Burd Andrew, Wong K C, Kumta Shekhar M
Division of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong.
Indian J Plast Surg. 2012 Jan;45(1):16-21. doi: 10.4103/0970-0358.96571.
The surgical management of advanced, incurable, malignant disease presents particular ethical and technical challenges. The clear goal is palliation and the surgical futility must be avoided. This case series presents some particular challenges in end-of-life surgery.
Fifteen patients referred with advanced malignant disease involving a limb girdle were reviewed.
In one case, a patient pleaded for surgery after initially requesting a delay to seek treatment from a Chinese Traditional Herbalist. The increase in tumour bulk led to problems with surgery and the patient died in a hospital a few weeks later. This case illustrates 'futility' not recognized and encountered. The remaining 14 patients exhibited positive palliation with improved quality of dying and appreciation expressed by patients, relatives and staff.
In selected cases, with a skilled and experienced surgical team, patients with advanced malignant disease can still benefit from aggressive surgical palliation. The margin of error is small between palliation being attempted and futility being achieved. This considerably adds to the challenge of end-of-life surgery.
晚期、无法治愈的恶性疾病的外科治疗面临着特殊的伦理和技术挑战。明确的目标是缓解症状，必须避免手术的无意义性。本病例系列展示了临终手术中的一些特殊挑战。
回顾了15例因晚期恶性疾病累及肢体带而转诊的患者。
在1例患者中，该患者最初请求推迟以便寻求中医治疗，之后又恳请进行手术。肿瘤体积增大导致手术出现问题，患者几周后在医院死亡。该病例说明了未被认识和遇到的“无意义性”。其余14例患者表现出积极的姑息治疗效果，患者、亲属和工作人员对临终质量的改善和满意度均有体现。
在特定病例中，凭借技术娴熟且经验丰富的手术团队，晚期恶性疾病患者仍可从积极的手术姑息治疗中获益。尝试姑息治疗与导致无意义治疗结果之间的误差范围很小。这极大地增加了临终手术的挑战。
