Ripamonti C, De Conno F, Ventafridda V, Rossi B, Baines M J
Pain Therapy and Palliative Care Division, National Cancer Institute, Milan, Italy.
Ann Oncol. 1993 Jan;4(1):15-21. doi: 10.1093/oxfordjournals.annonc.a058345.
Bowel obstruction is a common and distressing outcome in patients with abdominal or pelvic cancer.
Patients may develop bowel obstruction at any time in their clinical history, with an incidence ranging from 5.5% to 42% in ovarian carcinoma and from 10% to 28.4% in colorectal cancer. The causes of the obstruction may be benign postoperative adhesions, a focal malignant or benign deposit, relapse or diffuse carcinomatosis. The symptoms which are almost always present are intestinal colic (reported in 72%-76% of patients), abdominal pain due to distension, hepatomegaly or tumor masses (in 92% of patients) and vomiting (68%-100%) of cases.
While surgery must remain the primary treatment for malignant obstruction, it is now recognised that there is a group of patients with advanced disease or poor general condition who are unfit for surgery and require alternative management to relieve distressing symptoms. A number of treatment options are now available for the patient with advanced cancer who develops intestinal obstruction. In this review of the literature, the indications for surgery will be examined, the use of nasogastric tube and percutaneous gastrostomy evaluated and the place of drugs for symptom control described.
肠梗阻是腹部或盆腔癌症患者常见且令人痛苦的结局。
患者在其临床病程中的任何时候都可能发生肠梗阻，卵巢癌的发病率为5.5%至42%，结直肠癌的发病率为10%至28.4%。梗阻的原因可能是良性术后粘连、局灶性恶性或良性沉积物、复发或弥漫性癌转移。几乎总是出现的症状是肠痉挛（72% - 76%的患者有报告）、腹胀引起的腹痛、肝肿大或肿瘤肿块（92%的患者）以及呕吐（68% - 100%的病例）。
虽然手术仍然是恶性梗阻的主要治疗方法，但现在人们认识到，有一组晚期疾病或全身状况较差的患者不适合手术，需要采取替代治疗方法来缓解痛苦症状。对于发生肠梗阻的晚期癌症患者，现在有多种治疗选择。在这篇文献综述中，将研究手术指征，评估鼻胃管和经皮胃造瘘术的使用，并描述用于症状控制的药物的作用。
