惡性腸阻塞的緩和醫療

Palliative Care for Malignant Bowel Obstruction

黃麗霞(Li-Hsia Huang) ； 許煌汶(Huang-Wen Hsu)

《安寧療護雜誌》 15卷2期 (2010/07) Pp. 219-228

https://doi.org/10.6537/TJHPC.2010.15(2).7

摘要

惡性腸阻塞是緩和醫療常遭遇的問題，它是腹腔或骨盆腔癌末病人常見的併發症，其發生率在卵巢癌約爲5%-51%，大腸直腸癌約爲10%-28%，其餘的癌症約爲3%-15%。惡性腸阻塞常見的症狀有腹痛、腹脹、噁心、嘔吐與便秘。惡性腸阻塞的診斷可從病人的病史、理學檢查與影像學檢查來確立。目前是有很多治療選項可利用的，唯其選擇是取決於腸阻塞位置與程度、治療的目標、病人的狀況與預期生命以及病人的期望。在做治療決策時，是需要病人與家屬共同參與的。由多科專業的醫療團隊人員與病人及家屬詳細討論後，提供適合病人的處置計畫。 本文就惡性腸阻塞的病理生理機轉、臨床診斷以及處置略做討論，以供臨床人員的實務參考。

關鍵字

惡性腸阻塞 ； 卵巢癌 ； 大腸直腸癌 ； 決策

並列摘要

Malignant bowel obstruction (MBO) is a common palliative care problem particularly in patients with abdominal or pelvic cancer, with an estimated 3%-15% of all terminally-ill cancer patients suffering from bowel obstruction. In advanced abdominal and gynecological malignancy, 5%-51% of patients with ovarian cancer and 10%-28% of patients with colorectal cancer will suffer from MBO. Common principal MBO symptoms are abdominal pain, abdominal fullness, nausea, vomiting and constipation. The diagnosis of MBO is established on clinical evidence of a bowel obstruction via history, physical and radiographic examination. A number of treatment options are now available for patients with MBO, different options may be chosen depending on the site and extent of bowel obstruction, the goals of treatment, patient's conditions, life expectancy and patient's expectations. Involvement of patients and family members in the treatment decision-making is necessary, and a multidisciplinary team approach as well as detailed discussion between physicians, patients and family members can usually provide an individualized and appropriate management plan.

並列關鍵字

malignant bowel obstruction ； ovarian cancer ； colorectal cancer ； decision-making