This standard specifies the diagnostic criteria and treatment principles for acute and chronic proctitis caused by ionizing radiation. This standard is applicable to patients with rectal mucosal damage caused by accidental local high-dose irradiation and pelvic tumor radiotherapy. GBZ 111-2002 Diagnostic criteria for radiation proctitis GBZ111-2002 Standard download decompression password: www.bzxz.net

ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ111—2002
Diagnostic criteria for radiation proctitis
Diagnostic criteria for radiation proctitis Issued on April 8, 2002
Ministry of Health of the People's Republic of China
Implementation on June 1, 2002
3.1.1 and 3.2.1 of this standard are mandatory, and the rest are recommended. In accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases, this standard GBZ111-2002 is specially formulated
This standard makes necessary provisions for the diagnostic criteria and treatment principles of radiation proctitis, so as to correctly diagnose and treat radiation proctitis, and can be used in conjunction with GBZ109-2002 Diagnostic Criteria for Radiation Bladder Diseases.
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. Drafting units of this standard: Institute of Radiation Medicine, Fudan University, Peking University Third Hospital, Fudan University Cancer Hospital, Jiangsu Cancer Prevention and Treatment Institute. The main drafters of this standard are: Weng Zhigen, Zhang Shulan, Zhou Meihui, Xu Kangxiong, Zhang Zhenjun, Feng Xiao. The Ministry of Health of the People's Republic of China is responsible for interpreting this standard. 1 Scope
Diagnostic criteria for radiation proctitis
GBZ111-2002bzxZ.net
This standard specifies the diagnostic criteria and treatment principles for acute and chronic proctitis caused by ionizing radiation. This standard is applicable to patients with rectal mucosal damage caused by local high-dose accidental irradiation and pelvic tumor radiotherapy. 2 Definition
The following terms and definitions apply to this standard: 2.1 Acute radiation proctitis Acute radiation proctitis refers to acute proctitis caused by the rectum (mainly mucosa) being exposed to ionizing radiation (x, gamma and electronic radiation, etc.) exceeding the tolerance dose of the organ within half a year. 2.2 Chronic radiation proctitis Chronic radiation proctitis is caused by interstitial fibrosis and occlusive endothelial inflammation after acute radiation proctitis or direct radiation for half a year, which leads to local tissue ischemia and chronic inflammation of the rectum, intestinal stenosis, ulcers and fistula formation. 3 Diagnosis and treatment
3.1 Diagnosis and treatment of acute radiation proctitis 3.1.1
60Gy.
Diagnostic criteria and clinical classification
The cumulative absorbed dose of the rectum after fractionated radiation or equivalent single radiation to the rectum ranges from 45Gy to pelvic organ tumors, which are treated with intracavitary radiation or external radiation (near and long-distance radiation) or accidental high-dose radiation to the posterior rectum. Tenesmus, mucus stool, abdominal pain, etc. occur within a few days. Within a few weeks or even half a year, intestinal dysfunction (constipation or diarrhea), abdominal pain of varying degrees, blood in the stool, anal stinging, and rectal reactions such as pain during defecation appear clinically.
Fiber enteroscopy: mucosal edema, congestion, bleeding foci, erosion and even necrosis Clinical grading:
Abdominal pain, anal stinging, loose stools, occasional blood in the stool; mucosal congestion, bleeding spots, superficial mucosal erosion II degree tenesmus, urgency, frequent defecation, loose stools, pain during defecation, often blood in the stool; mucosal erosion, desquamation, ulcer formation
GBZ111-2002
III degree tenesmus, constipation, alternating loose stools, Anal stinging during bowel movements, bloody stools; deep ulceration and necrosis of the intestinal wall
3.1.2 Treatment principles
When the rectum shows early rectal reactions accompanied by bloody stools during radiotherapy or after accidental exposure to large local doses, radiotherapy should be suspended immediately or the radiation should be removed. Symptomatic treatment should be given first, and comprehensive treatment should be given. 3.1.3 Systemic treatment
When rectal reactions are severe, accompanied by ulcers and bloody stools, bed rest, sedation, and systemic treatment should be given. 3.1.3.1
Strengthen nutrition, give a diet high in protein and rich in vitamins (such as vitamins C, E, A and B group) and trace elements, pay attention to water, electrolytes and acid-base balance, and correct anemia. 3.1.3.2
Strengthen anti-infection measures and use effective antibiotics. According to the needs of the disease, hyperbaric oxygen therapy, various protease inhibitors, free radical scavengers and drugs that increase the body's immune function can be used. If necessary, traditional Chinese medicine and Chinese herbal medicine treatment that promotes blood circulation and removes blood stasis, improves microcirculation and combines syndrome differentiation methods can be used. 3.1.4 Local treatment Drug retention enema: once in the morning and once in the evening. Enema solution: (1) 40-50ml aluminum hydroxide emulsion; (2) 3.1.4.1
Compound procaine enema solution (0.25% procaine 200ml plus 80,000 units of gentamicin, 10mg of prednisone and 1-2ml of 1% epinephrine): (3) Vitamin B121mg plus 80,000 units of gentamicin plus a little ice cubes: (4) 3% sulfaguanidine suspension; (5) Vicks solution; (6) Compound Yunnan Baiyao, etc. When the blood in the stool does not stop, a low concentration (5% to 10%) formalin solution can be used for retention enema or, under proctoscopy, if the bleeding point is obvious, a 10% low concentration formalin solution can be applied locally in the cavity for treatment. 3.1.4.2 Severe bleeding from rectal ulcers should be treated surgically if necessary. 3.2 Diagnosis and treatment of chronic radiation proctitis 3.2.1 Diagnostic criteria and clinical grading
3.2.1.1 Diagnostic criteria
Pelvic organ tumors have been treated with radiotherapy or accidental local irradiation of the rectum (with a history of acute proctitis), resulting in rectal mucosal damage for more than half a year, several years or even more than ten years, and late rectal reactions such as difficulty in defecation, thinning of stools or frequent defecation, loose stools, blood in the stool, and pain during defecation, as well as rectal stenosis, ulcers, and fistula formation, may occur. 3.2.1.2 Clinical Grading
Grade I: occasional blood in the stool, mucosal edema, irregular bowel movements, loose stools or constipation; GBZ111-2002
Grade I: common blood in the stool, mucosal hypertrophy, rectal stenosis, and difficulty in defecation, which can be relieved by drugs. Grade I: blood in the stool, ulcer or fistula formation, rectal stenosis, severe difficulty in defecation, and even obstruction. 3.2.2
Treatment Principles
For patients who have been diagnosed with chronic radiation proctitis, unless necessary for treatment, it is strictly forbidden to undergo a proctoscopy. For long-term blood in the stool and anemia, symptomatic treatment should be carried out according to clinical symptoms, including anti-inflammatory and hemostatic treatment, laxative and other treatments. The diet should be mainly nutritious, easy to digest, and low in fiber. If necessary, stay in bed to reduce fatigue. 3.2.3
Systemic treatment can refer to the treatment of acute radiation proctitis. Local treatment
Drug retention enema: Chinese medicine white paste plus tin powder; antibiotics plus adrenaline isotonic solution; aluminum hydroxide emulsion plus procaine solution, and can also refer to the treatment of acute radiation proctitis. 3.2.4.2
Under the direct view of the rectoscopy, apply fibrin gelatin or 10% formalin solution to the bleeding point. Rectal stenosis, even obstruction, severe bleeding and fistula formation all require surgical treatment, such as rectal diversion surgery.
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