Rubin S C, Hoskins W J, Benjamin I, Lewis J L
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021.
Gynecol Oncol. 1989 Jul;34(1):16-9. doi: 10.1016/0090-8258(89)90097-8.
Intestinal obstruction in ovarian cancer patients is a major complication which frequently affects survival and quality of life. After a reasonable trial of conservative management fails, surgery is the only hope for relief of obstruction. In an effort to evaluate the success of such surgery we have reviewed the outcome of 54 operations (52 patients) for relief of intestinal obstruction performed over the 3-year period 1983-1985. Possible predictive factors for success and survival following surgery were analyzed. The sites of intestinal obstruction in the 54 procedures were as follows: small intestine 24 (44%); large intestine 18 (33%); combined small and large intestine 12 (22%). In 11 operations no surgical correction of the obstruction was possible. In 43, major intestinal procedures were performed, including 14 bypasses, 13 resections, and 20 colostomies. Of the 43 instances in which intestinal procedures were performed, 4 patients expired without leaving the hospital. At the time of discharge from the hospital the remaining 34 of these 43 patients were eating a regular or low-residue diet. Successful palliation of intestinal obstruction was thus achieved in 79% of the 43 instances in which a definitive procedure could be performed, and in 63% of the total of 54 operations. Mean survival following surgery was 6.8 months for the group undergoing a definitive procedure, and 1.8 months for the group undergoing exploration only. There was no significant difference between the two groups with regard to age, time from diagnosis, prior radiotherapy, number of prior laparotomies, site of obstruction, or use of total parenteral nutrition. None of the multiple clinical variables analyzed correlated with survival following definitive surgery. Most patients explored for intestinal obstruction due to advanced ovarian cancer can have their obstruction relieved and be discharged from the hospital. We were not able to define criteria that would allow selection of patients unlikely to benefit from surgery.
卵巢癌患者的肠梗阻是一种主要并发症，常影响生存和生活质量。在合理尝试保守治疗失败后，手术是缓解梗阻的唯一希望。为了评估此类手术的成功率，我们回顾了1983年至1985年这3年间为缓解肠梗阻而进行的54例手术（52例患者）的结果。分析了手术成功及术后生存的可能预测因素。54例手术中肠梗阻的部位如下：小肠24例（44%）；大肠18例（33%）；小肠和大肠联合梗阻12例（22%）。11例手术无法对梗阻进行手术矫正。43例进行了主要的肠道手术，包括14例旁路手术、13例切除术和20例结肠造口术。在进行肠道手术的43例中，4例患者未出院即死亡。在这43例患者出院时，其余34例患者饮食正常或为低渣饮食。因此，在能够进行确定性手术的43例中，79%的患者肠梗阻得到成功缓解，在54例手术总数中，63%的患者得到成功缓解。进行确定性手术的患者术后平均生存期为6.8个月，仅接受探查的患者为1.8个月。两组在年龄、诊断时间、既往放疗史、既往剖腹手术次数、梗阻部位或全胃肠外营养的使用方面无显著差异。分析的多个临床变量均与确定性手术后的生存无关。大多数因晚期卵巢癌而探查肠梗阻的患者能够缓解梗阻并出院。我们无法确定能够选择出不太可能从手术中获益的患者的标准。
