摘要
恶性肿瘤患者发生的急腹症被称为癌性急腹症,多见于消化系统肿瘤或原发其他脏器的肿瘤发生腹盆腔转移,如出血、穿孔、消化道梗阻、胆管梗阻合并感染、急性腹膜炎等。癌性急腹症是急危重症,预防重于治疗。对于高危患者,即便在疾病确诊时尚未发生急腹症,也应防患于未然,积极对局部淋巴结或原发灶进行局部处理,慎重选择药物。癌性急腹症以外科干预为主,但如何在积极治疗急腹症的同时抓住抗肿瘤治疗的时机,需要多学科综合治疗团队(MDT),包括诊断团队、治疗团队和支持团队的共同管理。癌性急腹症的患者大多分期较晚,故长期处理晚期疾病的肿瘤内科医生在癌性急腹症的预防、干预和全程管理中的作用不容忽视。对于潜在可切除、但适宜新辅助治疗以及技术上不可切除的癌性急腹症患者,应首先争取药物治疗机会;对于放化疗过程中出现的梗阻、出血或穿孔,应根据放化疗效果有效的情况考虑病因,进而选择是否进行手术。一些辅助用药也可能导致并发癌性急腹症的风险增加。本文从肿瘤内科视角,探讨不同情况下发生的癌性急腹症,如何衡量利弊抉择治疗。
Acute abdomen in patients with malignant tumors is called malignant acute abdomen,often seen in the digestive system tumor or abdominal pelvic metastasis of the other primary tumors.Bleeding;perforation,gastrointestinal obstruction,biliary obstruction with infection,acute peritonitis are acute and severe,however,prevention is more important than treatment.For high-risk patients,even if acute abdomen does not occur when the disease is diagnosed,we should make precautions,including actively local treatment of local lymph nodes or primary lesions and careful choice of drugs. Malignant acute abdomen is mainly treated by surgical intervention.However,to seize the opportunity of anti-tumor treatment while actively treating acute abdomen requires multidisciplinary team (MDT),including co-management of diagnostic team,treatment team and support team.Most patients with malignant acute abdomen are in late stage,so the role of medical oncologists can not be ignored in the prevention,intervention and management of malignant acute abdomen.For patients with potentially resectable malignant acute abdomen who are suitable for neoadjuvant therapy and technically unresectable malignant acute abdomen,the opportunity for drug treatment should be sought first.For those presenting with obstruction,bleeding or perforation during radiotherapy or chemotherapy,we should carefully evaluate the response of previous antitumor treatment,the reason of acute abdomen and discuss the option of surgery.Some concomitant medications may also increase the risk of malignant acute abdomen.Here,we discuss the role of medical oncologists in the management of malignant acute abdomen in the MDT setting.
作者
刘怡璘
张小田
Liu Yilin;Zhang X iaotian(Department of Gastrointestinal Oncology,Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education),Peking University Cancer Hospital and Institute,Bering 100142,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第11期1201-1205,共5页
Chinese Journal of Gastrointestinal Surgery
基金
首都特色临床应用基金(Z161100000516064).
关键词
癌性急腹症
多学科团队
肿瘤内科
Malignant acute abdomen
Multidisciplinary team
Medical oncology
作者简介
刘怡璘,女,1992年11月出生,在读硕士生,Email18811380292@163.com;通信作者:张小田,女,1975年6月出生,医学博士主任医师,教授,硕士生导师,Email:zhangxiaotianmed@163.com
