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目的探讨前列腺癌125I粒子植入术后直肠并发症及防治。方法2001年11月～2006年6月,在直肠超声引导下,经会阴前列腺125I放射粒子植入联合雄激素全阻断治疗中晚期前列腺癌90例,术后每1～3个月随访,观察直肠并发症及治疗。结果89例随访1～55个月,平均22个月。直肠并发症Ⅰ、Ⅱ、Ⅲ、Ⅳ级发生率分别为11.2%(10/89)、6.7%(6/89)、0%及2.2%(2/89)。Ⅰ、Ⅱ级16例观察及对症治疗,半年后症状逐渐减轻。Ⅳ级2例,1例因直肠炎在外院行多次检查和治疗,1例合并重度糖尿病,采用结肠腹壁造口,结合膀胱穿刺造瘘治疗,病情好转。结论125I放射粒子植入术后发生放射性直肠炎,一般采用观察及对症治疗,病情有自限性,不要盲目过度检查及治疗,对合并糖尿病者应积极治疗,以减少尿道直肠瘘的发生。
Objective To investigate the prevention and treatment of rectal complications after 125I seed implantation in prostate cancer. Methods From November 2001 to June 2006, under the guidance of rectal ultrasound, 90 cases of advanced prostate cancer were treated with 125I radioactive seed implantation of perineal prostate combined with androgen blockade. All cases were followed up every 1 to 3 months after operation Rectal complications and treatment. Results 89 cases were followed up for 1 ~ 55 months with an average of 22 months. The incidence of rectal complications Ⅰ, Ⅱ, Ⅲ and Ⅳ were 11.2% (10/89), 6.7% (6/89), 0% and 2.2% (2/89) respectively. Ⅰ, Ⅱ grade 16 cases of symptomatic treatment and treatment, symptoms gradually alleviate after six months. Ⅳ grade in 2 cases, 1 case of proctitis in the outside hospital for multiple checks and treatment, 1 case of severe diabetes mellitus, the use of colostomy stoma, combined with bladder puncture fistula treatment, the condition improved. CONCLUSION: Radioactive proctitis occurs after 125I radioactive particle implantation. Observation and symptomatic treatment are generally taken. The disease is self-limiting. Do not blindly check and treat blindly. Patients with diabetes mellitus should be actively treated to reduce the incidence of urethral rectal fistula.