协和医生说｜治疗肿瘤的内照射是什么？一文认识内照射及注意事项
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">有些肿瘤<span style="color: black;">病人</span>常会在接受放射治疗时听到“内照射”一词，<span style="color: black;">那样</span>，到底什么是内照射呢？今天，北京协和医院放射治疗科专家就带您一文<span style="color: black;">认识</span>什么<span style="color: black;">状况</span>下您<span style="color: black;">必须</span>做内照射，以及做内照射的<span style="color: black;">重视</span>事项——</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">内照射是什么？看哪个科？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">是否</span>还有外照射？</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBa0eS14xqIbdmRY1yv0mynXaRQ4MDugkqJ1TGYSbvSSxlE2MibxfsWw9g/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">内照射是放射治疗科的一项治疗项目。放射治疗<span style="color: black;">便是</span>利用放射线来杀灭肿瘤，<span style="color: black;"><strong style="color: blue;"><span style="color: black;">按照</span>射线<span style="color: black;">功效</span>方式分为内照射和外照射。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">外照射</strong></span>是利用加速器产生的射线，从不同方向经皮肤照射，穿过<span style="color: black;">有些</span>器官和组织，<span style="color: black;">最后</span>集中照射到肿瘤上，将肿瘤消灭。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">内照射</strong></span>是将能产生放射线的放射源<span style="color: black;">经过</span>特殊的管道置入到<span style="color: black;">病人</span><span style="color: black;">身体</span>的肿瘤表面，<span style="color: black;">乃至</span>肿瘤内部，直接对肿瘤进行照射。<span style="color: black;">由于</span><span style="color: black;">功效</span>距离短，<span style="color: black;">因此</span><span style="color: black;">叫作</span>为近距离放疗。</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">我<span style="color: black;">必须</span>做内照射吗？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">内照射能治好我的病吗？</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBasSZYDY0QdbPJgQQHicPicbu3fKMTZwx4KylicWOVYH3QRciaboD2cHZLhg/640?wx_fmt=png&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">内照射<span style="color: black;">必须</span>借助人体的自然腔道（阴道、子宫体、食道等）置入施源器或经组织间<span style="color: black;">移植</span>插植针的方式来实现。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">内照射最常用于宫颈癌、子宫内膜癌、阴道癌等妇科恶性肿瘤，<span style="color: black;">由于</span>妇科器官有天然的腔道——阴道、宫颈管、子宫腔，非常适合盛放放射源的特殊管道（施源器）<span style="color: black;">经过</span>，<span style="color: black;">针对</span>局部肿瘤给予高剂量的照射，达到彻底根除肿瘤的目的，<span style="color: black;">同期</span><span style="color: black;">因为</span>射线<span style="color: black;">功效</span>距离短，能很好的<span style="color: black;">守护</span>邻近的膀胱、直肠等正常器官，<span style="color: black;">病人</span>副反应不大。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">针对</span><span style="color: black;">初期</span>子宫内膜癌术后<span style="color: black;">病人</span>，单做几次内照射就能避免肿瘤复发。但内照射<span style="color: black;">亦</span><span style="color: black;">由于</span><span style="color: black;">功效</span>距离短、照射范围小，在治疗<span style="color: black;">不可</span>手术的宫颈癌、阴道癌、子宫内膜癌时，<span style="color: black;">必须</span>与外照射（消灭<span style="color: black;">周边</span>潜在淋巴转移）联合运用，<span style="color: black;">从而</span><span style="color: black;">亦</span>能达到大部分病人不手术就彻底治愈肿瘤的效果。</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">内照射要住院吗？ </strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBah7vYsZ6hch5R3t1DrCib3kkCAc1hiaEbu1QE93fFuP32hNXcZyfFo0rQ/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">单纯的内照射治疗是不<span style="color: black;">必须</span>住院的。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">治疗前，<span style="color: black;">一般</span><span style="color: black;">病人</span><span style="color: black;">必须</span>进行血常规、输血八项、凝血和核磁等<span style="color: black;">检测</span>。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">大夫</span>会结合肿瘤的<span style="color: black;">详细</span>位置准备合适的辅助<span style="color: black;">工具</span>来进行盛放放射源管道的固定，随后医护人员会转运<span style="color: black;">病人</span>到CT/磁共振定位室定位，<span style="color: black;">大夫</span><span style="color: black;">按照</span>CT/核磁图像在电脑系统上逐层（2.5mm一层）画出<span style="color: black;">必须</span>照射的范围和<span style="color: black;">必须</span><span style="color: black;">守护</span>的区域，<span style="color: black;">理学</span>师在计划系统上模拟出进行治疗的<span style="color: black;">方法</span>，最后由<span style="color: black;">大夫</span>与<span style="color: black;">理学</span>师<span style="color: black;">一块</span><span style="color: black;">评定</span>合格，才会交给治疗师进行治疗。<span style="color: black;">因此</span>虽然每次内照射<span style="color: black;">大夫</span>给<span style="color: black;">病人</span><span style="color: black;">安置</span>放射源管道的时间不长，但加上后面的定位、计划时间，每次治疗的全流程<span style="color: black;">通常</span><span style="color: black;">必须</span>40分钟到2个小时不等。治疗后由治疗师/护士取出管道，<span style="color: black;">病人</span>就<span style="color: black;">能够</span>回家了。但内照射<span style="color: black;">一般</span>得做4~6次，<span style="color: black;">1星期</span>2~3次。</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">内照射时我<span style="color: black;">必须</span>做什么？</strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">身上会带放射线吗？</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaLXD6yfiaHtDaWBXmXcGoIqUrpTxnTdruUhavHPsHYG7EJemVT8D9HXw/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">宫颈癌等妇科肿瘤<span style="color: black;">病人</span>在内照射治疗当天<span style="color: black;">必须</span>排便和憋尿。</strong></span>排便是要把直肠内的粪便、气体排空，使得肠道不扩张，<span style="color: black;">这般</span>直肠<span style="color: black;">才可</span>离宫颈这些照射区域更远，副反应更小；憋尿是为了<span style="color: black;">经过</span>膀胱充盈推开邻近小肠<span style="color: black;">守护</span>肠道，但<span style="color: black;">不消</span>憋太多，<span style="color: black;">否则</span>膀胱<span style="color: black;">亦</span>会距离宫颈过近。内照射时不<span style="color: black;">必须</span>空腹，<span style="color: black;">能够</span>穿宽松的运动衣服方便穿脱，<span style="color: black;">倘若</span>是做核磁引导近距离放疗的<span style="color: black;">病人</span>，<span style="color: black;">尽可能</span>不穿戴有金属的衣服以及穿戴金属首饰。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因为</span>盛放放射源的管道在设计完放疗计划后、<span style="color: black;">病人</span>进入治疗室时才会连接在<span style="color: black;">设备</span>上，<span style="color: black;">此时</span>放射源才会从<span style="color: black;">设备</span>的储源罐中<span style="color: black;">经过</span>电脑调控<span style="color: black;">精细</span>达到人<span style="color: black;">身体</span><span style="color: black;">必须</span>照射的位置，并<span style="color: black;">根据</span>预计的时间停留，等治疗结束后，放射源会立即回到<span style="color: black;">设备</span>里。<span style="color: black;"><strong style="color: blue;"><span style="color: black;">因此</span>治疗后<span style="color: black;">病人</span>身上是不带放射线的，</strong></span><span style="color: black;">况且</span>在<span style="color: black;">大夫</span>操作和等待放疗计划的过程中<span style="color: black;">亦</span>不会有射线，<span style="color: black;">因此</span><span style="color: black;">能够</span>和家人密切接触。</p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;">做完内照射我要<span style="color: black;">重视</span>什么？</strong></p><img src="https://mmbiz.qpic.cn/mmbiz_gif/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaqdyzbwG1d5Ewm3VwA43brPksGCicf1ZzkVWcQ0vrB1MIkgZJob92ibpw/640?wx_fmt=gif&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/hd4X4347ibZ8YJdAxlKnyj66gM9jKyzBaWXPhJefDia8DSB06CoFpjoxPxicdE2DvMhk3gF9Nz3cNDI78HToXvibzw/640?wx_fmt=png&from=appmsg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">宫颈癌等妇科肿瘤<span style="color: black;">病人</span>完成内照射后<span style="color: black;">每日</span><span style="color: black;">必须</span><span style="color: black;">运用</span>清水<span style="color: black;">经过</span>妇科冲洗器对阴道进行冲洗，<span style="color: black;">保持</span>1-3个月，<span style="color: black;">同期</span><span style="color: black;">必须</span>购买合适尺寸的阴道扩张棒，完成每周三次的阴道扩张，每次不少于10分钟，<span style="color: black;">保持</span>1年。<span style="color: black;">另外</span>，还需<span style="color: black;">根据</span><span style="color: black;">大夫</span><span style="color: black;">需求</span><span style="color: black;">定时</span>返院复查。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">文字/放射治疗科 张杰 于浪 晏俊芳</p>
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