恶性肠梗阻专家共识

1、Carla Ida Ripamonti, Alexandra M. Easson, Hans GerdesEUROPEAN JOURNAL OF CANCER Volume 44, issue 8, May 2008, Pages 1105-11151. Anthony T, Baron T, Mercadante S, et al. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manage2

2、007;34:S49591. Ripamonti C, Bruera E. Palliative management of malignantbowel obstruction. Int J Gynecol Cancer 2002;12:13543.2. Krouse RS. The international conference on malignant bowel obstruction: a meeting of the minds to advance palliative care research. J Pain Symptom Manage 2007;34:S16.3。Ali

3、 sidgiqui，et al：desease and sciences 2007 52（1）276281EJC 有肿瘤病史的患者有肿瘤病史的患者出现肠梗阻症状出现肠梗阻症状影像学检查影像学检查CT/MRI 临床评估临床评估患者因素患者因素临床决策临床决策技术因素技术因素 与患者及家属商定最终治疗方案与患者及家属商定最终治疗方案 数周数日数周数日（濒临死亡）（濒临死亡）l与手术相比，药物治与手术相比，药物治疗是更适宜的选择疗是更适宜的选择l评估治疗目标有助于评估治疗目标有助于指导干预方案（例如：指导干预方案（例如：减少恶心、呕吐，允减少恶心、呕吐，允许患者进食，减轻疼许患者进食，减轻疼痛，允许

4、患者回家或痛，允许患者回家或接受家庭护理）接受家庭护理）l药物治疗药物治疗l静脉或者皮下补液静脉或者皮下补液l内镜治疗鼻胃管引流内镜治疗鼻胃管引流 仅当其他措施无法减轻呕吐仅当其他措施无法减轻呕吐时方考虑时方考虑预计生存期预计生存期1 .Lowe AS, Beckett CG, Jowett S, et al. Self-expandable metal stent placement for the palliation of malignant gastroduodenal obstruction: experience in a large, single, UK centre. Cli

5、n Radiol 2007;62:73844.2. Telford JJ, Carr-Locke DL, Baron TH, et al. Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study.Gastrointest Endosc 2004;60:91620.3. Dormann A, Meisner S, Verin N, et al. Self-expanding metal stents

6、for gastroduodenal malignancies: systematic review of their clinical effectiveness. Endoscopy 2004;36:54350.4. Nassif T, Prat F, Meduri B, et al. Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study. Endoscopy 2003;35:483

7、9.5. Espinel J, Sanz O, Vivas S, et al. Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation. Surg Endosc 2006;20:10837.6. Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective r

8、andomized trial. Ann Surg 1999;230:3228. discussion 328-30.7. Jeurnink SM, Steyerberg EW, Hof GV, et al. Gastrojejunostomy versus stent placement in patients with malignant gastricoutlet obstruction: a comparison in 95 patients. J Surg Oncol 2007.1. Holt AP, Patel M, Ahmed MM. Palliation of patients

9、 with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice? Gastrointest Endosc 2004;60:101072. Jeurnink SM, Steyerberg EW, Hof GV, et al. Gastrojejunostomy versus stent placement in patients with malignant gastricoutlet obstruction: a comparison in 95 pa

10、tients. J Surg Oncol 2007.3. Wong YT, Brams DM, Munson L, et al. Gastric outletobstruction secondary to pancreatic cancer: surgical vs endoscopic palliation. Surg Endosc 2002;16:3102.1. Holt AP, Patel M, Ahmed MM. Palliation of patients with malignant gastroduodenal obstruction with self-expanding m

11、etallic stents: the treatment of choice? Gastrointest Endosc 2004;60:10107.1. Khot UP, Wenk Lang A, Murali K, et al. Systematic review of the efficacy and safety of colorectal stents. Br J Surg 2002;89:1096102.2. Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety

12、 of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastro 2004;99:20517.1 . Camunez F, Echenagusia A, Simo G, et al. Malignant colorectal obstruction treated by means of self-expanding metallic stents: Effectiveness before surgery and in palliation. Radiology 2000;216:4927.2

13、 . Law WL, Chu KW, Ho JW, et al. Self-expanding metallic stent in the treatment of colonic obstruction caused by advancedmalignancies. Dis Colon Rectum 2000;43:15227.3. Nash CL, Markowitz AJ, Schattner M, et al. Colorectal stents for the management of malignant large bowel obstruction. Gastrointest

14、Endo 2002;55:AB216.4. Pothuri B, Guiguis A, Gerdes H, et al. The use of colorectal stents for palliation of large bowel obstruction due to recurrent gynecologic cancer. Gynecol Oncol 2004;95:5137.1. Campagnutta E, Cannizzaro R, Gallo A, Zarrelli A, Valentini M, De Cicco M, et al. Palliative Treatmen

15、t of Upper Intestinal Obstruction by Gynecological Malignancy: The Usefulness of Percutaneous Endoscopic Gastrostomy. Gynecologic Oncology1996;62:1035.2. Pothuri B, Montemarano M, Gerardi M, Shike M, Ben-Porat L, Sabbatinin P, et al. Percutaneous endoscopic gastrostomy tube placement in patients wit

16、h malignant bowel obstruction due to ovarian carcinoma. Gynecologic Oncology 2005;96:3304.镇痛药根据WHO指南强烈推荐抗胆碱能药物丁溴东莨菪碱氢溴酸东莨菪碱持续疼痛绞痛给药方式n持续皮下给药（CSI）l持续静脉给药CIV）l经皮肤给药减少胃肠道分泌1、抗胆碱能药物丁溴东莨菪碱（40-120mg/d）甘罗溴铵（0.1-0.2mg，tid，sc或iv）氢溴酸东莨菪碱（0.8-2.0mg/d） 和/或2、生长抑素类似物奥曲肽0.2-0.9 mg/d，civ或csi止吐治疗l胃复安（仅用于不全肠梗阻及没有绞痛的患

17、者） 氟哌啶醇（5-15mg/dCSI） 甲氧异丁嗪 （50-150mg/dCSI）l镇静药 氯吡嗪（25-75mg/d直肠给药） 氯丙嗪 （50-100mg/d直肠给药/皮下）l抗组胺药盐酸吗嗪（100-150mg/d皮下或直肠 给药）恶心呕吐1. World Health Organization. Cancer Pain Relief. Second ed. Geneve: WHO; 1996.2. Hofmann B, Haheim LL, Soreide JA. Ethics of palliative surgery in patients with cancer. Br J Su

18、rg 2005;92:8029.3. Pothuri B, Guiguis A, Gerdes H, et al. The use of colorectal stents for palliation of large bowel obstruction due torecurrent gynecologic cancer. Gynecol Oncol 2004;95:5137.4.Fainsinger RL, Spachynski K, Hanson J, et al. Symptom control in terminally ill patients with malignant bo

19、wel obstruction. J Pain Symptom Manage 1994;9:128.5. Ventafridda V, Ripamonti C, Caraceni A, et al. The management of inoperable gastrointestinal obstruction in terminal cancer patients. Tumouri 1990;76:38993.6. Mercadante S. Pain in inoperable bowel obstruction. Pain Digest 1995;5:913.7. De Conno F

20、, Caraceni A, Zecca E, Spoldi E, Ventafridda V. Continuous subcutaneous infusion of hyoscine butylbromide reduces secretions in patients with gastrointestinal obstruction. J Pain Sympt Manage 1991;6:4846.Ventafridda V, Ripamonti C, Caraceni A, et al. The management of inoperable gastrointestinal obs

21、truction in terminal cancer patients. Tumouri 1990;76:38993.2. De Conno F, Caraceni A, Zecca E, Spoldi E, Ventafridda V. Continuous subcutaneous infusion of hyoscine butylbromide reduces secretions in patients with gastrointestinal obstruction. J Pain Sympt Manage 1991;6:4846.3. Ripamonti C, Mercada

22、nte S, Groff L, Zecca E, De Conno F, Casuccio A. Role of octreotide, scopolamine butylbromide and hydration in symptom control of patients with inoperable bowel obstruction having a nasogastric tube. A prospective, randomized clinical trial. J Pain Symptom Manage 2000;19:2334.4. Mercadante S, Ripamo

23、nti C, Casuccio A, Zecca E, Groff L. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Supportive Care in Cancer 2000;8:18891.1. Ripamonti C, Panzeri C, Groff L, Galeazzi G, Boffi R. The role of somatostatin and

24、 octreotide in bowel obstruction: pre-clinical and clinical results. Tumouri 2001;87:19.2. Anthone GJ, Bastidas JA, Orlandle MS, Yeo CJ. Direct proabsorptive effect of octreotide on ionic transport in the small intestine. Surgery 1990;108:113642.1. Ripamonti C, Mercadante S, Groff L, Zecca E, De Con

25、no F, Casuccio A. Role of octreotide, scopolamine butylbromide and hydration in symptom control of patients with inoperable bowel obstruction having a nasogastric tube. A prospective, randomized clinical trial. J Pain Symptom Manage 2000;19:2334.2. Mercadante S, Ripamonti C, Casuccio A, Zecca E, Gro

26、ff L. Comparison of octreotide and hyoscine butylbromide in controlling gastrointestinal symptoms due to malignant inoperable bowel obstruction. Supportive Care in Cancer 2000;8:18891.1. Mercadante S, Avola G, Maddaloni S, et al. Octreotide prevents the pathological alterations of bowel obstruction

27、in cancer patients. Support Care Cancer 1996;4:3934.Mercadante S, Kargar J, Nicolosi G. Octreotide may prevent definitive intestinal obstruction. J Pain Symptom Manage 1997;13:3525.3. Sun X, Li X, Li H. Management of intestinal obstruction in advanced ovarian cancer: an analysis of 57 cases in Chine

28、se. Zhonghua Zhong Liu Za Zhi 1995;17:3942.1. Cozzaglio L et al. Outcome of cancer patients receiving home parenteral nutrition. J Parenteral Enteral Nutrition 1997;21:33942.2. Hoda D, Jatoi A, Burnes J, Loprinzi C, Kelly D. Should patients with advanced, incurable cancers ever be sent home with Total parenteral nutrition? Cancer 2005;103:8638.1. Ripamonti C, Twycross R, Baines M, et al. Clinical-practice