[收稿日期]2020-04-07 [修回日期]2020-07-29[基金项目] 科大新医学”联合基金培养项目(WK9110000132)；安徽省自然科学基金青年基金项目(1608085QH214)[作者单位]中国科学技术大学附属第一医院(西区)，安徽省肿瘤医院放疗科，安徽合肥230031[作者简介]葛 宁(1981-)，男，硕士，主治医师.[文章编号]1000⁃2200(2020)08⁃1004⁃04㊃临床医学㊃ 葛 宁，刘浩武，康亚辉，张洪波
[摘要]目的：分析食管癌术后调强放疗致急性放射性胃炎的相关因素㊂方法：采用剂量-体积直方图计算60例食管癌术后调强放疗病人的胸腔胃最大剂量(Dmax)㊁胸腔胃平均剂量(Dmean)㊁不同位置胸腔胃体积㊁胃受照体积百分比(V5㊁V10㊁V20㊁V30㊁V40㊁V45㊁V50)㊁胃受照体积(aV5㊁aV10㊁aV20㊁aV30㊁aV40㊁aV45㊁aV50)㊂分析不同位置胸腔胃体积差别㊂ROC 曲线确定最佳临界值,logistic 多因素分析确定预测指标㊂结果：右侧胸腔胃体积与左侧㊁纵隔胸腔胃体积比较差异有统计学意义(P <0.05)㊂V50㊁aV50是预测急性放射性胃炎的指标(P <0.01)㊂结论：食管癌术后调强放疗计划评估中需要重点关注胸腔胃 V50和aV50的评估㊂[关键词]食管肿瘤；术后放疗；放射性胃炎
[中图法分类号]R 735.1 [文献标志码]A DOI :10.ki.issn.1000⁃2200.2020.08.004
Analysis of the influencing factors of radiation gastritis induced by intensity⁃modulated radiotherapy after esophageal cancer operation
GE Ning,LIU Hao⁃wu,KANG Ya⁃hui,ZHANG Hong⁃bo (Department of Radiotherapy ,Anhui Tumor Hospital ,The First Affiliated Hospital of University of Science and Technology of China (West ),Hefei Anhui 230031,China )
[Abstract ]Objective :To analyze the related factors of acute radiation gastritis induced by intensity⁃modulated radiotherapy after esophageal cancer surgery.Methods :The maximum dose (Dmax),mean dose (Dmean),intrathoracic stomach volume in different locations,illuminated volume percent(V5,V10,V20,V30,V40,V45and V50),intrathoracic stomach illuminated volume(aV5,aV10,aV20,aV30,aV40aV45and aV50)in 60esophageal cancer patients treated with postoperative intensity modulated cancer radiotherapy were calculated using the dose volume histogram.The differences of intrathoracic stomach volume in different locations were analyzed.The optimal critical value was determined by ROC curve,and the predictive index was determined by logistic multivariate analysis.Results :The differences of the intrathoracic stomach volume between the right side and left side,mediastinum were statistically significant(P <0.05).The V50and aV50were the indicator to predict acute radioation gastritis(P <0.01).Conclusions :In the evaluation of postopera
tive induced by intensity⁃modulated radiotherapy plan for esophageal cancer,the evaluation of V50and aV50in
pleural and gastric areas should be greatly focused on.[Key words ]esophageal neoplasms;postoperative radiotherapy;radiation gastritis
食管癌病人单纯手术术后5年生存低于20%[1]，其中Ⅲ期病人上纵隔局部复发高达88.7%[2]，放疗提高了ⅡB 期以上期别的总生存[3]，尤其提高了术后阳性淋巴结病人的局控率和长期生
存[4-5]，是食管癌术后综合的重要组成部分㊂在术后放疗过程中胸腔胃受照射不可避免，严重的
放射性胃炎可导致出血㊁穿孔影响病人生活质量甚
至生存㊂目前对于食管癌术后调强放疗致放射性胃
炎研究较少，前期工作中发现食管癌术后胸腔胃存
在右侧㊁纵隔㊁左侧3种位置，体积亦存在差距，本文
回顾我院60例食管癌术后调强放疗病人，通过分析
术后胸腔胃各相关指标, 探讨不同位置胸腔胃体积
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001J Bengbu Med Coll ,August 2020,Vol.45,No.8
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