Octreotide治療惡性腸阻塞的初步經驗

Palliative Treatment of Malignant Bowel Obstruction in Hospice Patients, Using Octreotide

許煌汶(Huang-Wen Hsu)

《安寧療護雜誌》 8卷2期 (2003/05) Pp. 175-184

https://doi.org/10.6537/TJHPC.2003.8(2).5

摘要

安寧病房惡性腸阻塞的問題，常發生於腸胃腫瘤或骨盆腔腫瘤的末期病人。主要臨床症狀有噁心、嘔吐、腹痛，治療方面包括傳統內科療法與外科手術。對於不能開刀的惡性腸阻塞的安寧病人而言，當傳統內科療法無法有效緩解症狀時，尋求另外有效的緩和治療是目前安寧療護的重要課題。近年來天然體抑素的衍生物octreotide，用來治療不能開刀的惡性腸阻塞的病人，在國外臨床報告的效果不錯。本文報告5例不能開刀的惡性腸阻塞的安寧病人，於傳統治療效果不佳後，使用octreotide0.3-0.4mg/day治療3-5天，結果有三位症狀完全緩解，有兩位症狀部分緩解。5位病人到過世時，腸阻塞的症狀都得到不錯控制。Octreotide已成為治療惡性腸阻塞的另一有效選擇藥物，希望將來健保局能選擇性開放給付，以嘉惠有需要的安寧病人。

關鍵字

惡性腸阻塞 ； 體抑素衍生物 ； 緩和醫療

並列摘要

The problem of malignant bowel obstruction in hospice ward usually occurred in the gastrointestinal or pelvic cancer patients. The major clinical symptoms are nausea, vomiting, continuous and/or colicky pain. Clinical management includes conventional medical treatment and surgery. When conventional medical treatment is ineffective in relieving the symptoms of inoperable malignant bowel-obstructed patients, it is important for hospice palliative care to find another effective treatment. Octreotide, a somatostatin analogue, has been used in the treatment of inoperable malignant bowel obstruction recently, and has been demonstrated good symptoms control in foreign literatures. We present 5 hospice patients with inoperable malignant bowel obstruction who had poor response to conventional treatment. Octreotide was administered at the dose of 0.3-0.4mg/day for 3 to 5 days, 3 patients had complete relief of their symptoms and the other 2 patients had partial response. All patients died with good symptoms control. Octreotide has become a useful drug in the palliative treatment of malignant bowel obstruction.

並列關鍵字

malignant bowel obstruction ； octreotide ； palliative care