恶性肿瘤相关急腹症多学科管理中国专家共识

Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen

恶性肿瘤相关急腹症是指由恶性肿瘤导致、或者各种抗肿瘤治疗手段引发的以急性腹痛为主要临床表现的一种非围手术期腹部急性病变。往往病情急重、甚至威胁生命。患者一旦出现恶性肿瘤相关急腹症,肿瘤的发生发展与急性并发症的演变过程往往互为因果,故诊疗通常需要施行以外科为主的多学科诊治模式(MDT),及时地根据患者临床病理影像特征和医疗资源可及性,在肿瘤内、外科医生的主要参与下,与其他相关专业团队通力合作,根据不同的肿瘤学评估和治疗目标,通过分层管理,制定最适当的治疗策略。国内外对于恶性肿瘤相关急腹症诊治共识尚属空白。因此,中国医师协会外科医师分会、中国医师协会肿瘤医师分会、中国医师协会外科医师分会多学科综合治疗专业委员会联合《中华胃肠外科杂志》,组织国内相关领域专家,讨论制定了《恶性肿瘤相关急腹症多学科管理的中国专家共识》。本共识核心内容主要有三大部分,即多学科诊断与评估、多学科预防与治疗以及常见恶性肿瘤相关急腹症的治疗(各论)。诊断与评估部分主要包括肿瘤学、影像学诊断及外科围手术期评估;预防与治疗部分主要包括恶性肿瘤急腹症的预防、以手术为核心的处理原则、抗肿瘤治疗诱发急腹症以及特殊生物学类型肿瘤相关急腹症的预防及管理;最后部分则分别论述了消化道梗阻(手术、姑息、内镜或介入治疗)、消化道穿孔(围手术期处理和手术治疗)、消化道出血(内科、内镜、介入和外科治疗)、胆道系统急腹症(急性胆管炎、急性胆囊炎和胆囊穿孔的治疗)及肝癌破裂(一般治疗、经动脉栓塞止血、外科治疗)等常见恶性肿瘤相关急腹症的治疗。本共识的制定,目的是提高临床医生对恶性肿瘤相关急腹症患者多学科规范化诊治的认识并指导临床实践。

Malignant tumor-associated acute abdomen refers to a non-perioperative acute abdominal disease caused by malignant tumors or caused by various anti-tumor treatments with acute abdominal pain as the main clinical manifestation.It is often critical and even life-threatening.For patients with malignant tumor-associated acute abdomen,the occurrence and development of tumors and the evolution of acute complications are often causal to each other.Therefore,diagnosis and treatment of malignant tumor-associated acute abdomen usually require the surgery-based multidisciplinary treatment(MDT).According to imaging features and access to medical resources,oncologists and surgeons,working with other relevant professional teams need to develop the most appropriate treatment strategy through hierarchical management based on different oncology assessments and treatment goals.Yet there is no consensus on diagnosis and treatment of malignant tumor-associated acute abdomen.Therefore,Chinese College of Surgeons,Chinese Society for Clinical Oncologists,Chinese Society of Multidisciplinary Team,and the Chinese Journal of Gastrointestinal Surgery gathered multidisciplinary experts in China to discuss and develop the Chinese expert consensus on multidisciplinary management of malignant tumor-associated acute abdomen.This consensus consists of three parts,namely multidisciplinary diagnosis and evaluation,multidisciplinary prevention and treatment,and specific treatment of common malignant tumor-associated acute abdomen.The diagnosis and evaluation section mainly includes oncology,imaging diagnosis and surgical perioperative evaluation.The prevention and treatment section mainly includes the prevention of malignant tumor-associated acute abdomen,the principle of treatment based on surgery,anti-tumor therapy-induced acute abdomen,as well as the prevention and management of special biological types of malignant tumor-associated acute abdomen.The last part discusses specific treatment of malignant tumor-associated acute abdomen such as gastrointestinal obstruction(surgery,palliative care,endoscopic or interventional surgery),gastrointestinal perforation(perioperative and surgical treatment),gastrointestinal bleeding(medical treatment,endoscopic surgery,interventional surgery,and surgical treatment),biliary system-associated acute abdomen(treatment of acute cholangitis,acute cholecystitis,and gallbladder perforation),and rupture of liver cancer(general treatment,transarterial embolization,and surgical treatment).We hope this consensus will help clinicians to understand the multidisciplinary standardized diagnosis and treatment of patients with malignant tumor-associated acute abdomen and to serve as a practical reference.