarrhea and hemorrhage of radiation enteritis was refractory even one year after operation.