在进展期恶性肿瘤背景下的非肿瘤性肠梗阻

Non-maligment bowel obstruction in the context of advanced cancer

目的恶性肠梗阻为进展期恶性肿瘤患者常见的并发症,以往认为恶性肠梗阻是一个标志性的终末事件。多项研究表明,对于恶性肠梗阻患者的治疗应以个体化姑息治疗为核心,进行终末期关怀治疗。方法2例恶性肿瘤背景下的非肿瘤性肠梗阻的患者均既往罹患腹部恶性肿瘤,均为胃恶性肿瘤。患者在肿瘤规范治疗后1年左右出现肠梗阻,其临床表现明确,1例患者持续3个月表现为不全肠梗阻-完全肠梗阻反复转换,1例患者表现为骤然发作的完全性肠梗阻。均经过以手术为核心的治疗使2例患者受益,改善生活质量,获得进一步治疗机会,并延长生存期。结果恶性肠梗阻的治疗需要多学科协作共同完成,其整体预后不佳,2位患者均通过手术获益较少见,准确的术前评估和完善的围术期治疗为患者赢得更多机会。结论医生不应因为恶性肠梗阻的整体预后不佳,就放弃对患者个体的解除梗阻的尝试,通过合理的评估、规范的治疗、积极的手术探查,可以对患者获得良好生存质量和继续姑息治疗机会产生积极的影响。

Objective Malignant intestinal obstruction is a common complication of patients with advanced malignant tumors.Malignant intestinal obstruction was previously considered to be a terminal event.Previous studies have shown that the treatment of patients with malignant intestinal obstruction should be treated with end-stage care,focusing on individualized palliative care.Methods Two patients with non-maligment bowel obstruction in the context of advanced cancer were previously suffering from abdominal malignant tumors,both of which were gastric malignant tumors.The patient developed intestinal obstruction about 1 year after the standard treatment of the tumor,and the clinical manifestations were clear.One patient had recurrent symptoms between incomplete intestinal obstruction and complete intestinal obstruction for 3 months.One patient showed a complete intestinal obstruction with sudden onset.Both patients benefited from surgery-centered treatment,leading to improved quality of life,obtaining further treatment opportunities,and prolonged survival.Results The treatment of malignant bowel obstruction requires multidisciplinary collaboration.Its overall prognosis is poor.The two patients got benefit through surgery.From these two cases we learned that accurate preoperative assessment and improved perioperative treatment will give patients more opportunities.Conclusion Doctors should not give up attempts to relieve obstruction of individual patients because of the poor overall prognosis of malignant intestinal obstruction.Through reasonable evaluation,standardized treatment,and active surgical exploration,patients can obtain good quality of life and continue palliative treatment opportunities.