恶性机械性肠梗阻临床诊疗

Medical diagnosis and treatment of malignant bowel obstruction

恶性机械性肠梗阻是晚期肿瘤常见并发症之一,通常以内科综合治疗为主。了解其病理生理机制(包括“不协调蠕动-组织水肿-不协调蠕动”及“分泌-扩张-分泌”恶性循环),明确梗阻的分类、亚型和完善肿瘤内科的系统评估(包括一般情况、脏器功能、肿瘤学评估、营养代谢及肠屏障功能)是其有效治疗的前提。治疗原则和目的是尽量减少,甚至解除机体肿瘤负荷,改善或根治肠梗阻所致不良症状、体征及肠功能异常,纠正水、电解质紊乱及营养代谢紊乱状态,最终改善患者生活质量及总生存。具体措施包括基础治疗、营养治疗和代谢调节、抗炎、减轻肠壁水肿、抑制消化道腺体分泌、修复肠道屏障及防治感染、抗肿瘤病因治疗及运动疗法、心理治疗。其中抗肿瘤病因治疗是临床中的难点,因恶性肠梗阻多伴随营养不良、一般情况差,难以耐受常规抗肿瘤治疗,抗肿瘤治疗上需兼顾肿瘤因素、营养状况及患者一般情况等,有效的抗肿瘤治疗是肠梗阻再通的基本保障。

Malignant bowel obstruction is one of the common complications of advanced tumors.The treatment is mainly based on comprehensive medical methods.Understanding the pathophysiological mechanism(including“uncoordinated peristalsis-tissue edema-uncoordinated peristalsis”and“secretion-expansion-secretion”vicious circle),clarify the classification and subtype of obstruction and completing the systematic evaluation of oncology(including general conditions,organ function,oncology evaluation,nutritional metabolism and intestinal barrier function),are the prerequisites for its effective treatment.The principle and purpose of treatment are to minimize or even relieve the body s tumor load,to improve or cure the adverse symptoms,signs and intestinal dysfunction caused by intestinal obstruction,to correct the state of water and electrolyte disorders and nutritional metabolism disorders,and ultimately to improve the patient s quality of life and overall survival.Specific measures includes basic treatment,nutritional therapy and metabolic regulation,anti-inflammatory,reducing intestinal wall edema,inhibiting the secretion of glands in the digestive tract,repairing the intestinal barrier and preventing infection,anti-tumor etiology treatment and exercise therapy,psychological support.Anti-tumor etiological treatment is a clinical difficulty,because malignant bowel obstruction is often accompanied by malnutrition and poor general conditions,and it is difficult to tolerate conventional anti-tumor therapy.Anti-tumor therapy needs to take into account tumor factors,nutritional status and patients general conditions.Effective anti-tumor treatment is the basic guarantee for intestinal obstruction recanalization.