慢性放射性溃疡的诊疗策略

摘要: 随着对肿瘤行放射治疗和各种介入治疗的增加，慢性放射性溃疡患者逐渐增多。慢性放射性溃疡多累及皮下深层，伴周围皮肤纤维化，溃疡迁延不愈，呈进行性、不可逆发展，常规换药、皮片移植难以取得良好疗效，严重影响患者生活质量。该文从慢性放射性溃疡发病机制、临床特点、病理变化、创面评估及修复策略等多个方面进行了系统论述，为慢性放射性溃疡的临床诊疗提供参考。
- 放射疗法 /
- 皮肤溃疡 /
- 辐射损伤 /
- 清创术 /
- 肌皮瓣 /
- 诊疗模式
Abstract: With the increase of radiotherapy and various interventional therapies for tumor, the number of patients with chronic radiation ulcers is increasing gradually. Chronic radiation ulcers mostly involve the deep subcutaneous layers, accompanied by fibrosis of the surrounding skin. The ulcers persist and develop progressively and irreversibly. It is difficult to achieve good curative effects by routine dressing change and skin grafting, seriously affecting the patients' quality of life. This article systematically discusses the pathogenesis, clinical characteristics, pathological changes, wound assessment, and repair strategies of chronic radiation ulcers to provide a reference for the clinical diagnosis and treatment of chronic radiation ulcers.
- Radiotherapy /
- Skin ulcer /
- Radiation injuries /
- Debridement /
- Myocutaneous flap /
- Practice patterns
所有作者均声明不存在利益冲突

HTML全文

参考文献(33)

[1]	ChandraRA, KeaneFK, VonckenFEM, et al. Contemporary radiotherapy: present and future[J]. Lancet, 2021,398(10295):171-184. DOI: 10.1016/S0140-6736(21)00233-6.
[2]	中华医学会医学美容与美学分会皮肤美容学组. 放射性皮炎诊疗专家共识[J]. 中华医学美学美容杂志, 2021, 27(5):353-357. DOI: 10.3760/cma.j.issn.1671-0290.2021.05.001.
[3]	KimJM, KimSA, KwonHJ, et al. Reconstruction of radiation-induced ulcers with free flaps using the perforating vessel as a recipient vessel[J]. Microsurgery, 2019,39(7):613-620. DOI: 10.1002/micr.30504.
[4]	KhodamoradiE, Hoseini-GhahfarokhiM, AminiP, et al. Targets for protection and mitigation of radiation injury[J]. Cell Mol Life Sci, 2020,77(16):3129-3159. DOI: 10.1007/s00018-020-03479-x.
[5]	DanforthJM, ProvencherL, GoodarziAA. Chromatin and the cellular response to particle radiation-induced oxidative and clustered DNA damage[J]. Front Cell Dev Biol, 2022,10:910440. DOI: 10.3389/fcell.2022.910440.
[6]	王萍, 范莉, 田梅. 放射性皮肤损伤机制的研究进展[J]. 中国辐射卫生, 2022, 31(4):524-529. DOI: 10.13491/j.issn.1004-714X.2022.04.027.
[7]	WeiJL, MengLB, HouX, et al. Radiation-induced skin reactions: mechanism and treatment[J]. Cancer Manag Res, 2018,11:167-177. DOI: 10.2147/CMAR.S188655.
[8]	范铭, 冯梅, 袁双虎. 放射性皮炎的预防与治疗临床实践指南[J]. 中华肿瘤防治杂志, 2023, 30(6):315-323. DOI: 10.16073/j.cnki.cjcpt.2023.06.01.
[9]	欧丹, 王孝深, 胡超苏. 放射性皮炎预防与治疗研究进展[J]. 中华放射肿瘤学杂志, 2019, 28(2):151-154. DOI: 10.3760/cma.j.issn.1004-4221.2019.02.014.
[10]	张心怡, 王宇翀, 薛春雨. 慢性放射性溃疡的研究进展[J]. 中国美容整形外科杂志, 2023, 34(12):740-743. DOI: 10.3969/j.issn.1673-7040.2023.12.010.
[11]	BorrelliMR, ShenAH, LeeGK, et al. Radiation-induced skin fibrosis: pathogenesis, current treatment options, and emerging therapeutics[J]. Ann Plast Surg, 2019,83(4S Suppl 1):S59-64. DOI: 10.1097/SAP.0000000000002098.
[12]	KingSN, Al-QuranZ, HurleyJ, et al. Cytokine and growth factor response in a rat model of radiation induced injury to the submental muscles[J]. Dysphagia, 2021,36(3):457-464. DOI: 10.1007/s00455-020-10162-7.
[13]	KhanMGM, WangY. Advances in the current understanding of how low-dose radiation affects the cell cycle[J]. Cells, 2022,11(3):356. DOI: 10.3390/cells11030356.
[14]	LabergeRM, SunY, OrjaloAV, et al. MTOR regulates the pro-tumorigenic senescence-associated secretory phenotype by promoting IL1A translation[J]. Nat Cell Biol, 2015,17(8):1049-1061. DOI: 10.1038/ncb3195.
[15]	ChenWC, WangY, ZhengJC, et al. Characterization of cellular senescence in radiation ulcers and therapeutic effects of mesenchymal stem cell-derived conditioned medium[J/OL]. Burns Trauma, 2023,11:tkad001[2024-03-08]. https://pubmed.ncbi.nlm.nih.gov/37188110/.DOI: 10.1093/burnst/tkad001.
[16]	WangZW, ChenZL, JiangZY, et al. Cordycepin prevents radiation ulcer by inhibiting cell senescence via NRF2 and AMPK in rodents[J]. Nat Commun, 2019,10(1):2538. DOI: 10.1038/s41467-019-10386-8.
[17]	WangHL, WangZW, HuangY, et al. Senolytics (DQ) mitigates radiation ulcers by removing senescent cells[J]. Front Oncol, 2020,9:1576. DOI: 10.3389/fonc.2019.01576.
[18]	杨飞, 谢卫国, 张伟, 等. 放射性溃疡严重程度分型及临床治疗分析[J]. 组织工程与重建外科杂志, 2022, 18(1):62-66. DOI: 10.3969/j.issn.1673-0364.2022.01.015.
[19]	李罡,张志,李叶扬,等.颈横动脉颈段皮支皮瓣修复颈部放射性溃疡的临床效果[J].中华烧伤杂志,2021,37(12):1116-1121.DOI: 10.3760/cma.j.cn501120-20200807-00371.
[20]	LiaoJB, ChenW, LeeHS, et al. Histopathology of fluoroscopy-induced radiation ulcer: a case series study in comparison with morphea[J]. J Dtsch Dermatol Ges, 2020,18(5):447-454. DOI: 10.1111/ddg.14092.
[21]	程琳, 杜伟力, 张颖, 等. 骶尾部慢性放射性溃疡的分期修复策略[J]. 中华烧伤杂志,2021, 37(3):225-231. DOI: 10.3760/cma.j.cn501120-20210104-00003.
[22]	张鲜英, 刘毅, 肖斌, 等. 慢性放射性溃疡创面的综合治疗[J]. 中国美容医学, 2017, 26(12):13-16. DOI: 10.15909/j.cnki.cn61-1347/r.002086.
[23]	DongWF, ZhangXL, LuoXZ, et al. Regional flap: a reliable coverage for post-radiation ulcer[J]. Int Wound J, 2023,20(6):2224-2232. DOI: 10.1111/iwj.14103.
[24]	肖敏, 朱媛, 张伟旭. 游离股前外侧皮瓣修复头部严重放射性溃疡1例[J]. 山东大学学报(医学版), 2021, 59(8):122-124. DOI: 10.6040/j.issn.1671-7554.0.2021.0655.
[25]	赖彦冰, 陈抗松, 谭玲梅, 等. 颞骨放射性骨坏死行人工耳蜗植入的经验分析[J]. 中华耳科学杂志, 2018, 16(6):772-777. DOI: 10.3969/j.issn.1672-2922.2018.06.007.
[26]	郭巧宁, 王虹伊, 姜鹏, 等. 鼻咽癌IMRT后发生头颈淋巴水肿的临床特征及危险因素分析[J]. 海南医学, 2022, 33(24):3191-3195. DOI: 10.3969/j.issn.1003-6350.2022.24.016.
[27]	CoriddiM, DayanJ, SobtiN, et al. Systematic review of patient-reported outcomes following surgical treatment of lymphedema[J]. Cancers (Basel), 2020, 12(3):565. DOI: 10.3390/cancers12030565.
[28]	谢昆, 张正奎, 温冰. 开胸术后继发伴人工植入物外露的复杂纵隔感染的诊疗方案[J]. 中华烧伤与创面修复杂志, 2024, 40(6): 536-542. DOI: 10.3760/cma.j.cn501225-20240227-00074-0515.
[29]	IsaacKV, ElzingaK, BuchelEW. The best of chest wall reconstruction: principles and clinical application for complex oncologic and sternal defects[J]. Plast Reconstr Surg, 2022, 149(3):547e-562e. DOI: 10.1097/PRS.0000000000008882.
[30]	杜伟力, 沈余明, 程琳, 等. 乳腺癌根治术后胸部放射性溃疡的修复策略及其临床效果[J]. 中华烧伤与创面修复杂志, 2024, 40(6): 521-528. DOI: 10.3760/cma.j.cn501225-20240315-00099.
[31]	WeiJY, MaLX, LiuWT, et al. Mechanisms and protective measures for radiation-induced brachial plexus nerve injury[J]. Brain Res Bull, 2024, 210:110924. DOI: 10.1016/j.brainresbull.2024.110924.
[32]	中华医学会整形外科学分会淋巴水肿治疗学组. 乳腺癌术后上肢淋巴水肿诊治指南与规范(2021年版)[J]. 组织工程与重建外科杂志, 2021, 17(6):457-461. DOI: 10.3969/j.issn.1673-0364.2021.06.001.
[33]	程琳, 沙艳东, 杜伟力, 等. 不同皮瓣修复骶尾部创面的效果比较[J]. 中华创伤杂志, 2021, 37(7):613-617. DOI: 10.3760/cma.j.cn501098-20210101-00001.