乙状结肠癌并发恶性肠梗阻处理的临床决策讨论  

Clinical decision making in the management of sigmoid carcinoma complicated by malignant obstruction

作　　者：刘华[1] 张小田[1] Hua Liu;Xiaotian Zhang(Department of Gastrointestinal Oncology,Peking University Cancer Hospital&Institute,Key Laboratory of Carcinogenesis and Transla-tional Research(Ministry of Education),Beijing 100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所消化肿瘤内科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京市100142

出　　处：《中国肿瘤临床》2022年第9期467-473,共7页Chinese Journal of Clinical Oncology

摘　　要：目的:乙状结肠癌并发恶性肠梗阻是结肠癌治疗过程中一个潜在且棘手的临床问题,本文旨在探索乙状结肠癌恶性肠梗阻综合治疗的策略和经验。方法:回顾和报告北京大学肿瘤医院1例乙状结肠癌并发恶性肠梗阻的综合治疗过程。结果:晚期转移性乙状结肠癌合并肠梗阻时以支持治疗为主,支持手段有肠梗阻导管置入或肠道支架置入,通过合理的支持治疗缓解急性肠梗阻,提供更安全的手术时机及抗肿瘤综合治疗的机会。营养支持治疗是恶性肠梗阻及抗肿瘤治疗贯穿全程的关键部分,是患者治疗获益的基础保障。结论:肿瘤原发灶导致的恶性肠梗阻可通过肠梗阻导管、肠道支架缓解肠梗阻及完善肠道准备,后择期行手术切除解决梗阻因素。肠道支架的置入在恶性结肠癌肠梗阻中推荐,但需把握适应证及医疗条件以恰当选择。Objective:Sigmoid carcinoma complicated with malignant obstruction is a potential and intractable clinical problem encountered during the treatment of colon cancer.This study aimed to explore clinical treatment strategies and experiences involving the management of malignant obstruction as a result of sigmoid colon carcinoma.Methods:We reviewed a case of sigmoid colon carcinoma with malignant obstruction in Peking University Cancer Hospital and reported the treatment strategies implemented.Results:Patients with advanced metastatic sigmoid colon carcinoma and resultant obstruction were mainly administered by supportive treatment,which included intestinal obstruction decompression using a tube or stent.Relief of acute obstruction using appropriate supportive therapies provides safer opportunities for both surgery and comprehensive antitumor therapy.Nutritional support is essential throughout the course of obstruction treatment and is a key component of successful antitumor therapy.Conclusions:Malignant obstructions caused by primary gastrointestinal tumors may be alleviated via intestinal obstruction decompression using tubes or stents.This allows for improved bowel preparation prior to surgical resection of the primary obstructive tumor.Intestinal stenting is recommended for the decompression of obstructive malignant colon cancers,although contraindications and medical comorbidities should be considered to ensure that the appropriate treatment modality is selected.

关 键 词：乙状结肠癌 恶性肠梗阻 小肠减压管 肠道支架 姑息手术 

分 类 号：R735.35[医药卫生—肿瘤]