Mangili G, Aletti G, Frigerio L, Franchi M, Panacci N, Viganò R, DE Marzi P, Zanetto F, Ferrari A
Division of Gynecology and Obstetrics, University "Vita e Salute," S. Raffaele Hospital, Milano, Italy.
Int J Gynecol Cancer. 2005 Sep-Oct;15(5):830-5. doi: 10.1111/j.1525-1438.2005.00144.x.
Bowel obstruction is the most common complication in patients with ovarian cancer. Management of this situation is controversial. The aim of our retrospective study was to determine the best approach for managing bowel obstruction in recurrent ovarian cancer. A retrospective analysis of data on 47 patients with intestinal obstruction by ovarian cancer was performed. Twenty-seven patients were submitted to surgery, with 21 intestinal procedures performed, 2 gastrostomy tubes placed, and 4 patients deemed inoperable. Twenty patients were managed medically with Octreotide (mean dosage of 0.48 mg/day), of which 1 patient required a nasogastric tube. Age, performance status, diagnosis of tumor to occlusion time, obstruction site, previous chemotherapy or radiotherapy, presence of ascites, or palpable masses were the variables analyzed. Student's t-test and Pearson chi-square test were used to compare the two different groups of treatment (surgical vs medical therapy). Disease-free-survival curves were plotted according to the Kaplan-Meier method and analyzed by the log-rank test. Cox's proportional hazards model was used for multivariate analysis. Values less than or equal to 0.05 were considered significant. The mean age of the patients was 58.7 years. Perioperative mortality and morbidity were both 22%. All patients died with minimal distress. Performance status results were significantly different between the patients submitted to surgery and patients treated with Octreotide (P= 0.03). No significant differences were found in the other variables analyzed. In multivariate analysis, only type of treatment emerges as a strong predictor of poor outcome (P < 0.001). Both surgery and Octreotide therapy are able to control distressing symptoms in end-stage ovarian cancer. Survival was significantly longer in the surgical group, and surgical palliation should be considered first in patients with good performance status.
肠梗阻是卵巢癌患者最常见的并发症。这种情况的处理存在争议。我们回顾性研究的目的是确定复发性卵巢癌肠梗阻的最佳处理方法。对47例卵巢癌所致肠梗阻患者的数据进行了回顾性分析。27例患者接受了手术，其中进行了21例肠道手术，放置了2根胃造瘘管，4例患者被认为无法手术。20例患者接受奥曲肽药物治疗（平均剂量0.48mg/天），其中1例患者需要鼻胃管。分析的变量包括年龄、体能状态、肿瘤诊断至梗阻时间、梗阻部位、既往化疗或放疗、腹水或可触及肿块的存在情况。采用学生t检验和Pearson卡方检验比较两种不同治疗组（手术治疗与药物治疗）。根据Kaplan-Meier方法绘制无病生存曲线，并通过对数秩检验进行分析。采用Cox比例风险模型进行多变量分析。小于或等于0.05的值被认为具有统计学意义。患者的平均年龄为58.7岁。围手术期死亡率和发病率均为22%。所有患者均在最小痛苦中死亡。接受手术的患者和接受奥曲肽治疗的患者的体能状态结果有显著差异（P=0.03）。在分析的其他变量中未发现显著差异。在多变量分析中，只有治疗方式是不良预后的有力预测因素（P<0.001）。手术和奥曲肽治疗都能够控制晚期卵巢癌的痛苦症状。手术组的生存期明显更长，对于体能状态良好的患者应首先考虑手术姑息治疗。
