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目的:探讨放射治疗胸部病变所致损伤的机制和特点,达到及时防治的目的。方法:收集3202例有完整影像学资料的胸部肿瘤病人的放射治疗临床资料,进行分析总结。结果:所有病例胸部异常病变检出率为34.01%,包括肺部阴影80.07%、食管不同程度的狭窄59.69%、心包积液5.05%、胸膜改变9.09%和肋骨骨折0.735%。其中只有60.61%有症状,发生时间为放疗开始后0.5～36mo,1～6mo多见。肺部改变表现为大小不等的片状影和条索影;食管病变表现为程度不同的管腔狭窄;心包和胸膜损伤表现为心包或胸腔有轻、中度的积液和轻度心包或胸膜增厚,伽玛刀治疗后表现为原病灶处的片状高密度影,边缘较清楚,有时中心密度较低,类似空洞表现。这些改变在门诊约50%的肺内病变误诊为肺结核,30%误诊为放射性肺炎,5%误诊为肺炎,3%误诊为肺部肿瘤,4例误诊为肺脓肿。86%的食管病变在影像科误诊为食管癌或食管炎,建议病人进一步检查和治疗;88%的胸膜、心包病变误诊为胸膜和心包炎或癌转移。结论:放射性损伤发生率较高,且易于误诊误治,需提高认识,重在预防。
Objective: To explore the mechanism and characteristics of radiotherapy for thoracic lesion-induced injury and to achieve the purpose of timely prevention and treatment. Methods: The clinical data of 3202 cases of thoracic tumor patients with complete imaging data were collected and analyzed. Results: The detection rate of abnormal thoracic lesions in all cases was 34.01%, including 80.07% of lung shadow, 59.69% of esophageal strictures, 5.05% of pericardial effusion, 9.09% of pleural changes and 0.735% of rib fractures. Only 60.61% of them had symptoms, and the occurrence time was 0.5 ~ 36 months after the start of radiotherapy, more common in 1 ~ 6 months. Pulmonary changes showed varying sizes of film-like shadow and cable shadow; esophageal lesions showed varying degrees of stenosis; pericardial and pleural injuries showed pericardial or pleural effusion and mild, moderate effusion and mild pericardial or Pleural thickening, gamma knife treatment showed the original lesion flake high density, the edge more clearly, and sometimes lower center density, similar to the empty performance. About 50% of these changes were clinically misdiagnosed as pulmonary tuberculosis in outpatients, 30% were misdiagnosed as radiation pneumonitis, 5% were misdiagnosed as pneumonia, 3% were misdiagnosed as lung tumors and 4 were misdiagnosed as pulmonary abscesses. Eighty-six percent of esophageal lesions were misdiagnosed as esophageal or esophagitis in the imaging department and the patient was advised to undergo further examination and treatment; 88% of the pleural and pericardial lesions were misdiagnosed as pleural and pericarditis or metastases. Conclusion: The incidence of radiation injury is high, and it is easy to misdiagnosis and mistreatment. It is necessary to raise awareness and focus on prevention.