癌性肠梗阻技术、情感和希望的博弈.pdfVIP

肿瘤代谢与营养电子杂志  2017年6月第4卷第2期            Electron J Metab Nutr Cancer，Jun. 2017，Vol. 4，No. 2 ·136 · ·专家论坛 · DOI：10.16689/11-9349/r.2017.02.002 癌性肠梗阻：技术、情感和希望的博弈 饶本强，石汉平（中国科学院北京转化医学研究院/航空总医院肿瘤医学中心/普外科，北京 100012）     摘要：MBO 是晚期肿瘤患者频发的终末期事件，给患者及其家属带来极大困扰。MBO 姑息手术治疗可以缓解患者 梗阻症状、恢复经口进食甚至好转出院。但是MBO 姑息手术治疗死亡率高、严重并发症多，短暂缓解的各种症状也可 能再发，而且对已扩散的肿瘤本身也没有确切的治疗作用，外科医师作出手术的决策尤为困难。MBO 患者手术治疗缺乏 高质量的统计数据，包括缺少姑息性手术的适应证标准、手术对患者生活质量的影响、手术的死亡率、并发症等信息使 MBO 30 情况进一步复杂化。本文对 患者的流行病学、症状和诊断、手术适应证、手术并发症和术后 天死亡率等问题进 行了系统性文献回顾，并结合我们的经验对MBO 手术方式、手术效果、术后营养治疗途径及姑息手术对患者生活质量 的影响进行了初步探讨。对于MBO 患者来说，生命已接近终点，但科学的手术治疗仍可以延长患者生存期，改善患者 MBO 临终前生存质量。近年来， 手术治疗取得了一些进展，包括术前肠梗阻精确诊断、手术方式的改进、姑息手术和其 他治疗方法的联合应用等，医学技术的进步为提高MBO 治疗效果带来了希望。     关键词：癌性肠梗阻；手术治疗；效果 Malignant bowel obstruction: a struggle of technology, emotion and hope RAO Ben-qiang, SHI Han-ping Department of General Surgery/Medical Oncology Center, Aviation General Hospital/Beijing Institute of Translational Medicine, Chinese Academy of Sciences, Beijing 10012, China Abstract: Malignant bowel obstruction (MBO) that incite considerable distress for patients and their families was a common pre-terminal event for patients with advanced cancer. Palliative operations could be successful for patients with MBO from relief of obstructive symptoms, ability to tolerate a diet or discharge to home, but were less effective for patients with MBO from carcinomatosis. However, patients with MBO from carcinomatosis could develop distressing symptoms despite maximal medical treatment and present the surgeon with an ethical dilemma. Surgical decision making for MBO was further complicated by a lack of high quality data, including information regarding indication of palliative operation, effect of surgery on quality of life o