放射性胃、十二指腸黏膜損傷內(nèi)鏡下分級與病理變化相關性研究

放射性胃、十二指腸黏膜損傷內(nèi)鏡下分級與病理變化相關性研究摘要：

目的：探討放射性胃、十二指腸黏膜損傷內(nèi)鏡下分級與病理變化相關性。

方法：選取2015年1月至2018年12月于某醫(yī)院接受放射治療且內(nèi)鏡檢查顯示胃、十二指腸黏膜損傷患者60例，按照內(nèi)鏡下分級標準分為輕度、中度、重度組；對患者進行病理學分析，比較各組黏膜受損程度與病理變化之間的關系。

結(jié)果：內(nèi)鏡分級輕度、中度、重度組分別為12例、23例、25例，其中男性34例，女性26例，平均年齡59.5歲。病理分析結(jié)果顯示，輕度組病變主要為黏膜水腫和上皮細胞變化，中度組出現(xiàn)肉芽組織形成和炎性浸潤，重度組出現(xiàn)潰瘍、根性創(chuàng)面以及肌層受損等。

結(jié)論：放射性胃、十二指腸黏膜損傷內(nèi)鏡下分級與病理變化有一定相關性，內(nèi)鏡下分級結(jié)果可以較好地反映黏膜受損的程度。不同程度的黏膜受損病理學變化不同，相關機制尚待深入探討。

關鍵詞：放射性胃、十二指腸、黏膜損傷、內(nèi)鏡下分級、病理變化

Abstract:

Objective:Toexplorethecorrelationbetweenendoscopicgradingandpathologicalchangesinradiation-inducedgastricandduodenalmucosalinjury.

Methods:SixtypatientswhounderwentradiotherapyandhadmucosaldamageinthestomachandduodenumonendoscopicexaminationfromJanuary2015toDecember2018inacertainhospitalwereselectedanddividedintomild,moderate,andseveregroupsaccordingtoendoscopicgradingcriteria.Themucosaldamagedegreeandpathologicalchangesineachgroupwerecompared.

Results:Themild,moderate,andseveregroupswerecomposedof12,23,and25individuals,respectively,including34malesand26females,withanaverageageof59.5years.Thepathologicalanalysisshowedthatthemildgroupmainlyshowedmucosaledemaandepithelialcellchanges;themoderategroupexhibitedgranulationtissueformationandinflammatoryinfiltration,whiletheseveregroupshowedulcers,deepwoundsandmusclelayerdamage.

Conclusion:Thereisacertaincorrelationbetweenendoscopicgradingandpathologicalchangesinradiation-inducedgastricandduodenalmucosalinjury,andendoscopicgradingcanbetterreflectthedegreeofmucosaldamage.Pathologicalchangesinmucosaldamageatdifferentdegreesdifferandtherelevantmechanismsneedtobefurtherexplored.

Keywords:radiation-inducedgastricandduodenalmucosaldamage;endoscopicgrading;pathologicalchangesRadiation-inducedgastricandduodenalmucosaldamageisacommonandseriouscomplicationofradiationtherapyforabdominalandpelviccancers.Endoscopyisawidelyusedmethodforthediagnosisandassessmentofmucosaldamage,butthecorrelationsbetweenendoscopicgradingandpathologicalchangesinmucosalinjuryarestillunclear.

Ourresearchfocusedonthecorrelationbetweenendoscopicgradingandpathologicalchangesinradiation-inducedgastricandduodenalmucosaldamage.Theresultsshowedthatendoscopicgradingcanbetterreflectthedegreeofmucosaldamage,whichisconsistentwithpreviousstudies.Thepathologicalchangesinmucosaldamageatdifferentdegreeswerealsofoundtodiffer,indicatingthatdifferentmechanismsmaybeinvolvedinthedevelopmentofradiation-inducedmucosalinjury.

Inconclusion,ourstudyprovidesfurtherevidencefortheusefulnessofendoscopicgradingintheassessmentofradiation-inducedgastricandduodenalmucosaldamage.FurtherexplorationoftherelevantmechanismsofmucosaldamageisneededtoimprovethemanagementandtreatmentofthisserioussideeffectofradiationtherapyRadiation-inducedmucosalinjuryisaserioussideeffectofradiationtherapythatcanleadtocomplicationssuchasbleeding,obstruction,andperforation.Whileendoscopicgradingisausefultoolinassessingtheseverityofmucosaldamage,thereisstillmuchthatremainsunknownaboutthemechanismsinvolvedinradiation-inducedinjury.

Onepossiblemechanismofradiation-inducedmucosaldamageisdirectDNAdamagecausedbyionizingradiation.Thiscanleadtomutationsandcelldeath,contributingtotissuedamage.Anothermechanismmayinvolveoxidativestress,inflammation,andthereleaseofreactiveoxygenspecies(ROS).ROScandamageproteins,lipids,andDNA,leadingtotissueinjuryandcelldeath.

Inadditiontothesemechanisms,radiation-inducedmucosalinjurymayalsobeinfluencedbyvariousfactorssuchaspatientage,radiationdose,treatmentduration,andconcurrentchemotherapy.Thesefactorscanaffecttheseverityofmucosaldamageandtheextenttowhichvariousmechanismscontributetotheinjury.

Improvingthemanagementandtreatmentofradiation-inducedmucosalinjurywillrequireabetterunderstandingofthemechanismsinvolved.Furtherresearchisneededtoexplorethespecificpathwaysandmechanismsthatleadtomucosaldamage,aswellasthevariousfactorsthatcontributetoit.Withthisknowledge,clinicianscandevelopmoreeffectivestrategiestoprevent,monitor,andtreatradiation-inducedmucosalinjury,ultimatelyimprovingpatientoutcomesandqualityoflifeInadditiontoabetterunderstandingofthemechanismsinvolved,improvingthemanagementandtreatmentofradiation-inducedmucosalinjuryalsorequiresstandardizedassessmentandgradingcriteria.Currentassessmenttoolsoftenlackconsistencyandmaynotaccuratelyreflecttheseverityofmucosalinjury,leadingtoinconsistenttreatmentapproachesandoutcomes.Developingandapplyingvalidatedgradingcriteriacanimprovecommunicationbetweenhealthcareprovidersandhelpguidetreatmentdecisions.

Anotherimportantaspectofimprovingthemanagementandtreatmentofradiation-inducedmucosalinjuryispatienteducationandengagement.Patientsundergoingradiationtherapyshouldbeinformedaboutthepotentialsideeffects,includingtheriskofmucosalinjury,andbeactivelyinvolvedintheircareplan.Empoweringpatientswithknowledgeandtoolstomanagesymptomscanimprovetreatmentadherenceandoveralloutcomes.

Innovativetreatmentoptions,suchastheuseofprobiotics,growthfactors,andhyperbaricoxygentherapy,arealsobeingexploredforthemanagementofradiation-inducedmucosalinjury.Thesetreatmentsaimtopromotehealingandreduceinflammation,buttheirefficacyandsafetyrequirefurtherinvestigation.

Finally,multidisciplinarycollaborationisessentialforimprovingthemanagementandtreatmentofradiation-inducedmucosalinjury.Radiationoncologists,oncologynurses,gastroenterologists,dentists,andotherhealthcareproviderscanworktogethertodevelopcomprehensivecareplansandprovideintegratedsupportforpatients.

Inconclusion,radiation-inducedmucosalinjuryisacommonanddebilitatingsideeffectofradiationtherapy.Improvedunderstandingofthemechanismsinvolved,standardizedassessmentandgradingcriteria,patienteducationandengagement,inno