Objective To explore the prevention and treatment effect of thalidomide combined trolamine cream retention enema on acute radiation proctitis,and the influence on the living quality.Methods From January 2015 to March 2017,69 patients were randomly divided into experimental group (n=35) and control group (n=34).All the patients were given concurrent chemoradiotherapy.The total dose of radiation was 50 Gy/25 f/5 w.Capecitabine was administered orally at the beginning of radiotherapy (1250 mg/m2,twice a day,d1-d14,21 days as a cycle for 2 cycles).Patients in experimental group received thalidomide (with initial dose of 100 mg/d orally) and retention enema with triethanolamine cream (triethanolamine cream 15 g and 100 ml warm normal saline for retention enema once a day until the end of radiotherapy).The occurrence of acute radiation proctitis,the tolerance of concurrent chemoradiotherapy and the changes of Karnofsky score,sleep status,diet status and weight status were observed.Results The incidence of acute radiation proctitis in experimental group was 77.1％ (27/35),lower than 100.0％ (34/34)of control group,and the level of acute radiation proctitis in experimental group was also lower than control group (P＜0.05).The radiation doses of acute radiation proctitis occured for the first time in experimental group was (36.4± 5.6) Gy,higher than (13.6± 3.7) Gy of control group (P＜0.05).In experimental group,the improvement rates of Karnofsky score,sleep status,diet status and weight status were 71.4％ (25/35),94.3％ (33/35),62.9％ (21/35) and 51.4％ (18/35),better than 2.9％ (1/34),0 (0/34),2.9％ (1/34) and 5.9％ (2/34) of control group (P＜0.05).The rates of radiotherapy interruption and the total course of radiotherapy in experimental group were lower than those in control group,while the complete cycles of chemotherapy in experimental group was more than that in control group (P＜0.05).No patient withdrew treatment due to severe side effects.Two patients in experiment group suffered from somnolence,and improved by symptomatic treatment.Conclusion Thalidomide combined with retention enema of triethanolamine cream can prevent and treat acute radiation proctitis caused by radiotherapy after radical resection of rectal cancer,as well as improve the quality of life.%目的 探讨沙利度胺联合三乙醇胺乳膏保留灌肠防治直肠癌术后放疗致急性放射性直肠炎的疗效及对患者放疗期间生活质量的影响.方法 收集2015年1月至2017年3月直肠癌Dixon术后患者69例,随机分为试验组(n=35)和对照组(n=34).两组均接受卡培他滨(1250 mg/m2口服,2次/天,d1～d14,21天为1周期,化疗2个周期)同期放疗(DT 50Gy/25 f,5周完成).试验组接受沙利度胺口服(初始剂量为100 mg/天)联合三乙醇胺乳膏保留灌肠(三乙醇胺乳膏15 g+100ml加温生理盐水保留灌肠,1次/天,直至放疗结束).观察两组急性放射性直肠炎的发生情况、同期放化疗耐受性及KPS评分、睡眠、饮食及体重变化情况.结果 试验组急性放射性直肠炎的发生率为77.1％(27/35),低于对照组100.0％ (34/34),且试验组急性放射性直肠炎级别低于对照组,差异有统计学意义(P＜0.05).试验组急性放射性直肠炎首次发生时受照射剂量为(36.4±5.6)Gy,高于对照组的(13.6±3.7) Gy,差异有统计学意义(P＜0.05).试验组的KPS评分改善率为71.4％(25/35)、睡眠改善率为94.3％(33/35)、饮食改善率为62.9％ (21/35)、体重改善率为51.4％(18/35),均优于对照组的2.9％(1/34)、0(0/34)、2.9％(1/34)和5.9％(2/34),差异均有统计学意义(均P＜0.05).试验组放疗中断率、放疗总疗程均低于对照组,试验组化疗完成次数多于对照组,差异均有统计学意义(P＜0.05).两组患者均无因严重不良反应而终止治疗.试验组出现嗜睡2例,经对症处理后好转.结论 沙利度胺联合三乙醇胺乳膏保留灌肠防治直肠癌术后放疗致急性放射性直肠炎安全、有效,并且可以改善患者放疗期间的生活质量.
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