1 Milford Care Centre, Limerick, Ireland.
2 Cicely Saunders Institute, Dept of Palliative Care, Policy & Rehabilitation, King's College London, UK.
Palliat Med. 2017 Dec;31(10):975-981. doi: 10.1177/0269216317697897. Epub 2017 Mar 1.
Rectal tenesmus is a distressing symptom in patients with advanced cancer and challenging to treat. There is lack of consensus on the appropriate management of tenesmus in this patient population.
To identify and examine the effectiveness of interventions to palliate rectal tenesmus caused by advanced cancer when surgery, radiotherapy or chemotherapy are no longer treatment options.
A systematic review of the literature following standard systematic review methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance.
A comprehensive search of the electronic databases MEDLINE, EMBASE and the Cochrane Library was conducted from date of inception to April 2016. PubMed 'related articles' search, grey literature search and hand-searches of the bibliographies of relevant papers and textbooks were also performed. Non-cancer patients were excluded. Any studies involving surgery or radiotherapy to treat tenesmus were excluded. Studies involving interventions to treat pelvic pain syndromes without specific outcome measures on severity of tenesmus were excluded. The quality of the studies was assessed using a National Institute for Health and Clinical Excellence-recommended quality assessment tool.
From 861 studies, 9 met full criteria and were selected. All were case series investigating the use of pharmacological interventions (diltiazem, nifedipine, methadone, mexiletine hydrochloride, lidocaine and bupivacaine), anaesthetic interventions (lumbar sympathectomy, neurolytic superior hypogastric plexus block), and endoscopic laser interventions. The included studies showed substantial heterogeneity, and therefore, a meta-analysis was not feasible.
From this review, we identified a significant gap in research into the palliation of rectal tenesmus. A multimodal approach may be necessary due to the complexity of the pathophysiology of tenesmus. Future research should focus on randomised controlled trials of drug therapies whose potential effectiveness is suggested by case series.
直肠痉挛是晚期癌症患者的一种痛苦症状，难以治疗。对于这类患者，对于直肠痉挛的治疗尚没有达成共识。
当手术、放疗或化疗不再是治疗选择时，确定并研究缓解晚期癌症引起的直肠痉挛的干预措施，并评估其疗效。
按照标准系统综述方法和系统综述和荟萃分析的首选报告项目指南进行文献的系统综述。
从建库开始到 2016 年 4 月，全面检索 MEDLINE、EMBASE 和 Cochrane Library 电子数据库。还进行了 PubMed 的“相关文章”搜索、灰色文献搜索以及相关论文和教科书的参考文献手工搜索。非癌症患者被排除在外。任何涉及手术或放疗治疗直肠痉挛的研究均被排除在外。涉及治疗盆腔疼痛综合征的干预措施，而没有特定的直肠痉挛严重程度的结局指标的研究也被排除在外。使用国家卫生与临床优化研究所推荐的质量评估工具评估研究的质量。
从 861 项研究中，有 9 项研究符合全部标准被纳入。这些研究均为关于药物干预（地尔硫卓、硝苯地平、美沙酮、盐酸美西律、利多卡因和布比卡因）、麻醉干预（腰交感神经切除术、神经松解性腹下丛阻滞）和内镜激光干预的使用的病例系列研究。纳入的研究存在很大的异质性，因此无法进行荟萃分析。
通过本综述，我们发现对于直肠痉挛缓解的研究存在显著的空白。由于直肠痉挛的病理生理学复杂，可能需要多模式治疗方法。未来的研究应集中在药物治疗的随机对照试验上，这些药物治疗的潜在疗效已经在病例系列研究中得到了提示。
