癌性急腹症多学科团队综合处理——基于肿瘤放疗科的思考  

Role of oncologic radiotherapy in multidisciplinary team treatment of malignant acute abdomen

作　　者：戴宇翃[1] 孙黎[1] 邱红[1] Dai Yuhong;Sun Li;Qiu Hong(Tongji Hospital Cancer Center,Tongji Medical College Affiliated,Huazhong University of Science &Technology,Wuhan430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院肿瘤中心消化系统肿瘤科,武汉430030

出　　处：《中华胃肠外科杂志》2018年第11期1212-1217,共6页Chinese Journal of Gastrointestinal Surgery

摘　　要：癌性急腹症起病急、进展快、病因复杂、治疗困难、病死率高,需要多学科诊疗模式的参与。较单一学科诊疗模式,多学科综合团队(MDT)讨论可以使诊断更加准确,MDT会议能促进不同学科专家更好地进行沟通.选择最为合理的诊疗方案,提高诊疗的效率及质量。良好的MDT可以涵盖疾病诊断、评估和治疗的各个阶段,并给予良好衔接。本文将从肿瘤放疗科角度,探讨放射相关癌性急腹症的发生以及放疗在癌性急腹症治疗中的地位。常见放疗相关的胃肠恶性肿瘤急腹症包括出血、消化道梗阻和穿孔等。对于无法进行手术、内镜止血或栓塞治疗的胃癌急性出血患者,可考虑使用姑息性放疗作为癌性出血的止血治疗;姑息性大分割放疗可缓解胃癌所致梗阻症状。在急性下消化道出血的患者中.采用放射治疗作为止血手段的研究较少;对于发生肠梗阻的患者.在无法手术的情况下可考虑行姑息性放疗。癌性急腹症病因复杂、起病急、进展快、合并症多,应充分发挥MDT的作用,对于症状相对较轻、发展相对较为缓慢的患者,可谨慎选择放疗作为治疗手段,必要时急诊给予手术、介入等治疗.切不可盲目等待观察,延误治疗时机。Malignant acute abdomen is a emergency with abrupt onset,rapid progress and often a complex etiology,presenting difficulties for treatment and high mortality. Therefore,multidisciplinary team (MDT)treatment modality is required.Compared with single-discipline diagnosis and treatment modality,diagnosis made from MDT discussion is more accurate,where specialists can improve efficiency and quality of the treatment through better communication.A good MDT can cover all stages from the diagnosis to the assessment and treatment of the disease,and combine them into a more coherent process.This article discusses the development of radiotherapy-related malignant acute abdomen and the role of radiotherapy in the treatment of malignant acute abdomen from the perspective of oncologic radiotherapy.Common causes of radiotherapy-related acute abdomen from gastric cancer include gastric hemorrhage,upper gastrointestinal obstruction and gastric perforation,while those of radiotherapy-related acute abdomen from colorectal cancer include lower gastrointestinal hemorrhage, intestinal obstruction,intestinal perforation and intestinal fistula. For patients with acute bleeding from gastric cancer that can not be treated by surgery,endoscopic hemostasis or embolization, palliative radiotherapy should be considered.Palliative hypofractionated radiotherapy has the advantage of reducing tumor burden in addition to relieving symptoms of gastric cancer.In patients with acute lower gastrointestinal hemorrhage, as relatively few studies have been established,short course of hypofractionated radiotherapy can be selectively applied.For patients with obstruction,palliative radiotherapy may be considered when surgical assessment is not feasible or tolerable.As malignant acute abdomen has rapid onset and progress,complex etiology and high rate of comorbidity MDT should be fully carried out.For patients with mild symptoms and slow development,radiotherapy can be applied with caution.Emergency treatment such as surgery and intervention should be given

关 键 词：癌性急腹症 多学科团队 放射治疗 

分 类 号：R730.55[医药卫生—肿瘤]