Mystakidou Kyriaki, Tsilika Eleni, Kalaidopoulou Ourania, Chondros Kostas, Georgaki Stavroula, Papadimitriou Lila
Microbiology Department, Areteion Hospital, University of Athens, Greece.
Anticancer Res. 2002 Mar-Apr;22(2B):1187-92.
Conservative treatment of inoperable bowel obstruction in terminal cancer patients has been found to be effective in controlling the distressing symptoms caused by this complication. The purpose of this study was to evaluate the efficacy of octreotide in the management of nausea, vomiting and abdominal pain, secondary to bowel obstruction in terminally ill cancerpatients, when surgery was inappropriate.
Sixty-eight terminally ill cancer patients participated in the study (age range 42-77 years, 36 male, 32 female). The primary cancer location was in the gastrointestinal system, the abdomen and the pelvis. The survival time ranged from 7 to 61 days. Diagnosis was made on clinical grounds and confirmed by plain abdominal radiography. The patients were randomly assigned into two equal groups, A (N=34) and B (N=34). Group A received, by continuous subcutaneous (c.sc.) administration with a pump: hyoscine butylbromide 60-80mg/day and chlorpromazine (15-25 mg/day); group B received octreotide 600-800 microg/day and chlorpromazine (15-25 mg/day). As an opioid, patients received either a low-dose of morphine (1,530mg/day) in continuous subcutaneous administration or TTS Fentanyl (25-75 microg/hour). Diary cards were used to monitor vomiting. nausea, pain intensity, anorexia and fatigue. The symptoms were assessed at T1-baseline, T2 and T3-third and sixth day of treatment, respectively, and T4- one day before death.
Data analysis showed there were statistically significant differences between the two groups: a) in vomiting and nausea in relation to percentage change from T1 to T2 and b) in fatigue and anorexia in relation to symptom improvement at T1 to T2, T1 to T3 and T1 to T4 (p<0.05), while in pain there was no statistically significant difference between the two groups in relation to percentage change from T1 to T2, T1 to T3 and T1 to T4.
The administration of octreotide, in combination with traditional pharmacological treatment, can be very effective in the symptom management of inoperable bowel obstruction in terminal cancerpatients
已发现对晚期癌症患者无法手术的肠梗阻进行保守治疗，在控制该并发症引起的痛苦症状方面是有效的。本研究的目的是评估奥曲肽在手术不适用时，对晚期癌症患者因肠梗阻继发的恶心、呕吐和腹痛的治疗效果。
68例晚期癌症患者参与了本研究（年龄范围42 - 77岁，男性36例，女性32例）。原发癌部位在胃肠道、腹部和盆腔。生存时间为7至61天。根据临床症状做出诊断，并经腹部平片证实。患者被随机分为两组，A组（N = 34）和B组（N = 34）。A组通过泵持续皮下（c.sc.）给药：丁溴东莨菪碱60 - 80mg/天和氯丙嗪（15 - 25mg/天）；B组接受奥曲肽600 - 800μg/天和氯丙嗪（15 - 25mg/天）。作为阿片类药物，患者接受持续皮下低剂量吗啡（1,5 - 3.0mg/天）或透皮芬太尼（25 - 75μg/小时）。使用日记卡监测呕吐、恶心、疼痛强度、厌食和疲劳情况。分别在T1（基线）、T2（治疗第三天）、T3（治疗第六天）和T4（死亡前一天）评估症状。
数据分析显示两组之间存在统计学显著差异：a）在呕吐和恶心方面，从T1到T2的百分比变化；b）在疲劳和厌食方面，在T1到T2、T1到T3以及T1到T4的症状改善情况（p < ），而在疼痛方面，两组从T1到T2、T1到T3以及T1到T4的百分比变化无统计学显著差异。
奥曲肽与传统药物治疗联合使用，在晚期癌症患者无法手术的肠梗阻症状管理中可能非常有效。
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