非典型肺类癌全身多处转移并静脉阻塞综合征的循证治疗

Evidence-based Treatment for Systemic Multiple Metastases and Venous Obstruction Syndrome in Patients with Atypical Pulmonary Carcinoma

目的针对晚期肺类癌伴肺内、多发淋巴结转移合并上腔静脉阻塞综合征患者病情和治疗预期循证医学证据及患者意愿制定治疗决策。方法按PICO原则,对患者在治疗中面临的问题进行转换后文献检索。选择最佳的临床证据进行解读,并在结合患者意愿的前提下指导治疗决策。结果根据检索结果,4个临床问题均获得循证医学支持,包括上腔静脉阻塞、呼吸困难、头部等局部疼痛控制、远期生存率和治疗并发症。根据患者意愿,最终到某省级肿瘤专科医院选择上腔静脉支架植入及华法令抗凝治疗。术后患者上肢及头颈部水肿消失,脱离气管插管及无创呼吸机,生活完全自理,生活质量及短期预后得到改善,目前持续随访中。结论采用循证治疗方法,能在结合患者意愿的前提下为晚期肺类癌伴肺内、多发淋巴结转移患者选择合理的治疗方案。

Objective For patients with advanced pulmonary carcinoid with pulmonary and multiple lymph node metastasis and patients with superior vena cava obstruction syndrome,according to the patient＇s condition,expected treatment,evidence-based medical evidence and patient＇s willingness to make decisions.Methods According to the PICO principle,the problem patients faced in the treatment was converted to the literature search.Choosing the best clinical evidence to guide the treatment decision with the patients wish to do so. Results According to the retrieval results,4 clinical problems were supported by evidence-based medicine,including the upper vena cava obstruction,dyspnea,head and other local pain control,long-term survival rate and treatment complications.According to the wishes of patients,they finally went to a provincial cancer hospital and was treated with superior vena cava stent implantation and warfarin anticoagulation therapy.After surgery,the patient＇s upper limbs and head and neck edema disappeared,separated from the trachea intubation and noninvasive ventilation,life completely self-care,quality of life and short-term prognosis was improved. Conclusion Evidence-based treatment can be used to select a reasonable treatment plan for patients with advanced pulmonary carcinoid with pulmonary and multiple lymph node metastasis.