本文選題：胰腺癌 + 放療　； 參考：《河北北方學(xué)院》2017年碩士論文

【摘要】：放射性胃、十二指腸黏膜損傷是上腹部腫瘤放射治療時(shí)常見(jiàn)并發(fā)癥,多見(jiàn)于胰腺癌、肝癌、膽管癌等上腹部腫瘤的放療。輕者內(nèi)鏡下可見(jiàn)黏膜充血、水腫、糜爛,嚴(yán)重者出現(xiàn)潰瘍、穿孔、梗阻、胃潴留等,臨床則出現(xiàn)上腹部疼痛,吞咽困難,腹脹,惡心嘔吐,嘔血等。胰腺位于腹膜后,毗鄰胃和十二指腸,其黏膜組織是人體內(nèi)除骨髓外對(duì)射線最為敏感的組織,易受到放射性損傷,嚴(yán)重影響患者的生活質(zhì)量。本課題搜集從2010年7月至2016年7月在空軍總醫(yī)院行胰腺癌放療患者,搜集整理放療后胃、十二指腸損傷內(nèi)鏡下表現(xiàn)并進(jìn)行分級(jí),分析放療后胃、十二指腸黏膜損傷胃鏡下分級(jí)與病理變化相關(guān)性,探討影響放射性胃、十二指腸損傷發(fā)生的風(fēng)險(xiǎn)因素。放療前后均有胃鏡和病理檢查的有103例患者,收集患者基本臨床資料,包括性別、年齡、腫瘤部位、腹部手術(shù)史、放療后臨床癥狀等。放療后胃鏡診斷放射性損傷,在損傷部位活檢進(jìn)行病理分析。病理分析主要包括單核細(xì)胞、中性粒細(xì)胞、嗜酸性粒細(xì)胞浸潤(rùn)和黏膜腺體萎縮程度。所有數(shù)據(jù)使用SPSS22.0統(tǒng)計(jì)軟件分析。放射性損傷胃鏡下分級(jí)與病理采用Speraman相關(guān)性分析,單因素分析采用卡方檢驗(yàn),組間比較采用Mann-Whitney U檢驗(yàn),P0.05有統(tǒng)計(jì)學(xué)意義。胰腺癌放療后內(nèi)鏡觀察,0級(jí)胃、十二指腸黏膜光滑,無(wú)變形,絨毛正常13例,Ⅰ級(jí)黏膜充血、腫脹,組織脆性增加13例,Ⅱ級(jí)黏膜點(diǎn)片狀出血8例,Ⅲ級(jí)黏膜點(diǎn)片狀糜爛9例,Ⅳ級(jí)黏膜形成潰瘍36例,Ⅴ級(jí)病變包括:潰瘍合并狹窄6例,狹窄后導(dǎo)致十二指腸梗阻5例,單純十二指腸狹窄5例,潰瘍合并出血8例。Ⅰ級(jí)以上總發(fā)生率為87.4%(90/103),其中胃和十二指腸共同損傷53.4%(55/103),單純胃黏膜損傷34.0%(35/103),單純十二指腸損傷為10.7%(11/103)。損傷部位活檢后觀察單核細(xì)胞浸潤(rùn)程度(4例VS29例VS34例VS36例)、中性粒細(xì)胞浸潤(rùn)程度(48例VS24例VS20例VS11例)、嗜酸性粒細(xì)胞浸潤(rùn)程度(68例VS24例VS8例VS3例)及胃、十二指腸黏膜萎縮程度(24例VS33例VS29例VS17例)。胃鏡下黏膜損傷分級(jí)與慢性炎癥、中性粒細(xì)胞、嗜酸性粒細(xì)胞浸潤(rùn)及黏膜腺體萎縮均呈正相關(guān)(r=0.466,p=0.000;r=0.434,p=0.000;r=0.274,p=0.05;r=0.480,p=0.000),內(nèi)鏡損傷分級(jí)與放療后臨床癥狀呈正相關(guān)(r=0.421,p=0.000)。影響胃鏡下?lián)p傷分級(jí)因素為年齡(P=0.023),其余無(wú)影響。放療同步替吉奧、吉西他濱化療對(duì)胃和十二指腸損傷有影響(p=0.036),不同放療方法對(duì)胃和十二指腸損傷無(wú)影響。結(jié)論:⒈胃鏡下?lián)p傷分級(jí)與病理表現(xiàn)呈正相關(guān),隨著分級(jí)加重,病理表現(xiàn)也逐漸加重,表現(xiàn)在單核細(xì)胞、中性粒細(xì)胞、嗜酸性粒細(xì)胞浸潤(rùn)加深,黏膜腺體萎縮加重。⒉胃鏡下?lián)p傷分級(jí)與臨床癥狀呈正相關(guān),隨著分級(jí)加重,臨床癥狀也越嚴(yán)重。根據(jù)患者臨床癥狀,可適當(dāng)給予消化酶和促進(jìn)胃腸動(dòng)力藥物,改善消化不良癥狀。⒊同步化療對(duì)放射性胃、十二指腸損傷及損傷分級(jí)無(wú)影響,醫(yī)師可根據(jù)患者情況選擇同步放化療,增加療效。⒋氨磷汀與抑酸劑對(duì)放射損傷及損傷分級(jí)無(wú)影響,但質(zhì)子泵抑制劑對(duì)放射性潰瘍有一定的效果。⒌不同放療方法均能導(dǎo)致放射性胃腸損傷,根據(jù)腫瘤位置、臨床分期及患者經(jīng)濟(jì)條件選擇適宜的放療方法。⒍胰腺癌放療患者,應(yīng)定期行胃鏡檢查,避免發(fā)生潰瘍、穿孔、梗阻、出血等并發(fā)癥,提高患者生活質(zhì)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.

【學(xué)位授予單位】：河北北方學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R730.55

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