Department of Surgical Oncology, Familial High-risk Gastrointestinal Cancer Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Colorectal Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Gastrointest Surg. 2019 Feb;23(2):425-432. doi: 10.1007/s11605-018-3990-8. Epub 2018 Oct 3.
Despite the availability of effective colorectal cancer (CRC) screening strategies, up to 10% of CRC patients present with obstructive symptoms as the first sign of disease. For patients with acute or subacute malignant obstruction that requires urgent intervention, treatment options include endoscopic stenting as a bridge to surgery, one-stage surgical resection and anastomosis, or diverting ostomy which may or may not be followed by later tumor resection and stoma closure. However, to date, there is no consensus guideline for the optimal approach to manage malignant colorectal obstruction. This article aims to illustrate clinical scenarios in palliative, curative, and potentially curative settings, and delineate the key factors to be considered when making an individualized decision in order to determine the optimal treatment.
尽管存在有效的结直肠癌 (CRC) 筛查策略，但仍有高达 10%的 CRC 患者以疾病的首发症状——梗阻症状就诊。对于有急性或亚急性恶性梗阻且需要紧急干预的患者，治疗选择包括内镜支架作为手术的桥梁、一期手术切除和吻合，或转流性肠造口术，该术式可能随后进行肿瘤切除和造口关闭，也可能不进行。然而，迄今为止，尚无关于处理恶性结直肠梗阻的最佳方法的共识指南。本文旨在举例说明姑息、治愈和潜在治愈情况下的临床情况，并阐述在做出个体化决策时需要考虑的关键因素，以确定最佳治疗方案。
