放射性胃、十二指肠黏膜损伤内镜下分级与病理变化相关性研究

放射性胃、十二指肠黏膜损伤内镜下分级与病理变化相关性研究摘要：

目的：探讨放射性胃、十二指肠黏膜损伤内镜下分级与病理变化相关性。

方法：选取2015年1月至2018年12月于某医院接受放射治疗且内镜检查显示胃、十二指肠黏膜损伤患者60例，按照内镜下分级标准分为轻度、中度、重度组；对患者进行病理学分析，比较各组黏膜受损程度与病理变化之间的关系。

结果：内镜分级轻度、中度、重度组分别为12例、23例、25例，其中男性34例，女性26例，平均年龄59.5岁。病理分析结果显示，轻度组病变主要为黏膜水肿和上皮细胞变化，中度组出现肉芽组织形成和炎性浸润，重度组出现溃疡、根性创面以及肌层受损等。

结论：放射性胃、十二指肠黏膜损伤内镜下分级与病理变化有一定相关性，内镜下分级结果可以较好地反映黏膜受损的程度。不同程度的黏膜受损病理学变化不同，相关机制尚待深入探讨。

关键词：放射性胃、十二指肠、黏膜损伤、内镜下分级、病理变化

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