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[便秘与癌症:当前策略]

[Constipation and cancer: Current strategies].

作者信息

Gervais Claire, Ducrotté Philippe, Piche Thierry, Di Palma Mario, Jovenin Nicolas, Scotté Florian

机构信息

AP-HP, hôpital européen Georges-Pompidou, service d'oncologie médicale-unité fonctionnelle de soins de support, 20, rue Leblanc, 75015 Paris, France.

CHU de Rouen, Inserm UMR 1073, hôpital Charles-Nicolle, service d'hépato-gastro-entérologie et nutrition, 1, rue de Germont, 76031 Rouen cedex, France.

出版信息

Bull Cancer. 2016 Sep;103(9):794-804. doi: 10.1016/j.bulcan.2016.05.010. Epub 2016 Jun 21.

Abstract

Digestive disorders, in particular constipation, are symptoms very often reported by cancer patients as having a major impact on their quality of life. An accurate diagnosis of bowel delayed transit and defecation disorders is required to best adapt therapeutic management. Constipation associated with cancer may be related to several causes, which can be placed in three nosological categories that sometimes overlap: chronic constipation prior to cancer and having its own evolution; constipation related to the cancer condition, in particular the occlusive syndrome, and constipation induced by cancer therapies. The stricter application of diet and lifestyle measures is often necessary and sometimes sufficient. Laxative drug treatments come under various galenic forms and administration routes and must be selected according to the clinical features of constipation. Surgical management can be indicated in case of ileus or pelvic static disorders. In the case of refractory constipation induced by opioids and within the framework of palliative care to treat an advanced pathology, a peripheral morphinic antagonist can offer fast symptom relief. A way forward to improve the patients' quality of life could be to identify the contributing factors (in particular, genetic factors) to determine which patients are the more at risk and anticipate their management.

摘要

消化系统疾病,尤其是便秘,是癌症患者经常报告的症状,对他们的生活质量有重大影响。为了最佳地调整治疗管理,需要准确诊断肠道传输延迟和排便障碍。癌症相关便秘可能与多种原因有关,这些原因可分为三个有时重叠的疾病分类:癌症之前的慢性便秘及其自身的发展过程;与癌症病情相关的便秘,特别是梗阻综合征,以及癌症治疗引起的便秘。通常需要更严格地应用饮食和生活方式措施,有时这些措施就足够了。泻药治疗有多种剂型和给药途径,必须根据便秘的临床特征进行选择。肠梗阻或盆腔静止性疾病时可考虑手术治疗。对于阿片类药物引起的难治性便秘以及在姑息治疗晚期疾病的框架内,外周吗啡拮抗剂可快速缓解症状。改善患者生活质量的一个方法是确定促成因素(特别是遗传因素),以确定哪些患者风险更高,并对他们的管理进行预判。

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