抄録
Eighteen patients who were to undergo radiation tharapy to the pelvis for carcinoma of the uterine were studied. All patients were treated by means of 137Cs and telecobalt treatmant or 10 million volt linear accelerator. Almost all cases recieved 4000 to 6000 rads of total dosage. The changes noted in the bowel are classified into 6 grades based on their appearance at proctosig-moidoscopy. The commonest changes consist of local edema, hyperemia, and teleangiectatic areas. Such changes are classified as an actve slight lesion (6 cases). Friable mucosa that bleeds easily and has erosion is classified as an active moderate lesion (5 cases). If condition progresses, the changes are fol-lowed by the appearance of ulceration. This is an active severe lesion (3 cases). Atrophic mucosa is an inactive slight lesion (2 cases). Granular mucosa is classified as an inactive moderate (0 case). If bowel stricture or fistulas occurs, this is an inactive severe lesion (0 case). Endoscopic changes are most frequently found in rectum and rectosigmoid junction, The changes are always localized at anterior wall of the rectum and only 6 in 16 cases with endoscopical abnomalities have a lesion at one side of the wall. It seems that there is no relation to effective radiation doses and endoscopical findings. Symptoms of radiation injury to the lower bowel frequently appear from one to two years after radiation therapy. Onset and term of symptoms are no relation to endoscopical grades. The mucosa in biopsy specimens are abnormal in every case. In a majority of patients the biopsy specimens reveals increased Paneth cells, eosinophilic infiltration containing eosinophilic crypt abscess, edema in stroma, appearance of hyaline like substance and dilated blood vessels. Compared with ulcerative colitis, irradiation proctitis has more lymphcytes and plasma cells infiltration than neut rophils. These findings are useful in diagnosis of irradiation proctitis and increased Paneth cells are noteworthy and has been previously described.
