Surgical intervention for malignant bowel obstruction caused by gastrointestinal malignancies

BACKGROUND Malignant bowel obstruction(MBO)is a common event for end-stage gastrointestinal cancer patients.Previous studies had demonstrated manifestations and clinical management of MBO with mixed malignancies.There still lack reports of the surgical treatment of MBO.AIM To analyze the short-term outcomes and prognosis of palliative surgery for MBO caused by gastrointestinal cancer.METHODS A retrospective chart review of 61 patients received palliative surgery between January 2016 to October 2018 was performed,of which 31 patients underwent massive debulking surgery(MDS)and 30 underwent ostomy/by-pass surgery(OBS).The 60-d symptom palliation rate,30-d morbidity and mortality,and overall survival rates were compared between the two groups.RESULTS The overall symptom palliation rate was 75.4%(46/61);patients in the MDS group had significantly higher symptom palliation rate than OBS group(90%vs 61.2%,P=0.016).Patients with colorectal cancer who were in the MDS group showed significantly higher symptom improvement rates compared to the OBS group(overall,76.4%;MDS,61.5%;OBS,92%;P=0.019).However,patients with gastric cancer did not show a significant difference in symptom palliation rate between the MDS and OBS groups(OBS,60%;MDS,80%;P=1.0).The median survival time in the MDS group was significantly longer than in the OBS group(10.9 mo vs 5.3 mo,P=0.05).CONCLUSION For patients with MBO caused by peritoneal metastatic colorectal cancer,MDS can improve symptom palliation rates and prolong survival,without increasing mortality and morbidity rates.

Safety and efficacy of self-expandable metallic stents in malignant small bowel obstructions

In this report, we present 3 cases of malignant small bowel obstruction, treated with palliative care using endoscopic self-expandable metallic stent(SEMS) placement, with the aim to identify the safety and efficacy of this procedure. Baseline patient characteristics, procedure methods, procedure time, technical and clinical success rates, complications, and patient outcomes were obtained. All 3 patients had pancreatic cancer with small bowel strictures. One patient received the SEMS using colonoscopy, while the other 2 patients received SEMS placement via double balloon endoscopy using the through-the-overtube technique. The median procedure time was 104 min. The technical and clinical success rates were 100%. Post-treatment, obstructive symptoms in all patients improved, and a low-residue diet could be tolerated. All stents remained within the patients until their deaths. The median overall survival time(stent patency time) was 76 d. SEMS placement is safe and effective as a palliative treatment for malignant small bowel obstruction.

Clinical observation of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction

Objective： The aim of the study was to observe the effectiveness of continuously subcutaneous-pumped octreotide infusion in palliative treatment of malignant bowel obstruction （MBO）. Methods： Clinical data were retrospectively analyzed in 26 carcinoma patients complicated with MBO, in the Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, China, from March 2007 to April 2009. All 26 carcinoma patients with MBO were divided into no groups： the controlling group （CG, routine therapy, 15 patients） and the octreotide group （OG, 11 patients）. The octreotide group received routine therapy combined with octreotide （0.3 mg/d） by 24 hours continuously subcutaneous octreotide infusion. The changes of curative effectiveness related to symptoms, the times of recovering exsufflation and defecation, the average drain of gastrointestinal drainage tube, the duration of gastrointestinal drainage tube and the rate of extubation, were observed and compared between the two groups. Results： After treatment, remarkable changing rates of MBO related symptoms were 81.8% （9/11） in OG, and 46.7% （7/15） in CG （P 〈 0.05）. The 78% of SG and 30% of CG recovered the exsufflation and defecation, and the mean times they needed were 3.2 d and 5.8 d, respectively （P 〈 0.05）. The durations of gastrointestinal drainage tube of OG and CG were （5 ± 1.2） d and （10 ±2.3） d, respectively, and the rates of extubation were 54.5% and 20%, respectively. The improvement rate in the octreotide group was better than that in the controlling group and the difference was significant （72.7% and 26.7%, P 〈 0.05）. Conclusion; The administration of octreotide in combination with routine treatment can be very effective in the treatment of MBO. It can relieve the symptoms of MBO effectively and improve the quality of life of the end-stage patients. It has provided one kind of new treating thought and method for treatment of malignant bowel obstruction.

Palliative treatment for incurable malignant colorectal obstructions: A meta-analysis

AIM:To perform a meta-analysis of palliative stent placement vs palliative surgical decompression for management of incurable malignant colorectal obstructions.METHODS:The databases of Medline,Web of Science,Embase,and the Cochrane Central Register of Controlled Trials were searched from their inception to July 2012 for studies(prospective,retrospective,randomized controlled trials,and case-control trials)designed as comparative analyses of patients with incurable malignant colorectal obstructions treated by selfexpanding metallic stents(SEMS)or palliative surgery.No language restrictions were imposed.The main outcome measures were hospital stay,intensive care unit admission,clinical success rate,30-d mortality,stoma formation,complications,and overall survival time.The data extraction was conducted by two investigators working independently and using a standardized form.The Mantel-Haenszel 2method was used to estimate the pooled risk ratios with 95%CI under a fixed-effects model;when statistical heterogeneity existed in the pooled data(as evaluated by Q test and I2statistics,where P<0.10 and I2<25%indicated heterogeneity),a random-effects model was used.RESULTS:Thirteen relevant articles,representing837 patients(SEMS group,n=404;surgery group,n=433),were selected for analysis.Compared to the surgery group,the SEMS group showed lower clinical success(99.8%vs 93.1%,P=0.0009)but shorter durations of hospital stay(18.84 d vs 9.55 d,P<0.00001)and time to initiation of chemotherapy(33.36 d vs15.53 d,P<0.00001),and lower rate of stoma formation(54.0%vs 12.7%,P<0.00001).Additionally,the SEMS group experienced a significantly lower rate of30-d mortality(4.2%vs 10.5%,P=0.01).Stent-related complications were not uncommon and included perforation(10.1%),migration(9.2%),and occlusion(18.3%).Surgery-related complications were slightly less common and included wound infection(5.0%)and anastomotic leak(4.7%).The rate of total complications was similar between these two groups(SEMS:34.0%vs surgery:38.1%,P=0.60),but the surgeryrelated complications occurred earlier than stent-related complications(rate of early complications:33.7%vs13.7%,P=0.03;rate of late complications:32.3%vs12.7%,P<0.0001).The overall survival time of SEMSand surgery-treated patients was not significantly different(7.64 mo vs 7.88 mo).CONCLUSION:SEMS is less effective than surgery for palliation of incurable malignant colorectal obstructions,but is associated with a shorter time to chemotherapy and lower 30-d mortality.

Role of self-expanding metal stents in patients with malignant colorectal obstruction: A systematic review and meta-analysis

AIM: To assess the safety and efficacy of self-expandable metal stents(SEMSs) for malignant colorectal obstruction. METHODS: Data regarding technical success, clinical success, and procedure related complications were collected from included studies. Der Simonian-Laird random effects model was used to generate the overall outcome. Thirty international studies with a total of 2058 patients with malignant colorectal obstruction were included. RESULTS: The technical and clinical success rates for SEMS placement were 94%(95%CI: 92-96) and 91%(95%CI: 88-93), respectively. Overall complication rate for SEMS was 23%(95%CI: 18-29). Stent migration8%(95%CI: 6-10) and stent obstruction 8%(95%CI: 6-11) were the most common complications, followed by perforation 5%(95%CI: 4%-7%). Surgical or endoscopic re-interventions were needed in 14%(95%CI: 10-18) of patients. Endoscopic repeat stent placement was required in 8%(95%CI: 6-10), while surgical intervention was needed in 6%(95%CI: 4-8).CONCLUSION: SEMS are effective when used as palliation or bridge to surgery for malignant colorectal obstruction with high technical and clinical success. About 14% of patients require repeat endoscopic or surgical intervention for stent failure or to manage stent related complications.

Comparable results of surgical versus non-surgical management for patients with malignant bowel obstruction-a lesson from S1316 study

We had the pleasure to read the paper published online by Krouse et al.in August 2023 in the Lancet Gastroenterology and Hepatology(1).The study labeled as S1316 was a prospective pragmatic comparative effectiveness trial evaluating the surgical versus non-surgical management for patients with malignant small intestinal bowel obstruction(MIO)and having an intra-abdominal or retroperitoneal primary cancer and were aged 18 years or older with a Zubrod performance status 0-2 within 1 week before admission;had a surgical indication;and treatment equipoise.The patients were divided in two pathways.Those who accepted the randomization were randomly assigned to surgical and non-surgical treatment groups.Those who declined consent for random assignment were offered a prospective observational patient choice pathway where the patients with their caring team decide upon the treatment option.

Topical Delivery of Modified Da-Cheng-Qi Decoction(加味大承气汤) Using Low-Frequency Ultrasound Sonophoresis for Refractory Metastatic Malignant Bowel Obstruction:An Open-Label Single-Arm Clinical Trial

Objective:To evaluate the efficacy and safety of topical delivery of modified Da-Cheng-Qi Decoction(加味大承气汤,MDCQD)by low-frequency ultrasound sonophoresis(LFUS)in patients with refractory metastatic malignant bowel obstruction(MBO)using an objective performance criteria(OPC)design.Methods:Fifty patients with refractory metastatic MBO were enrolled in this open-label single-arm clinical trial.Alongside fasting,gastrointestinal decompression,glycerol enema,intravenous nutrition and antisecretory therapy,a 50 g dose of MDCQD(prepared as a hydrogel)was applied through topical delivery at the site of abodminal pain or Tianshu(S 25)using LFUS for 30 min,twice daily for 5 consecutive days.The overall outcomes were the remission of intestinal obstruction,improvement on abdominal pain,abdominal distention,nausea and vomiting scores.Indicators of safety evaluation included liver and renal function as well as blood coagulation indicators.Results:Among 50 patients,5 patients(10%)showed complete remission of intestinal obstruction and 21 patients(42%)showed improvement of intestinal obstruction.The overall remission rate of bowel obstruction was 52%.The results of the symptom score,based on the severity and frequency of the episode,were as follows:26 patients(52%)showed improvment on symptom scores,20 patients(40%)did not respond to treatment,and 4 patients(8%)discontinued treatment due to intolerance.No serious adverse effects or abnormal changes on liver and renal functions or blood coagulation were observed.Conclusion:Topical delivery of MDCQD at 100 g/day using LFUS can improve the treatment response in patients with refractory metastatic MBO.

超声内镜引导下肠-肠吻合术治疗恶性肠梗阻的应用效果

目的 探讨超声内镜引导下肠-肠吻合术(EUS-EE)治疗恶性肠梗阻(MBO)的效果。方法回顾性分析2022年6月-2023年12月该院收治的14例因MBO行EUS-EE患者的临床资料。术前采用改良式肠道准备方案行肠道准备,统计分析EUS-EE术后患者症状缓解情况、营养状态改善情况和并发症发生情况。结果 14例均成功实施EUS-EE,选用结直肠梗阻评分系统(CrOSS),评估术前和术后肠梗阻症状和缓解情况,术后1周,CrOSS评分由术前的1至2分上升至2~4分;术后1周,患者主观总体评估(PGSGA)量表评分为(9.64±3.13)分,明显低于术前的(12.36±3.22)分,差异有统计学意义(t=2.26,P=0.032);术后5例出现体温升高,3例出现气腹,2例出现短肠综合征,经过对症治疗,均得到缓解。术后随访1年内,患者的中位生存时间为81 (41,500) d,1年生存率为64.29%。结论 EUS-EE具有症状缓解率高、创伤小和再干预率低等优点。对于基础状况不佳或预期生存时间短的患者,EUS-EE有助于改善身体不适症状,提高患者生活质量,延长生存周期。

透明帽辅助水交换单人肠镜技术在肠道金属支架置入术中的应用

目的探讨透明帽辅助水交换单人肠镜技术在肠道金属支架置入术中的应用价值。方法将2020年1月至2022年12月丽水市中医院进行肠镜金属支架置入术的97例患者,采用随机数字表法分为观察组49例和对照组48例;观察组采用透明帽辅助水交换单人肠镜技术置入肠道金属支架,对照组采用传统单人肠镜技术置入肠道金属支架,比较两组患者支架置入成功率、术中腹痛评分、梗阻缓解率、支架置入相关并发症发生率、肠功能恢复时间等情况。结果观察组49例均成功置入结肠支架,对照组成功置入43例,未成功5例,两组比较差异有统计学意义(P<0.05);与对照组比较,观察组腹痛评分明显降低(P<0.001);两组患者梗阻缓解率、支架置入相关并发症发生率、肠功能恢复时间等情况比较差异均无统计学意义(均P>0.05)。结论将水交换单人肠镜技术与二氧化碳、透明帽辅助技术结合起来,发挥各自独特的优势,能够明显减轻腹痛、提高肠道金属支架置入成功率,是一种较为安全、有效的新技术,值得临床推广应用。

化疗治疗胃腺癌腹膜转移合并恶性肠梗阻的临床疗效分析

目的对比接受化疗和保守治疗的胃腺癌腹膜转移合并恶性肠梗阻患者的预后,以分析化疗的有效性。方法本研究回顾性筛查2013年1月至2021年12月中山大学附属第六医院收治的所有胃腺癌腹膜转移合并恶性肠梗阻的病例。根据诊断为恶性肠梗阻后是否行化疗,将研究对象分为保守治疗组和化疗组。利用倾向性匹配,按1:1进行配对后,对比和分析两组患者的梗阻缓解率、1个月内死亡率及总生存时间。结果共匹配71对患者,配对后化疗组和保守治疗组的基线资料具有可比性。保守治疗组患者的梗阻缓解率为31.0%,1个月内死亡率为16.9%,中位总生存时间为1.87个月。化疗组患者的梗阻缓解率为76.1%,1个月内死亡率为7.0%,中位总生存时间为6.73个月。与保守治疗组相比,化疗组的梗阻缓解率较高,1个月内死亡率较低,中位总生存时间较长,差异均具有统计学意义(P<0.05)。结论对于胃腺癌腹膜转移合并恶性肠梗阻的患者,化疗有效,是重要的治疗选择。

经鼻插入型肠梗阻导管在治疗恶性肠梗阻中的应用效果分析

目的研究经鼻插入型肠梗阻导管在治疗恶性肠梗阻(MBO)中的应用效果。方法选择我院2020年2月~2022年2月收治的120例MBO患者,以随机数字表法分为观察组60例及常规组60例,两组均开展禁食水、补液、纠正酸碱平衡以及静脉肠外营养支持等常规治疗。常规组实施普通胃管减压处理,观察组开展经鼻插入型肠梗阻导管处理。分析两组临床疗效、肠梗阻缓解情况、并发症发生情况,入院第5天、第10天的血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平的差异。结果观察组治疗总有效率高于常规组(P<0.05)。观察组引流量为(102.33±12.50)ml,多于常规组的(78.37±7.39)ml,而排气时间、腹胀腹痛减轻时间分别为(2.59±0.31)d、(3.21±0.53)d,均短于常规组的(3.71±0.44)d、(4.51±0.62)d(P<0.05)。观察组并发症发生率低于常规组(P<0.05)。入院第5天、第10天观察组的IL-6、TNF-α水平低于常规组(P<0.05)。结论经鼻插入型肠梗阻导管应用于MBO治疗中的效果较佳,可有效缓解肠梗阻症状,减少并发症的发生,降低血清炎症因子水平。

预防性回肠造口对防止癌性肠梗阻患者术后吻合口瘘的临床价值分析

目的探讨预防性回肠造口对防止癌性肠梗阻患者术后吻合口瘘的临床价值。方法78例癌性(乙状结肠癌及直肠癌)肠梗阻患者,根据随机数字表法分为对照组(56例)和观察组(22例)。对照组采用一期大肠癌根治性手术治疗,观察组在对照组基础上联合预防性回肠造口治疗。比较两组手术指标、白蛋白水平、生活质量评分及术后并发症发生情况。结果两组手术时间、肿瘤距肛门距离比较差异无统计学意义(P>0.05)。观察组住院时间(23.19±3.24)d短于对照组的(32.56±4.61)d,治疗费用(4.96±0.73)万元少于对照组的(6.83±0.81)万元,差异有统计学意义(P<0.05)。手术前,两组白蛋白水平比较差异无统计学意义(P>0.05);手术后,两组白蛋白水平均高于本组手术前,且观察组白蛋白(48.24±7.39)g/L高于对照组的(44.12±6.21)g/L,差异有统计学意义(P<0.05)。手术后,两组生理、心理、环境、独立性、社会关系、精神支柱评分均明显高于手术前,且观察组生理、心理、环境、独立性、社会关系、精神支柱评分分别为(17.38±2.62)、(17.45±2.55)、(18.25±1.75)、(18.12±1.83)、(17.86±2.74)、(18.33±1.67)分,均明显高于对照组的(15.29±2.55)、(15.21±2.49)、(14.37±2.52)、(14.79±2.50)、(14.32±2.48)、(15.05±2.50)分,差异有统计学意义(P<0.05)。观察组并发症发生率9.09%低于对照组的30.36%,差异有统计学意义(P<0.05)。结论预防性回肠造口能防止癌性肠梗阻患者术后发生吻合口瘘,可减轻手术创伤,提高患者生活质量,值得推广应用。

胃肠减压联合生长抑素治疗对恶性肠梗阻患者免疫炎症及肠黏膜屏障的影响

目的:探讨胃肠减压联合生长抑素治疗对恶性肠梗阻患者免疫炎症及肠黏膜屏障的影响。方法:选取64例恶性肠梗阻患者作为研究对象,按照治疗方法的不同将患者分为对照组(n=30)和观察组(n=34)。对照组给予对症治疗和生长抑素治疗;观察组在对照组治疗基础上给予胃肠减压治疗。比较两组患者临床疗效、临床症状改善情况、炎症因子、T淋巴细胞亚群水平、肠黏膜屏障功能及不良反应发生情况。结果:观察组治疗总有效率为94.12%,高于对照组的73.33%(P<0.05),呕吐停止时间、腹痛腹胀消失时间、肛门恢复排气时间、影像学积气、积液消失时间均短于对照组(P<0.05)。与治疗前比较,两组患者治疗后白细胞介素1β(IL-1β)、IL-6、IL-8、IL-10、肿瘤坏死因子α(TNF-α)、CD8^(+)、D乳酸、内毒素(ET)及二胺氧化酶(DAO)水平均下降(P<0.05),且观察组低于对照组(P<0.05);CD4^(+)、CD4^(+)/CD8^(+)水平均升高(P<0.05),且观察组高于对照组(P<0.05)。两组患者治疗期间均无不良反应发生。结论:恶性肠梗阻患者采用胃肠减压联合生长抑素治疗的临床疗效更佳,且在控制机体炎症反应、缓解临床症状、促进免疫功能及肠黏膜屏障功能恢复方面的效果更好,安全性较高。

恶性肠梗阻治疗中国专家共识(2023年)

恶性肠梗阻是晚期肿瘤患者常见终末期事件,20%的肿瘤最终发展为恶性肠梗阻。然而,恶性肠梗阻患者预后差,缺乏有效的治疗方法,恶性肠梗阻的诊疗路径、治疗策略、手术适应证和禁忌证、手术治疗能否获益等均是需要探索性的课题。中国抗癌协会组织多位在恶性肠梗阻诊疗领域具有丰富临床经验的专家就恶性肠梗阻的定义、流行病学、病理生理、治疗原则和方法、疗效评价进行讨论,重新定义恶性肠梗阻,总结恶性肠梗阻发生、发展的病理生理机制,提出恶性肠梗阻“多学科会诊、分级诊疗、整合治疗和精准强化”治疗策略,明确手术适应证、手术方式、手术效果评价方法和指标,并对恶性肠梗阻手术治疗与药物治疗效果进行了评价。《恶性肠梗阻治疗中国专家共识(2023年)》对提高恶性肠梗阻规范化治疗水平具有一定意义。

扶正攻下法治疗晚期肝癌恶性肠梗阻经验体会

肠梗阻是晚期恶性肿瘤常见并发症,治疗难度大。西医内科保守治疗效果有限,中医具有独特优势,可弥补西医之不足。肝癌相关性肠梗阻临床并不少见,但中医药治疗文献报道极少。正气虚损、腑气不通为基本病机,扶正攻下为基本治法。扶正包括益气、养阴、补血、温阳,攻下以泻热通腑为主。在该治法指导下进行中医宏观精准辨证治疗,一人一方,及时调方,最大化发挥中医药疗效。结合验案介绍吴孝雄副主任医师运用扶正攻下法治疗晚期肝癌相关性肠梗阻经验,为中西医优势互补治疗肝癌并发症提供切入点。

奥曲肽持续皮下泵入治疗恶性肠梗阻的临床观察

目的观察奥曲肽持续皮下泵入给药在恶性肠梗阻姑息性治疗中的作用。方法收集2007年3月至2009年4月收治的26例恶性肠梗阻患者进行回顾分析。分为奥曲肽组11例和对照组15例,比较两组患者在治疗前后肠梗阻相关症状变化、肛门恢复排气排便时间、胃肠减压引流液量、鼻胃管留置时间、拔管率和肠梗阻近期疗效。结果奥曲肽组肠梗阻相关症状改善率为81.8%(9/11),明显优于对照组46.7%(7/15)。奥曲肽组患者恢复排气排便所需平均时间为3.2天,明显优于对照组5.8天。奥曲肽组鼻胃管留置时间为(5±1.2)天,拔管率为54.5%,均明显优于对照组(10±2.3)天和20.0%。奥曲肽组肠梗阻的近期疗效好转率为72.7%,优于对照组26.7%。结论奥曲肽持续皮下泵入给药配合常规治疗,能够显著改善晚期恶性肠梗阻患者,尤其是终末期患者的生活质量,为恶性肠梗阻的治疗提供了一种新的治疗思路和方法 。

中药灌肠治疗恶性肠梗阻106例临床观察

目的:探讨中药灌肠治疗恶性肠梗阻的临床疗效,为治疗此类患者提供依据。方法:回顾性分析本科2002年10月—2008年12月收治的106例恶性肠梗阻患者应用中药保留灌肠治疗的临床资料。结果:106例患者中40例(37.7%)完全缓解,43例(40.6%)好转,总有效率78.3%。无效23例(21.7%),均为高位完全梗阻。23例无效患者在观察期间病情未出现明显恶化。结论:中药灌肠治疗恶性肠梗阻操作方便,疗效肯定,且价格低廉,值得临床推广应用。

胃癌腹腔转移所致恶性肠梗阻的诊治及营养支持策略

我国是胃癌发病率较高的国家之一,年新发病例占世界总数的42%,发病特点以进展期胃癌占大多数,复发转移率高,预后差。恶性肠梗阻是胃癌腹腔转移患者的主要临床表现之一,由于对其认知度不高,治疗水平参差不齐,许多患者未能得到有效的诊断和治疗,承受巨大的痛苦和精神压力。近年来,随着生长抑素等药物的应用,使得更多胃癌腹腔转移所致恶性肠梗阻患者的症状得到了有效的缓解,部分患者获得了化疗等抗肿瘤治疗的机会,延长了生存时间。本文就胃癌腹腔转移所致恶性肠梗阻的诊治进展及营养支持策略进行综述。

奥曲肽持续静脉泵入治疗恶性肠梗阻临床价值

目的了解奥曲肽治疗恶性肠梗阻的近期疗效、安全性、中位生存期和总生存期。方法将晚期恶性肠梗阻非手术治疗患者48例分为两组:对照组(n=22)常规治疗,即禁食、鼻胃管胃肠减压、全肠外营养支持、预防感染、止痛等;治疗组(n=26)除常规治疗外,应用奥曲肽300μg/24 h持续静脉泵入。评价两组有效率,观察两组治疗开始前后的鼻胃管引流量,并统计鼻胃管拔除率。通过随访,统计两组患者的中位生存期和总生存期。结果对照组和治疗组有效率分别为22.8%和42.4%,拔管率分别为22.7%和34.6%,两组比较差异有统计学意义(P<0.05)。与对照组相比,治疗组治疗第6天胃管引流量更少(260±146)ml/d vs(505±168)ml/d,(P<0.01),PS评分改善更佳,中位生存期延长1.4周,总生存期差异无统计学意义。结论 300μg//24 h的奥曲肽治疗恶性肠梗阻具有重要的作用,有良好的安全性,可改善临床症状和PS状况,但对患者的总生存期无明显延长。

雷替曲塞等化疗药物低剂量动脉灌注治疗胃癌术后并发恶性肠梗阻

目的探讨雷替曲塞等小剂量化疗药物介人性动脉灌注对胃癌术后腹腔转移致恶性肠梗阻的疗效。方法 42例胃癌术后伴不完全性肠梗阻患者,经肠系膜上动脉或加腹腔动脉、肠系膜下动脉等插管,灌注低剂量化疗药物,药物用量为雷替曲塞2 mg,奥沙利伯50~100 mg,多西他赛20~40 mg,化疗周期为每3~4周动脉灌注1次。本组病例至少灌注1次,最多7次。对照组42例给予内科姑息治疗,未给予化疗药物。结果介人化疗后肠梗阻缓解有效率为80.95%（34/42例）;对照组肠梗阻缓解有效率为42.85%（18/42例）,两组相比差异显著（P〈0.01）。介入化疗组排气、排便及腹痛腹胀的缓解时间均短于对照组,肠道通畅总维持时间长于对照组,两组相比统计学差异均显著。介人化疗组生存时间为2~36个月,中位生存时间5个月;对照组平均生存期为（2.69±2.25）个月,中位生存时间为3个月,两组生存时间统计学差异非常显著（P〈0.01）。介入治疗组对腹水治疗的总有效率为76.0（19/25）,也高于对照组（P〈0.01）。介入治疗组治疗后KPS评分提高,ECOG评分下降。结论小剂量化疗药物动脉灌注对胃癌术后腹腔转移致肠梗阻副作用小,能在短期内明显缓解癌性肠梗阻症状,肠道通畅维持时间长,并能有效控制伴随的腹水症状,延长生存时间,提高生活质量,尤其适用于老年及体质虚弱者。