1例惡性腸梗阻的循證治療_《中國循證醫學雜志》

作者：

汪漢 , 岳冀蓉 , 侯言彬 ,  鄧玨琳

四川大學華西醫院老年科（成都 610041）;

關鍵詞：

腸梗阻東莨宕堿奧曲肽治療

DOI：

10.7507/1672-2531.20080013

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目的　針對1例晚期結腸癌合并腸梗阻（惡性腸梗阻）患者，檢索當前最佳證據，為患者實施藥物治療或姑息手術治療提供依據，力爭減少患者癥狀，提高生活質量。
方法　按PICO原則，將臨床問題轉化為可回答的形式，通過計算機系統檢索Cochrane 圖書館（2007年第1期）、 MEDLINE（1950.1～2007.3）和 ACP Journal Club（1991.1～2007.3）等數據庫，查找與惡性腸梗阻治療相關的系統評價和隨機對照試驗，并對相關證據進行評價。
結果　東莨宕堿和奧曲肽均能有效緩解惡心、嘔吐、腹痛等癥狀，但奧曲肽在減少胃液量方面優于東莨宕堿。胃復安對于控制由晚期癌癥引起的疲乏，惡心以及腸梗阻有效。在藥物治療前及治療初期可以暫時置入鼻胃管以引流大量分泌物，但長期使用鼻胃管患者難以耐受，且可能引起鼻粘膜缺血壞死，乃至感染等。惡性腸梗阻的姑息手術治療方案目前還僅僅是經驗性治療，不同地區差異明顯，應結合患者情況進行考慮。最終，我們以文獻檢索結果為基礎，告知患者及家屬不同治療方案的優勢和副作用，征得患者及家屬同意，為患者制定了個體化治療方案。
結論　對晚期結腸癌合并腸梗阻患者，當前證據顯示以減輕患者癥狀，提高生活質量的藥物姑息治療有效，但是否采用姑息手術的證據不足，此時，應充分考慮患者情況和醫生臨床經驗。

引用本文： 汪漢,岳冀蓉,侯言彬,鄧玨琳. 1例惡性腸梗阻的循證治療. 中國循證醫學雜志, 2008, 08(1): 55-57. doi: 10.7507/1672-2531.20080013 復制

1.	Mercadante S, Ripamonti C, Casuccio A, et al. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer, 2000, 8(3): 188-191.
2.	Ripamonti C, Mercadante S, Groff L, et al. Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manage, 2000, 19(1): 23-34.
3.	Mystakidou K, Tsilika E, Kalaidopoulou O, et al. Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double-blind, controlled clinical trial.? Anticancer Res, 2002, 22(2B): 1187-1192.
4.	Zhang Y, Gao Y, Ma Q, et al. Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction. Dig Liver Dis, 2006, 38(3): 188-194.
5.	Hardy J, Ling J, Mansi J, et al. Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med, 1998, 12(6): 437-442.
6.	Laval G, Girardier J, Lassauniere JM, et al. The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction Palliat Med, 2000, 14(1): 3-10.
7.	Glare P, Pereira G, Kristjanson LJ, et al. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer, 2004, 12(6): 432-440.
8.	Feuer DJ, Broadley KE. Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Ann Oncol, 1999, 10 (9): 1035-1041.
9.	Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (2).
10.	Mercadante S, Casuccio A, Mangione S, et al. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage, 2007, 33(2): 217-223.
11.	Bruera E, Belzile M, Neumann C, et al. A double blind crossover study of controlled release metoclopramide and placebo for the chronic nausea and dyspepsia of advanced cancer. J Pain Symptom Manage, 2000, 19 (6): 427-435.
12.	Hardy J, Daly S, McQuade B, et al. A double blind, randomised parallel group, multi-national, multi-centre study comparing single dose ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg tds p.o. in the treatment of opioid induced nausea and emesis in cancer patients. Support Care Cancer, 2002, 10(2): 231-236.
13.	Pictus D, Marx MV, Weyman PJ. Chronic intestinal obstruction: value of percutaneous gastrostomy tube placement. Am J Roentgenol, 1988, 150 (2): 295-297.
14.	Feuer DJ, Broadley KE, Shepherd JH, et al. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (4).

1. Mercadante S, Ripamonti C, Casuccio A, et al. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Support Care Cancer, 2000, 8(3): 188-191.
2. Ripamonti C, Mercadante S, Groff L, et al. Role of octreotide, scopolamine butylbromide, and hydration in symptom control of patients with inoperable bowel obstruction and nasogastric tubes: a prospective randomized trial. J Pain Symptom Manage, 2000, 19(1): 23-34.
3. Mystakidou K, Tsilika E, Kalaidopoulou O, et al. Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double-blind, controlled clinical trial.? Anticancer Res, 2002, 22(2B): 1187-1192.
4. Zhang Y, Gao Y, Ma Q, et al. Randomised clinical trial investigating the effects of combined administration of octreotide and methylglucamine diatrizoate in the older persons with adhesive small bowel obstruction. Dig Liver Dis, 2006, 38(3): 188-194.
5. Hardy J, Ling J, Mansi J, et al. Pitfalls in placebo-controlled trials in palliative care: dexamethasone for the palliation of malignant bowel obstruction. Palliat Med, 1998, 12(6): 437-442.
6. Laval G, Girardier J, Lassauniere JM, et al. The use of steroids in the management of inoperable intestinal obstruction in terminal cancer patients: do they remove the obstruction Palliat Med, 2000, 14(1): 3-10.
7. Glare P, Pereira G, Kristjanson LJ, et al. Systematic review of the efficacy of antiemetics in the treatment of nausea in patients with far-advanced cancer. Support Care Cancer, 2004, 12(6): 432-440.
8. Feuer DJ, Broadley KE. Systematic review and meta-analysis of corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancers. Ann Oncol, 1999, 10 (9): 1035-1041.
9. Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (2).
10. Mercadante S, Casuccio A, Mangione S, et al. Medical treatment for inoperable malignant bowel obstruction: a qualitative systematic review. J Pain Symptom Manage, 2007, 33(2): 217-223.
11. Bruera E, Belzile M, Neumann C, et al. A double blind crossover study of controlled release metoclopramide and placebo for the chronic nausea and dyspepsia of advanced cancer. J Pain Symptom Manage, 2000, 19 (6): 427-435.
12. Hardy J, Daly S, McQuade B, et al. A double blind, randomised parallel group, multi-national, multi-centre study comparing single dose ondansetron 24 mg p.o. with placebo and metoclopramide 10 mg tds p.o. in the treatment of opioid induced nausea and emesis in cancer patients. Support Care Cancer, 2002, 10(2): 231-236.
13. Pictus D, Marx MV, Weyman PJ. Chronic intestinal obstruction: value of percutaneous gastrostomy tube placement. Am J Roentgenol, 1988, 150 (2): 295-297.
14. Feuer DJ, Broadley KE, Shepherd JH, et al. Surgery for the resolution of symptoms in malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev, 2000, (4).

《中國循證醫學雜志》

1例惡性腸梗阻的循證治療

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1例惡性腸梗阻的循證治療

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