晚期卵巢癌肠梗阻的治疗方法探讨（附57例分析）

MANAGEMENT OF INTESTINAL 0BSTRUCTION IN ADVANCED OVARIAN CANCER AN ANALYSIS OF 57 CASES

１９７７年３月～１９９３年２月间，住院治疗的晚期卵巢癌患者共５３２例，发生肠梗阻５７例，其中５４例死于该并发症。全部梗阻患者的中数存活时间为１１０天，存活１年以上者仅为９％（５／５７）。５７例中，２３例以手术为主，１８例以化疗为主，１６例单纯保守治疗，中数生存期分别为９６天、１２０天、８１天，差异无显著性意义（Ｐ＞０．０５）。手术治疗的受益率为６１％（１４／２３）、死亡率９％（２／２３）、失败率２６％（６／２３）。虽然化疗的缓解率达到８９％（１６／１８），显著高于手术组（Ｐ＜０．０５），但通过化疗的缓解是暂时的，只适用于未用过顺铂为基础的联合化疗者。作者建议卵巢癌肠梗阻的治疗应当个体化，并提出了３种治疗方法的适应证及禁忌证。

AbstractThe records of 532 patients with advanced ovarian cancer during March 1977 to February 1993were retrospectively reviewed.Fifty seven cases developed intestinal obstruction,and 54 cases died ofthis complication.The median survival period for all patients with obstruction was 110 days,and only5cases survived for more than one year.Twenty three cases were treated mainly by surgery, 18 bychemotherapy,and 16 by conservative measures.The median survival periods for each group was 96days,120 days , and 81 days, respectively. Their survival times are not statistically different(P>0.05 ). Of the patients surgically treated, 61%(14/23) benefitted from operation, 26%(6/23) had an imoperable disease at laparotomy, and 9%(2/23) developed fatal surgical complications.Even though the response rate in patients receiving chemotherapy was much higher than in those sur-gically treated (P<0.05), the effect of chemotherapy was just temporary, and occurred only in pa-tients who had never been treated with high dose PDD-based regimens. In this report, the individulizedmanagement of intestinal obstruction induced by ovarian cancers is suggested, and indications and con-traindications for three treatment modalities are proposed.