Department of Surgery, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark.
Department of Gastrointestinal and Hepatic Diseases, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.
Langenbecks Arch Surg. 2024 Aug 6;409(1):239. doi: 10.1007/s00423-024-03436-3.
Small bowel obstruction (SBO) accounts for a substantial proportion of emergency surgical admissions. Malignancy is a common cause of obstruction, either due to a primary tumour or intra-abdominal metastases. However, little is known regarding the current treatment or outcomes of patients with malignant SBO. This study aimed to characterise the treatment of malignant SBO and identify areas for potential improvement and compare overall survival of patients with malignant SBO to patients with non-malignant SBO.
This was a subgroup analysis of a multicentre observational study of patients admitted with SBO. Details regarding these patients' diagnoses, treatments, and outcomes up to 1-year after admission were recorded. The primary outcome was overall survival in patients with malignant SBO.
A total of 316 patients with small bowel obstruction were included, of whom 33 (10.4%) had malignant SBO. Out of the 33 patients with malignant SBO, 20 patients (60.6%) were treated with palliative intent although only 7 patients were seen by a palliative team during admission. Nutritional assessments were performed on 12 patients, and 11 of these patients received parenteral nutrition. 23 patients underwent surgery, with the most common surgical interventions being loop ileostomies (9 patients) and gastrointestinal bypasses (9 patients). 4 patients underwent right hemicolectomies, with a primary anastomosis formed and 1 patient had a right hemicolectomy with a terminal ileostomy. Median survival was 114 days, and no difference was seen in survival between patients treated with or without palliative intent.
Malignant SBO is associated with significant risks of short-term complications and a poor prognosis. Consideration should be given to the early involvement of senior decision-makers upon patient admission is essential for optimal management and setting expectation for a realistic outcome.
小肠梗阻（SBO）占急诊手术入院的很大一部分。恶性肿瘤是梗阻的常见原因，无论是原发性肿瘤还是腹腔内转移。然而，对于恶性 SBO 患者的治疗和结局知之甚少。本研究旨在描述恶性 SBO 的治疗方法，并确定潜在的改进领域，并将恶性 SBO 患者的总生存率与非恶性 SBO 患者进行比较。
这是一项对 SBO 患者入院的多中心观察性研究的亚组分析。记录了这些患者的诊断、治疗和入院后 1 年的结果的详细信息。主要结局是恶性 SBO 患者的总生存率。
共纳入 316 例小肠梗阻患者，其中 33 例（10.4%）为恶性 SBO。在 33 例恶性 SBO 患者中，20 例（60.6%）患者接受姑息治疗，尽管只有 7 例患者在入院期间接受了姑息治疗团队的治疗。对 12 例患者进行了营养评估，其中 11 例患者接受了肠外营养。23 例患者接受了手术，最常见的手术干预是回肠造口术（9 例）和胃肠旁路术（9 例）。4 例患者接受了右半结肠切除术，其中 1 例形成了原发性吻合术，1 例患者接受了右半结肠切除术和末端回肠造口术。中位生存期为 114 天，姑息治疗与非姑息治疗患者的生存率无差异。
恶性 SBO 与短期并发症和不良预后的风险显著相关。考虑在患者入院时尽早让高级决策者参与至关重要，以便进行最佳管理并为现实的结果设定预期。
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