恶性肠梗阻的整合治疗

doi:10.16689/j.cnki.cn11－9349/r.2019.04.006

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肿瘤代谢与营养电子杂志 ›› 2019, Vol. 6 ›› Issue (4) : 421-426. DOI: 10.16689/j.cnki.cn11－9349/r.2019.04.006

共识、指南与标准

恶性肠梗阻的整合治疗

石汉平，陈永兵，饶本强，王昆华，丛明华，李苏宜，陈俊强，巴一，束永前，沈琳，李薇，陈子华，江志伟，刘明，于世英

作者信息 +

Integrated treatment of malignant bowel obstruction

SHI Han-ping, CHEN Yong-bing, RAO Ben-qiang, WANG Kun-hua, CONG Ming-hua, LI Su-yi, CHEN Jun-qiang, BA Yi, SHU Yong-qian, SHEN lin, LI Wei, CHEN Zi-hua, JIANG Zhi-wei, LIU Ming, YU Shi-ying； Chinese Society of Nutrition Oncology

Author information +

1Department of Gastrointestinal Surgery/Clinical Nutrition, Beijing Shijitan Hospital/Capital Medical University Beijing International Science and Technology Cooperation Base for Cancer Metabolism and Nutrition/Department of Oncology, Capital Medical University, Beijing 100038, China；2Department of Gastrointestinal and Hernia Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China；3Departments of General Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China；4Department of Nutrition and Metabolism Treatment of Cancer,Provincial Hospital Affiliated to Anhui Medical University, Hefei 230031,Anhui,China； 5Department of Gastrointestinal Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China； 6Tianjin Medical University Cancer Institute and Hospital,National Clinical Research Center for Cancer,Tianjins Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy,Tianjin Medical University, Tianjin 300060,China；7Department of Oncology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China；8Department of Gastroenterology, Beijing Cancer Hospital,Beijing 100142, China；9Cancer Center, the First Hospital of Jilin University, Changchun 130021, Jilin, China；10 Department of Gastrointestinal Surgery,Xiangya Hospital Central South University,Changsha 410008, Hunan, China；11Department of Gastrointestinal Surgery,Nanjing General Hospital of Nanjing Military Command, PLA, Nanjing 210002, Jiangsu, China； 12Department of General Surgery, the Fourth Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang, China； 13Cancer Center of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China

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摘要

恶性肠梗阻（malignant bowel obstruction，MBO）是由恶性肿瘤导致的肠梗阻，最常见于卵巢、胃和结直肠肿瘤。MBO的病理生理与良性疾病所致的肠梗阻既有相似之处，也有显著不同，其治疗既遵循肠梗阻的一般原则，也遵循恶性肿瘤的一般原则。尽管MBO总体预后差，但是MBO并非不治之症。MBO的治疗是一种整合疗法，包括如下11个方面：抑制分泌、制止呕药、抑制炎症、控制疼痛、抗击肿瘤、液体管理、促进排空、改善体能、减压引流、改善营养、肠腔再通。MBO目前没有一个适用于所有患者的金科玉律，也没有一把可以确切解决所有问题的万能钥匙。理想的MBO治疗只能是个体化基础上的综合治疗。组建跨专业的多学科MBO诊疗团队，制订平衡理想与现实的MBO诊疗规范，确立以解决主要矛盾——提高生活质量为导向的治疗目标，充分听取患者本人及亲属的意见，积极有效的综合治疗仍然可以显著改善肿瘤患者生活质量、延长生存时间。

Abstract

Malignant bowel obstruction is a type of intestinal obstruction caused by a malignant tumor, most commonly seen in ovarian, gastric, and colorectal tumors. The pathophysiology of MBO is both similar and significantly different from that of intestinal obstruction caused by benign diseases. Despite the poor overall prognosis, MBO is not an incurable disease. The treatment of MBO is an integrated therapy that includes the following 11 aspects: inhibiting secretion, stopping vomiting, suppressing inflammation, controlling pain, fighting tumors, fluid management, promoting drainage, improving body energy, decompression and drainage, improving nutrition, and recanalization of intestinal cavities. MBO currently does not have a golden rule for all patients, nor does it have a master key that can solve all problems with certainty. The ideal MBO treatment can only be a comprehensive treatment on an individual basis. To form a cross major multi-disciplinary team of MBO diagnosis and treatment, formulate balance the ideal and the reality of MBO diagnostic standard, in order to solve the main contradiction, improve the quality of life as the guidance of treatment goals, fully listen to the opinions of the patient and family, and positive and effective comprehensive treatment can significantly improve the quality of life in patients with tumor and prolong survival time.

导出引用

石汉平，陈永兵，饶本强，王昆华，丛明华，李苏宜，陈俊强，巴一，束永前，沈琳，李薇，陈子华，江志伟，刘明，于世英. 恶性肠梗阻的整合治疗[J]. 肿瘤代谢与营养电子杂志. 2019, 6(4): 421-426 https://doi.org/10.16689/j.cnki.cn11－9349/r.2019.04.006

SHI Han-ping, CHEN Yong-bing, RAO Ben-qiang, WANG Kun-hua, CONG Ming-hua, LI Su-yi, CHEN Jun-qiang, BA Yi, SHU Yong-qian, SHEN lin, LI Wei, CHEN Zi-hua, JIANG Zhi-wei, LIU Ming, YU Shi-ying； Chinese S. Integrated treatment of malignant bowel obstruction[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2019, 6(4): 421-426 https://doi.org/10.16689/j.cnki.cn11－9349/r.2019.04.006

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