1例恶性肠梗阻的循证治疗_《中国循证医学杂志》

作者：

汪汉 , 岳冀蓉 , 侯言彬 ,  邓珏琳

四川大学华西医院老年科（成都 610041）;

关键词：

肠梗阻东莨宕碱奥曲肽治疗

DOI：

10.7507/1672-2531.20080013

视频：

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目的　针对1例晚期结肠癌合并肠梗阻（恶性肠梗阻）患者，检索当前最佳证据，为患者实施药物治疗或姑息手术治疗提供依据，力争减少患者症状，提高生活质量。
方法　按PICO原则，将临床问题转化为可回答的形式，通过计算机系统检索Cochrane 图书馆（2007年第1期）、 MEDLINE（1950.1～2007.3）和 ACP Journal Club（1991.1～2007.3）等数据库，查找与恶性肠梗阻治疗相关的系统评价和随机对照试验，并对相关证据进行评价。
结果　东莨宕碱和奥曲肽均能有效缓解恶心、呕吐、腹痛等症状，但奥曲肽在减少胃液量方面优于东莨宕碱。胃复安对于控制由晚期癌症引起的疲乏，恶心以及肠梗阻有效。在药物治疗前及治疗初期可以暂时置入鼻胃管以引流大量分泌物，但长期使用鼻胃管患者难以耐受，且可能引起鼻粘膜缺血坏死，乃至感染等。恶性肠梗阻的姑息手术治疗方案目前还仅仅是经验性治疗，不同地区差异明显，应结合患者情况进行考虑。最终，我们以文献检索结果为基础，告知患者及家属不同治疗方案的优势和副作用，征得患者及家属同意，为患者制定了个体化治疗方案。
结论　对晚期结肠癌合并肠梗阻患者，当前证据显示以减轻患者症状，提高生活质量的药物姑息治疗有效，但是否采用姑息手术的证据不足，此时，应充分考虑患者情况和医生临床经验。

引用本文： 汪汉,岳冀蓉,侯言彬,邓珏琳. 1例恶性肠梗阻的循证治疗. 中国循证医学杂志, 2008, 08(1): 55-57. doi: 10.7507/1672-2531.20080013 复制

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).

《中国循证医学杂志》

1例恶性肠梗阻的循证治疗

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《中国循证医学杂志》

1例恶性肠梗阻的循证治疗

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