胸腔胃在食管癌术后辅助放疗中的剂量分析及胃镜下胃黏膜表现

摘要

Objective:To investigate the dose and gastroscopic findings of thoracic stomach after adjuvant radio-therapy of resection of esophageal carcinoma.Methods:All 45 cases of esophageal cancer patients with postoperative radiotherapy were divided into 3 groups,the left,right and mediastinalintrathoracic stomach groups,each 15 cases.To use the radiotherapy planning system(TPS)to make radiotherapy plan,anduse the dose volume histograms diagram (DVH)to compare the average dose(Dmean ),the volume of stomach receiving 5Gy(V5 ),25Gy(V25 ),40Gy(V40 ), 50Gy(V50 )of theintrathoracic stomach.Digestive tract reaction were observed during radiotherapy,and the changes of gastric mucosa were observed by gastroscopy after radiotherapy.Results:The Dmean ,V5 ,V25 ,V40 ,V50 of mediastinal in-trathoracic gastric were significantly higher than that of left and right(P <0.05).Through the gastroscope inspection, we found that most thoracic stomach of patientsappearmucosal hyperemia and edema,few had mucosal erosion.Con-clusion:The dose of mediastinal intrathoracic stomach was larger than the left and right.The radioactive gastric injury occurrence probability may be high.%目的：分析食管癌术后辅助放疗对胸腔胃的照射剂量及胃镜下胃黏膜变化。方法：收集食管癌术后辅助放疗的患者45例，利用治疗计划系统制作放疗计划，并给予50Gy／25f 的处方剂量。根据术后胸腔胃位置不同，分为左侧、右侧及纵隔3组，每组15例。利用体积－剂量直方图分析比较各组胸腔胃接受的平均剂量（Dmean ）、接受5Gy、25Gy、40Gy、50Gy 照射的靶体积百分比（V5、V25、V40、V50）。观察患者放疗中上消化道不良反应情况，放疗后定期复查胃镜，观察胃黏膜变化。结果：纵隔胸腔胃受到照射的 Dmean、V5、V25、V40、V50明显高于左侧及右侧胸腔胃（P ＜0．05），左侧及右侧胸腔胃受照剂量无明显差异（P ＞0．05）。通过胃镜检查发现大部分患者出现黏膜充血水肿的表现，少部分患者有黏膜糜烂出血的表现。结论：纵隔胸腔胃较左侧及右侧胸腔胃受照剂量较大，放射性胃损伤发生几率可能高。