Badgwell Brian, Feig Barry W, Ross Merrick I, Mansfield Paul F, Wen Sijin, Chang George J
Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1400 Holcombe Boulevard, P.O. Box 301402, Houston, Texas 77030-1402, USA.
Ann Surg Oncol. 2007 Nov;14(11):3141-7. doi: 10.1245/s10434-007-9510-9. Epub 2007 Aug 7.
Cancer patients may be at increased risk for pneumoperitoneum due to local tumor invasion, immunosuppression, chemotherapy, and frequent endoscopy. The purpose of this study was to characterize clinical presentations and management strategy for pneumoperitoneum in cancer patients.
All patients with an ICD-9 diagnosis of visceral perforation or who had undergone a surgical oncology consultation between January 2000 and October 2006 were identified. Those patients with evidence of pneumoperitoneum on radiography underwent chart review. Patients were grouped according to treatment with or without surgery and results were compared using Chi-square and Kaplan Meier analysis.
Of 1,750 patients identified, 123 had 124 episodes of pneumoperitoneum. Treatment given was comfort care (n = 19), non-operative management (n = 33), or surgery (n = 72). Disease stage was IV in 89% of the comfort care group, 70% of the non-operative group, and 65% of the surgery group (P = 0.6). Factors predictive of management on univariate analysis were the presence of symptoms at presentation, abdominal tenderness, fever, pneumatosis on imaging, and prior abdominal radiation; but only fever, abdominal tenderness, and abdominal radiation were significant in multivariate analysis. With comfort care, non-operative management, and surgery, 30-day mortality rates were 100%, 12%, and 15%, respectively.
Pneumoperitoneum in cancer patients requires a tailored approach that considers both clinical presentation and oncological prognosis. Conventional wisdom for surgical evaluation--symptom severity, pain, and tenderness--still applies, but some patients can be successfully treated without surgery.
由于局部肿瘤侵犯、免疫抑制、化疗以及频繁的内镜检查，癌症患者发生气腹的风险可能会增加。本研究的目的是描述癌症患者气腹的临床表现及管理策略。
确定所有在2000年1月至2006年10月期间国际疾病分类第九版（ICD - 9）诊断为内脏穿孔或接受过外科肿瘤学会诊的患者。对那些在影像学检查中有气腹证据的患者进行病历审查。根据是否接受手术治疗对患者进行分组，并使用卡方检验和Kaplan - Meier分析比较结果。
在确定的1750例患者中，123例有124次气腹发作。给予的治疗方式为姑息治疗（n = 19）、非手术治疗（n = 33）或手术治疗（n = 72）。姑息治疗组89%、非手术治疗组70%、手术治疗组65%的患者疾病分期为IV期（P = 0.6）。单因素分析中预测治疗方式的因素包括就诊时是否有症状、腹部压痛、发热、影像学上的积气以及既往腹部放疗；但多因素分析中只有发热、腹部压痛和腹部放疗具有显著性。采用姑息治疗、非手术治疗和手术治疗时，30天死亡率分别为100%、12%和15%。
癌症患者的气腹需要一种综合考虑临床表现和肿瘤预后的个体化治疗方法。手术评估的传统观念——症状严重程度、疼痛和压痛——仍然适用，但一些患者可以在不进行手术的情况下得到成功治疗。
