Brazilian Society of Surgical Oncology guidelines for malignant bowel obstruction management 巴西外科肿瘤学会对恶性肠梗阻管理的指南
Renato Morato Zanatto MD, ScM | Claudia Naylor Lisboa MD, ScM Junea Caris de Oliveira MD, ScM, PhD - | Teresa Cristina da Silva dos Reis MD, ScM (0)Audrey Cabral Ferreira de Oliveira MD | | Manoel J. P. Coelho Jr. MD, ScM | 奥德里·卡布拉尔·费雷拉·德·奥利维拉医学博士 | | 曼努埃尔·J·P·科埃略医学博士，科学硕士 |Bruno de Ávila Vidigal MD - | Heber Salvador de Castro Ribeiro MD, ScM, PhD ( | 布鲁诺·德·阿维拉·维迪加尔医学博士 - | 海伯·萨尔瓦多·德·卡斯特罗·里贝罗医学博士，科学硕士，博士 （|Reitan Ribeiro MD | Paulo Henrique de Sousa Fernandes MD, ScM | Reitan Ribeiro MD | 保罗·亨利克·德·索萨·费尔南德斯医学博士，科学硕士 |Alexcia Camila Braun ScM (-) | Rodrigo N. Pinheiro MD, ScM (1)Alexandre F. Oliveira MD, ScM, PhD | Gustavo A. Laporte MD, ScM, PhD Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Jaú, SP, Brazil 巴西圣保罗州亚乌市阿马拉尔·卡瓦略癌症医院外科肿瘤科 Instituto Nacional de Cancer José Alencar Gomes da Silva-INCA, Rio de Janeiro, RJ, Brazil 巴西里约热内卢州立何塞·阿伦卡尔·戈麦斯·达席尔瓦国家癌症研究所-INCA Department of Clinical Oncology, Clínica de Oncologia/Grupo CAM-CLION, Salvador, Bahia, Brazil 巴西巴伊亚州萨尔瓦多市临床肿瘤学科，肿瘤诊所/CAM-CLION 集团 部门 Departament of Surgical Oncology, Hospital Santo Alberto, Manaus, Amazonas, Brazil 巴西亚马逊州马瑙斯市圣阿尔贝托医院外科肿瘤科 Clínica Linharense de Oncologia-CLIONCO, Linhares, ES, Brazil 巴西埃斯皮里托桑托州林哈雷斯肿瘤诊所-CLIONCO Department of Surgical Oncology, A.C.CamargoCancer, CenterSão Paulo, SP, Brazil 巴西圣保罗州圣保罗市 A.C.Camargo 癌症中心外科肿瘤科 Department of Surgical Oncology, Erasto Gaertner Hospital, Curitiba, Brazil 巴西库里蒂巴埃拉斯托·盖特纳医院外科肿瘤科部门 Universidade Federal de Uberlândia-UFU, Uberlândia, Brazil 乌贝兰迪亚联邦大学-UFU，巴西乌贝兰迪亚 Surgical Oncology Service, Federal District Base Hospital, Brasilia, DF, Brazil 巴西联邦区基地医院外科肿瘤服务 Department of Surgical Oncology, Juiz de Fora Federal University, Juiz de Fora, Minas Gerais, Brazil 巴西米纳斯吉拉斯州茹伊斯迪福拉联邦大学外科肿瘤科 部门 Department of Surgical Oncology, Santa Casa de Porto Alegre/Santa Rita Hospital/Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil 巴西波尔图阿雷格里圣卡萨医院/圣里塔医院/波尔图阿雷格里联邦健康科学大学外科肿瘤科
Correspondene 对应
Renato Morato Zanatto, MD, ScM, Department of Surgical Oncology, Amaral Carvalho Cancer Hospital, Rua Marcel Maziteli Trindade, 291, Jardim Bela Vista, 17.206-400, Jaú, SP, Brazil. Email: renato.zanatto@gmail.com Renato Morato Zanatto, MD, ScM, 手术肿瘤科，阿马拉尔·卡瓦略癌症医院，Rua Marcel Maziteli Trindade，291 号，Jardim Bela Vista，17.206-400，Jaú，SP，巴西。 电子邮件：renato.zanatto@gmail.com
Abstract 摘要
Background: Malignant bowel obstruction (MBO) is a frequent complication in advanced cancer patients and especially those with abdominal tumors. The clinical management of MBO requires a specific and individualized approach based on the disease prognosis. Surgery is recommended. Less invasive approaches such as endoscopic treatments should be considered when surgery is contraindicated. The priority of care for inoperable and consolidated MBO is to control the symptoms and promote the maximum level of comfort. 背景：恶性肠梗阻（MBO）是晚期癌症患者中经常发生的并且尤其是腹部肿瘤患者中常见的并发症。MBO 的临床管理需要基于疾病预后的特定和个性化方法。手术是推荐的治疗方法。当手术有禁忌症时，应考虑较少侵入性的治疗方法，如内窥镜治疗。对于不可手术和已固定的 MBO，护理的优先级是控制症状并促进最大程度的舒适。
Objectives: This study aimed to develop recommendations for the effective management of MBO. 目标：本研究旨在制定有效管理 MBO 的建议。
Methods: A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology, of whom 41 surgeons participated in the survey. A literature review of studies retrieved from the National Library of Medicine database was conducted on particular topics chosen by the participants. These topics addressed questions regarding the MBO management, to define the level of evidence and 方法：向巴西外科肿瘤学会的所有成员发放了一份问卷，其中 41 名外科医生参与了调查。从国家医学图书馆数据库检索的研究文献进行了文献回顾，涉及由参与者选择的特定主题。这些主题涉及有关 MBO 管理的问题，以确定证据水平和。
巴西外科肿瘤学会恶性肠梗阻治疗指南
Renato Morato Zanatto MD, ScM | Claudia Naylor Lisboa MD, ScM | Junea Caris de Oliveira 医学博士、理科硕士、哲学博士| Teresa Cristina da Silva dos Reis 医学博士、理科硕士 | Audrey Cabral Ferreira de Oliveira MD | Manoel JP Coelho Jr. 医学博士、理学硕士 | Bruno de Ávila Vidigal 医学博士 | Heber Salvador de Castro Ribeiro 医学博士、理科硕士、哲学博士| Reitan Ribeiro 医学博士 | Paulo Henrique de Sousa Fernandes MD, ScM | Alexcia Camila Braun ScM | Rodrigo N. Pinheiro 医学博士、理科硕士 | Alexandre F. Oliveira 医学博士、理科硕士、哲学博士| Gustavo A. Laporte 医学博士@理科硕士、哲学博士
strength of each recommendation, and an adapted version of the Infectious Diseases Society of America Health Service rating system was used. 每个建议的强度，使用了美国传染病学会卫生服务评级系统的改编版本。
Results: Most aspects of the medical approach and management strategies reviewed were strongly recommended by the participants. 结果：参与者强烈推荐审查的医疗方法和管理策略的大多数方面。
Conclusions: Guidelines outlining the strategies for management MBO were developed based on the strongest evidence available in the literature. 结论：根据文献中最有力的证据，制定了管理 MBO 策略的指导方针。
KEYWORDS 关键词
abdominal neoplasms, malignant bowel obstruction, practice guideline, treatment 腹部肿瘤，恶性肠梗阻，实践指南，治疗
1 | INTRODUCTION 1 | 介绍
Malignant bowel obstruction (MBO) associated with advanced-stage cancers is a medical complication frequently occurring in patients with gastrointestinal and gynecological tumors. Hence, it remains a challenge for surgeons to decide whether to perform palliative surgery or provide exclusive conservative medical comfort measures as end-of-life care. Recognizing MBO requires clinical evidence with a medical history of cancer often of gynecological or gastrointestinal origin, physical examination, and imaging examinations (computerized tomography or magnetic resonance imaging [MRI]) showing the presence of an intraperitoneal malignant disease. Despite the fact that most of the diagnosed primary tumors are of gynecological and gastrointestinal origin, extra-abdominal malignancies are also involved with MBO as part of the potential medical complications. 恶性肠梗阻（MBO）与晚期癌症相关，是胃肠道和妇科肿瘤患者中经常发生的医学并发症。因此，对外科医生来说，决定是进行姑息手术还是提供独家保守的医疗舒适措施作为临终关怀仍然是一个挑战。识别 MBO 需要临床证据，通常是妇科或胃肠道起源的癌症病史，体格检查和影像检查（计算机断层扫描或磁共振成像[MRI]）显示腹腔内恶性疾病的存在。尽管大多数诊断的原发肿瘤是妇科和胃肠道起源的，但额外的腹外恶性肿瘤也可能与 MBO 相关，作为潜在的医学并发症之一。
The primary cancers commonly associated with MBO are colorectal cancer , ovarian cancer , and stomach cancer ( . The syndrome can present with multiple or single points of obstruction and may be due to other underlying causes and mechanisms. The obstruction can be partial or complete. Depending on the degree of lumen occlusion, patients with an MBO will present with pain due to abdominal distension, cramps, nausea and vomiting, cessation of gas and feces elimination, and progressive inability to eat. 与 MBO 常见相关的原发性癌症包括结肠癌 ，卵巢癌 和胃癌 。这种综合症可以表现为多个或单个梗阻点，可能是由于其他潜在原因和机制引起的。梗阻可以是部分或完全的。根据腔内阻塞的程度，患有 MBO 的患者会出现因腹部胀气、痉挛、恶心和呕吐、气体和粪便排泄停止以及逐渐无法进食而引起的疼痛 。
This high load of symptoms compromises the patient's quality of life. It is associated with a dismal prognosis and a short life expectation of a few weeks to months, making the diagnosis of MBO a preterminal event and causing a devastating impact on the lives of affected patients and their families. The nature and aggressiveness of the symptoms are due to the obstruction of the intestinal lumen, impaired peristalsis, and altered motility due to tumor growth. The retention of fluids and gases causes an increase in endoluminal pressure, production of 5 -hydroxytryptamine by intestinal enterochromaffin cells, activation of the interneuronal system, and release of nociceptive mediators leading to splanchnic vasodilation and cell hypersecretion. This series of events causes the appearance of intense intestinal edema, increase in retained secretions, distension, and abdominal pain, a condition that must be differentiated from those unrelated to tumor growth such as bridles, actinic adhesions, constipation, and opioid colon. 这种症状的高负荷影响了患者的生活质量。它与糟糕的预后和数周到数月的短寿命预期相关，使 MBO 的诊断成为临终事件，并对受影响患者及其家人的生活造成毁灭性影响。症状的性质和侵袭性是由于肠腔阻塞、蠕动受损和肿瘤生长导致的运动异常。液体和气体的滞留导致内腔压力增加，肠内分泌细胞产生 5-羟色胺，激活间神经系统，释放痛觉介质导致腹腔血管扩张和细胞分泌增加。这一系列事件导致强烈的肠道水肿、保留分泌物增加、腹胀和腹痛的出现，这种情况必须与与肿瘤生长无关的情况区分开，如肠系带、光化粘连、便秘和阿片类结肠。
In view of the suspicion of MBO, the literature recommends the performance of imaging tests. Computed tomography (CT) is considered the gold standard for diagnosis, being useful not only in identifying the level and degree of obstruction but also in determining the associated pathological processes, playing a fundamental role in defining the appropriate surgical and invasive approaches. CT has a lower predictive value in identifying the glow rates of peritoneal carcinomatosis and does not clearly differentiate MBO from nonmalignant adhesions. Despite its low accuracy, plain abdominal radiography is also useful in assessing constipation and its severity as a potential cause of symptoms and remains an important initial imaging study in almost all patients with suspected bowel obstruction, considering its low cost and accessibility. 鉴于 MBO 的怀疑，文献建议进行影像检查。计算机断层扫描（CT）被认为是诊断的金标准，不仅有助于确定梗阻的程度和级别，还有助于确定相关的病理过程，对于定义适当的外科手术和侵入性方法起着基础性作用。CT 在识别腹膜癌转移的发光速率方面具有较低的预测价值，并且不能清楚地区分 MBO 和非恶性粘连。尽管其准确性较低，普通腹部 X 线摄影在评估便秘及其严重程度作为症状潜在原因方面也很有用，并且在几乎所有疑似肠梗阻患者中仍然是一项重要的初始影像研究，考虑到其低成本和易获得性。
Conservative measures include bowel rest and drug therapy. Anticholinergic drugs, antisecretory drugs such as somatostatin analogs, neuroleptics, glucocorticoids, and opioids are the essential drugs that inhibit inflammation and decrease intraluminal secretion volume, prevent painful peristaltic movements, and promote gastric emptying, reducing pain and cramps, nausea, and vomiting in up to of the cases. 保守措施包括肠道休息和药物疗法。抗胆碱药物、抗分泌药物如生长抑素类似物、神经阻滞药、糖皮质激素和阿片类药物是抑制炎症、减少肠腔分泌量、预防疼痛性蠕动、促进胃排空的必需药物，可在 的病例中减轻疼痛和痉挛、恶心和呕吐。
After more than 30 years of octreotide use, some controversial issues remain, and further research is recommended to clarify the time of use and effectiveness related not only to the number of days free from vomiting as an endpoint but also to discuss the reduction in the daily frequency of vomiting as a relevant clinical parameter, considering the high cost of the drug. 使用奥曲肽 30 多年后，仍存在一些有争议的问题，建议进一步研究以澄清使用时间和有效性，不仅与无呕吐天数作为终点相关，还要讨论减少每日呕吐频率作为相关临床参数，考虑到药物的高成本。
However, when consensus and guidance regarding the definition of a care plan for these patients were sought, which includes the appropriate surgical approach and clinical management of symptoms, clinical issues related to their medical management were observed owing to the lack of robust evidence required to establish the ideal treatment for MBO. The Palliative Care Status of MBO demands the development of an individualized individualization and personalized approach focused on the patients' desires, as well as the expectations of the patients and their family members. Surgical intervention plays a fundamental role in the correction of serious situations such as peritonitis, perforation, or signs of ischemia. Complete or persistent obstructions during the period of conservative treatment are also an indication of surgery. Techniques involving segmental resection of 然而，当寻求关于为这些患者制定护理计划的定义的共识和指导时，包括适当的手术方法和症状的临床管理，由于缺乏建立 MBO 理想治疗所需的有力证据，观察到与其医疗管理相关的临床问题。 MBO 的姑息护理状态要求制定一个以患者愿望为重点的个性化和个性化方法，以及患者及其家人的期望。手术干预在纠正严重情况（如腹膜炎、穿孔或缺血征象）中发挥着基础作用。在保守治疗期间出现完全或持续性梗阻也是手术的指征。涉及分段切除的技术
每项建议的强度，以及传染病的改编版本
手术指征。涉及分段切除的技术
loops, intestinal bypass, ostomy, and drainage are recommended strategies. However, most patients are considered inoperable ; in all contexts, the surgical approach is associated with high morbidity ( ) and mortality ( ), prolonged hospitalization, and risk of early reobstruction ( ). 循环、肠道旁路、造口和引流是推荐的策略。然而，大多数患者被认为不适合手术；在所有情况下，手术方法与高发病率（ ）和死亡率（ ）、长期住院以及早期再阻塞的风险相关。
Several studies have been conducted to identify the prognostic factors, performance status (PS), ascites , carcinomatosis, multiple points of obstruction, and palpable abdominal mass, to help select patients who can safely undergo surgical or invasive approaches, with better-defined risks and benefits. 8 , 15,16 已进行了多项研究以确定预后因素、表现状态（PS）、腹水、癌症转移、多个梗阻点和可触及的腹部肿块，以帮助选择可以安全接受手术或侵入性方法的患者，风险和收益更明确。8，15，16
The decision to use an open surgical approach involves the proper selection of these patients and determination of whether MBO is a manifestation of terminal disease or an initial event, with the patient in good clinical condition to tolerate the stressful effects of surgery and its risks already described. However, questions related to nasogastric decompression, laparoscopy, debulking procedures, and the use of parenteral nutrition still persist. The effectiveness of a palliative intervention must be evaluated based on the success in controlling the symptoms and complete resolution of symptoms recognized by the patient. If accompanied by a general improvement in quality of life, limited morbidity and mortality, and rational use of resources, the approach has enormous added value. 决定采用开放手术方法涉及正确选择这些患者，并确定 MBO 是否是晚期疾病的表现或初次事件，患者身体状况良好，能够承受手术的应激效应和已描述的风险。然而，与鼻胃减压、腹腔镜检查、减压手术和使用肠外营养液相关的问题仍然存在。必须根据成功控制症状和患者认可的症状完全消失来评估姑息干预的有效性。如果伴随着生活质量的普遍改善、有限的发病率和死亡率以及资源的合理利用，这种方法具有巨大的附加价值。
In recent years, the development of more effective techniques for symptomatic treatment, such as stents and decompression endoscopic or radiological procedures, in particular gastrostomy, has improved the quality of care for these patients, whenever conventional surgery cannot be indicated, thus decreasing the complication and mortality rates and increasing the success rates in controlling the symptoms, particularly nausea and vomiting, in more her than of the patients with high-level obstruction and of those with low-level obstructions. 近年来，针对症状性治疗的更有效技术的发展，如支架和减压内窥镜或放射学程序，特别是胃造瘘术，已经改善了这些患者的护理质量，每当常规手术不适用时，从而降低并发症和死亡率，并提高了控制症状的成功率，特别是恶心和呕吐，在高位梗阻患者中的超过 和低位梗阻患者中的 。
The decision regarding the treatment of any surgical condition is usually carried out based on the existing principles, well-described surgical procedures, and robust evidence in the literature. When dealing handling MBO cases, there are still shadow areas that must be clarified. 有关任何外科疾病治疗的决定通常是基于现有原则、详细描述的外科手术程序和文献中的充分证据进行的。在处理 MBO 病例时，仍然存在必须澄清的模糊领域。
Since only a few trials related to the surgical palliative care for MBO have been conducted this questionnaire seeks to bring together the best available scientific evidence and the current state-of-the-art approaches aimed at treating this condition, comparing them with the practices and assessment results of 41 cancer surgeons, to generate data that can build a robust body of knowledge, improve the diagnostic approach, and define the best clinical and surgical management strategy for each patient. 由于与 MBO 相关的手术姑息治疗试验很少，本问卷旨在汇集最佳的科学证据和当前最先进的治疗方法，旨在治疗这种疾病，将其与 41 名癌症外科医生的实践和评估结果进行比较，生成可以建立强大知识体系的数据，改善诊断方法，并为每位患者制定最佳的临床和手术管理策略。
2 | MATERIALS AND METHODS 2 | 材料和方法
This study was carried out between June 10, 2021, and October 29, 2021. A questionnaire was administered to all members of the Brazilian Society of Surgical Oncology (BSSO). Of them, of whom only 41 surgeons participated in the study. In total, 11 clinically relevant questions about the management of MBO were divided into the following main topics: imaging method, surgical indications, use of the nasogastric tube, symptomatic medications, total parenteral nutrition (TPN), chemotherapy, decompression gastrostomy, stents, derived procedures, pressurized intraperitoneal aerosol chemotherapy (PIPAC) and hyperthermic intraperitoneal chemotherapy (HIPEC). A working group was created to review the literature available in the National Library of Medicine database and draft recommendations for each of the assigned questions. Initial recommendations were reviewed by 13 BSSO medical coordinators. An adapted version of the Infectious Diseases Society of America Health Service rating system was used to define the level of evidence and strength of each recommendation proposed by the working group (Table 1). Finally, through the Survey Monkey website, voting was carried out to determine the level of agreement among the members of the expert panel for each of the recommendations. To establish a consensus, at least of the panel members had to agree with the answer; failure to achieve this percentage resulted in another round of voting at the end of the survey. Ultimately, a recommendation was suggested as approved by the majority. 这项研究是在 2021 年 6 月 10 日至 2021 年 10 月 29 日期间进行的。一份问卷调查被分发给所有巴西外科肿瘤学会（BSSO）的成员。其中，只有 41 名外科医生参与了这项研究。总共有 11 个与 MBO 管理相关的临床问题，分为以下主要主题：影像方法、手术适应症、鼻胃管的使用、症状性药物、全静脉营养（TPN）、化疗、减压胃造瘘术、支架、衍生手术、压力腹腔内喷雾化化疗（PIPAC）和热热腹腔内化疗（HIPEC）。成立了一个工作小组，审查了美国国家医学图书馆数据库中可用的文献，并为分配的每个问题起草了建议。初始建议由 13 名 BSSO 医学协调员审查。采用美国传染病学会卫生服务评级系统的改编版本来定义工作小组提出的每个建议的证据水平和强度（表 1）。 最终，通过 Survey Monkey 网站进行投票，以确定专家组成员对每项建议的一致程度。为建立共识，至少 名专家组成员必须同意答案；未能达到此百分比将导致在调查结束时进行另一轮投票。最终，建议被提议为获得多数人批准。
3 | RESULTS AND DISCUSSION 3 | 结果和讨论
3.1 | PIPAC
MBO is a contraindication of PIPAC as well as those with a life expectancy of less than 3 months, who received exclusive TPN, with decompensated ascites, who underwent simultaneous tumor debulking with gastrointestinal resection, who developed anaphylactic reaction before chemotherapy in addition or as a relative contraindication to extraperitoneal metastasis, with an Eastern Cooperative Oncology Group (ECOG) PS score of , and with portal vein thrombosis. MBO 是 PIPAC 的禁忌症，以及那些预期寿命不足 3 个月、接受独家 TPN、伴有失代偿性腹水、同时进行肿瘤减灭伴有胃肠切除手术、在化疗前发生过过敏反应或作为相对禁忌症的外腹膜转移、具有东部合作肿瘤学小组（ECOG）PS 评分为 ，以及具有门静脉血栓的患者。
Recommendation: PIPAC is contraindicated in the treatment of MBO treatment. 建议：PIPAC 在 MBO 治疗中是禁忌的。
Evidence level: IV; Recommendation degree: C. 证据等级：IV；推荐程度：C。
The context of MBO makes complete surgical debulking extremely unlikely. However, in an isolated focus of carcinomatosis and if it is possible to resect the affected area to achieve a CCO or CC1 cytoreduction (in specific histological types and responses to adjuvant cancer therapies), the addition of HIPEC can be considered for selected patients after multidisciplinary discussion in centers with experience in performing the technique. MBO 的背景使得完全手术切除极不可能。然而，在癌病灶的孤立焦点中，如果可能切除受影响区域以达到 CCO 或 CC1 细胞减少（在特定组织学类型和对辅助癌症治疗的反应中），在具有执行该技术经验的中心进行多学科讨论后，可以考虑为选择患者添加 HIPEC。
Recommendation: Cytoreductive surgery plus HIPEC can be considered for selected patients after multidisciplinary discussion in centers with experience in performing the technique 建议：在有经验进行该技术的中心进行多学科讨论后，可以考虑为选择患者进行细胞减灭手术加 HIPEC
Evidence level: IV; Recommendation degree: C. 证据级别：IV；推荐程度：C。
建议进行回肠旁路、造口术和引流
TABLE 1 Levels of evidence and grades of recommendation 表 1 证据水平和推荐等级
Levels of evidence 证据水平
I
II
III
Grade of recommendation 推荐等级
A
B
C
D
E
Evidence from at least one large randomized controlled trial with of good methodological quality (low 至少有一项具有良好方法学质量的大型随机对照试验的证据
potential bias) or meta-analyses of well-conducted randomized trials without heterogeneity 潜在偏见）或对进行良好随机试验的元分析进行分析，而无异质性
Small randomized trials or large randomized trials with suspected bias (poor methodological quality), 小规模随机试验或存在疑似偏倚（方法质量差）的大规模随机试验
meta-analyses of these trials, or trials that demonstrated sample heterogeneity 这些试验的荟萃分析，或者展示样本异质性的试验
Prospective cohort studies 前瞻性队列研究
Retrospective cohort or case-control studies 回顾性队列或病例对照研究
Studies without control groups, case reports, and expert advice 研究缺乏对照组、病例报告和专家建议
A
Strong evidence of efficacy with substantial clinical benefit: strongly recommended 强有力的证据表明具有实质性的临床益处：强烈推荐
Strong or moderate evidence of efficacy, but with limited clinical benefit: usually recommended 强或中等疗效的证据，但临床益处有限：通常建议
Insufficient proof of efficacy or benefit does not outweigh risk or disadvantages (i.e., adverse events, costs, other factors): recommended in some cases 疗效或益处不足的证据不足以抵消风险或不利因素（即不良事件、成本、其他因素）：在某些情况下推荐。
Moderate evidence of ineffectiveness or occurrence of adverse outcomes: rarely recommended 中等证据表明无效或出现不良结果的情况很少推荐
Strong evidence of ineffectiveness or occurrence of adverse outcomes: never recommended 强有力的证据表明无效或出现不良结果：绝不推荐
3.3 | Complementary examinations in the diagnosis 3.3 | 诊断中的补充检查
Abdominal radiography should be performed as an initial screening in patients with suspected MBO. Abdominal CT plays a key role in the diagnosis of MBO. It can determine the level of obstruction by defining whether the obstruction is high or low or total or partial, and may detect the presence of ischemia, necrosis, or perforation. Still, the evaluation of the disease along with the detection of ascites and multiple metastases in distant organs contributes to the determination of the prognosis and selection of treatment. MRI is more timeconsuming, more expensive, and more variable in terms of image quality compared with CT. In the evaluation of more acutely manifesting MBO, CT is preferred as it detects perforation more accurately and quickly compared with MRI. 腹部 X 线检查应作为疑似 MBO 患者的初步筛查。腹部 CT 在 MBO 的诊断中起着关键作用。它可以通过确定梗阻的高低或全面或部分来确定梗阻的级别，并可能检测出缺血、坏死或穿孔的存在。然而，对疾病的评估以及在远端器官中检测腹水和多发性转移有助于确定预后和选择治疗。与 CT 相比，MRI 在图像质量方面更耗时、更昂贵且更不稳定。在对更急性表现的 MBO 进行评估时，CT 更受青睐，因为与 MRI 相比，它可以更准确、更快速地检测出穿孔。
Recommendation: The radiological evaluation of MBO conditions is initially composed of abdominal radiography and contrast CT. MRI is less available and adds few advantages compared to CT. 建议：对 MBO 病况的放射学评估最初由腹部 X 光和对比 CT 组成。与 CT 相比，MRI 的可用性较低，并且几乎没有优势。
Evidence level: II; Recommendation degree: B. 证据等级：II；推荐程度：B。
In MBO, the nonsurgical management must be selected quickly, as the delay in conducting the treatment, beyond , increases the risk of mortality by three times and systemic infectious complications by two times, with a significant increase in time of hospitalization. Endoscopic procedures are promising for patients who are not candidates for surgery or who refuse to undergo an open surgical intervention. The most frequently performed percutaneous decompression procedure is gastrostomy, also called "PEG tube" and eventually PEG/J. PEG is used as an alternative to nasogastric tubes and minimizes their side effects, such as strictures, nasal discomfort, nasal erosions, and even bronchoaspiration. Due to the ease of insertion in most cases, PEG is commonly used in patients unlikely to survive a resection or bypass. Because the tube is placed along the anterior wall of the stomach, decompression and symptom relief are not completely achieved additional palliative measures are often required to treat symptoms. In combination with other medical techniques, percutaneous gastrostomy offers the possibility of intermittent ingestion of oral fluids. These procedures should be performed by experienced endoscopists or interventional radiologists. They are easily performed by these professionals and enable symptom control in more than of patients. Complications related to the insertion of PEG for bowel decompression rarely occur particularly when used for relatively short periods of time in the advanced malignancy setting. Greater care is needed in patients with ascites, who have higher complication rates and require prior treatment of ascites with relief paracentesis or placement of intraperitoneal relief catheters. 在 MBO 中，非手术治疗必须迅速选择，因为治疗延误超过 ，会使死亡风险增加三倍，全身感染并发症增加两倍，住院时间显著增加。内窥镜手术对于那些不适合手术或拒绝接受开放手术干预的患者是有希望的。最常见的经皮减压手术是胃造瘘术，也称为“PEG 管”，最终 PEG/J。PEG 被用作鼻胃管的替代品，并减少其副作用，如狭窄、鼻部不适、鼻部糜烂，甚至支气管吸入。由于在大多数情况下插入容易，PEG 常用于不太可能存活手术切除或旁路的患者。由于管道沿胃前壁放置，减压和症状缓解并不能完全实现，通常需要额外的姑息措施来治疗症状。结合其他医疗技术，经皮胃造瘘术提供了间歇性口服液体的可能性。 这些程序应由经验丰富的内窥镜医生或介入放射科医生执行。这些专业人士可以轻松执行这些程序，并使超过 的患者症状得到控制。与用于肠减压的 PEG 插入相关的并发症很少发生，特别是在晚期恶性肿瘤设置中短时间使用时。对于腹水患者，需要更加小心，因为他们的并发症率较高，并且需要先进行腹水缓解穿刺或放置腹腔内减压导管的治疗。
Recommendation: The percutaneous endoscopic procedure should only be performed by trained endoscopists or experienced interventional radiologists and should be indicated for debilitated patients, those not suitable for receiving anesthesia, and those with a life expectancy of less than 90 days. 建议：经皮内窥镜手术应仅由经过培训的内窥镜医师或有经验的介入放射科医师执行，并应适用于虚弱患者、不适合接受麻醉的患者以及预期寿命不足 90 天的患者。
Evidence level: III; Recommendation degree: B. 证据等级：III；推荐程度：B。
推荐等级
A
B
C
D
强有力的疗效证据，具有重大临床益处：强烈推荐
强或中等证据支持有效性，但临床益处有限：通常推荐使用
效益或功效的证据不足不能超过风险或缺点（例如，不良事件、成本、其他因素）：在某些情况下推芓使用
证据显示效果不佳或有不良结果发生: 很少推荐
强有力的证据显示无效或出现不良结果：永不推荐
推芓翻译: The 经皮的 内窥镜 程序应仅由受过训练的内窥镜医师或有经验的人员执行介入放射科医师应为虚弱患者指明
患者，那些不适合接受麻醉的人，以及那些有一
预期寿命不足 90 天。
证据等级：III；推荐程度：B.
共识水平：同意一 ；不同意一 ；投票
弃权-17.8%。
3.5 | Stents 3.5 | 支架
Endoscopic self-expanding metallic stents play an important role in the resolution of MBO. For this reason, they have been increasingly indicated for the resolution of primary obstructions and obstructions caused by peritoneal carcinomatosis. Endoluminal wall stents have a high success rate for symptom relief in MBO. In malignant obstructions of the upper digestive tract, endoluminal wall stents have a success rate of greater than (gastric, duodenal, and jejunal obstructions); in complete and incomplete colorectal obstructions, it has a success rate of . Definitive stent implantation may include preliminary procedures for channeling the lumen, for example, laser or balloon dilations. Although the risks include perforation , stent migration ), or reocclusion , stents can often lead to adequate palliation of symptoms for long periods of time. Stents insertion is indicated for selected patients with limited carcinomatosis and obstructions restricted to a single proximal point. In addition to benefits such as shorter hospital stay, lower morbidity, and lower mortality and cost, with stent placement, MBO symptoms decrease within , and the patient is allowed to take oral feedings. Currently, the early recurrence of symptoms in up to of cases is discussed, often requiring additional approaches such as stent replacement or additional surgical approach through perforation (4.5%), migration (11%), or potential tumor growth, which is subjected to new endoscopic intervention. In addition, it should be performed by trained professionals in high-volume centers that can provide adequate surgical interventions in cases where complications occur. Although less durable for obstruction relief compared with surgical approaches, stenting is more often consistent with the goals of end-of-life care with success in of cases. 内窥镜自膨胀金属支架在解决 MBO 中发挥着重要作用。因此，它们越来越被指示用于解决原发性梗阻和由腹膜癌症引起的梗阻。内腔壁支架在缓解 MBO 症状方面具有很高的成功率。在上消化道恶性梗阻中，内腔壁支架的成功率大于 （胃、十二指肠和空肠梗阻）；在完全和不完全结肠梗阻中，成功率为 。确定性支架植入可能包括用于引导腔道的初步程序，例如激光或球囊扩张。尽管风险包括穿孔 、支架迁移 ）或再闭塞 ，支架通常能够长时间有效缓解症状。支架插入适用于患有有限癌症和梗阻局限于单个近端点的患者。 除了诸如较短的住院时间、较低的发病率和死亡率以及成本较低等好处外，支架植入还可使 MBO 症状在 内减轻，并允许患者口服进食。目前，有 病例早期症状复发的情况，通常需要额外的方法，如支架更换或通过穿孔（4.5%）、迁移（11%）或潜在肿瘤生长的额外外科手术干预，这需要进行新的内窥镜干预。此外，应由受过培训的专业人员在能够提供充分外科干预的高容量中心进行操作，以处理并发症发生的情况。尽管与外科手术方法相比，支架在缓解梗阻方面的持久性较差，但在 病例中更常符合终末期护理目标并取得成功。
Recommendation: Upper digestive tract stents are recommended for primary obstructions and obstructions due to peritoneal carcinomatosis. They must be performed under endoscopic guidance by trained professionals. They are mainly indicated for debilitated patients who are not suitable for receiving anesthesia and undergoing surgery. It is also recommended for patients who might require palliative chemotherapy for immediate symptom relief. Colonic and rectal stents have a high success rate in selected patients with MBO. 建议：上消化道支架适用于原发性梗阻和由于腹膜癌症引起的梗阻。必须由受过培训的专业人员在内窥镜指导下进行。主要适用于身体虚弱的患者，不适合接受麻醉和手术。也建议对可能需要进行姑息化疗以立即缓解症状的患者使用。在选择的 MBO 患者中，结肠和直肠支架具有较高的成功率。
Evidence level: II; Recommendation degree: B. 证据等级：II；推荐程度：B。
A MBO is usually a late event in the course of the disease, and patients have a median survival of 1-9 months after diagnosis. Although MBO symptoms recur after initial control in four of five MBO patients and in of surgically treated patients, the role of TPN in the management of consequent progressive starvation remains controversial in the oncological literature. One of the objectives of TPN is the maintenance or recovery of the nutritional status of patients who are candidates for surgery. In MBO, TPN only plays a permissive role, prolonging the intestinal rest period while keeping the patient alive. The benefits of TPN are uncertain, with a very low level of evidence provided primarily by studies that were only conducted in patients who received TPN, rather than comparing them with those who did not receive TPN. The possible indication of TPN depends mainly on the evaluation of two premises: patients who died early due to nutritional deterioration or due to rapid tumor progression. Approximately of MBO patients who received TPN developed complications, including infection in the catheter insertion site (central venous catheter), thrombosis, electrolyte disturbances, and fluid overload; TPN is administered to help maintain the nutritional status of patients for a maximum of 2-3 months before death. TPN is discontinued when the intestinal transit is restored, after the initiation of other treatments for MBO, or when the patient has other conditions that are contraindicated for parenteral support, such as refractory cachexia, active process of death, or an MBO whose broader critical picture was not thoroughly investigated. In these situations, discontinuation of parenteral support is recommended and should be discussed with patients and family members. Finally, only of patients who survived more than 3 months were able to benefit from TPN. Thus, it should not be routinely used in the treatment of MBO. MBO 通常是疾病过程中的晚期事件，患者在诊断后的 1-9 个月内具有中位生存期。尽管 MBO 症状在五分之四的 MBO 患者和 接受手术治疗的患者中初步控制后会复发，但在肿瘤学文献中，TPN 在处理随之而来的进行性饥饿方面的作用仍存在争议。TPN 的目标之一是维持或恢复那些需要手术的患者的营养状况。在 MBO 中，TPN 仅起到一种许可的作用，延长肠道休息期同时保持患者生命。TPN 的益处尚不确定，主要由仅在接受 TPN 的患者中进行的研究提供了非常低水平的证据，而不是将其与未接受 TPN 的患者进行比较。TPN 的可能适应症主要取决于对两个前提的评估：由于营养恶化或肿瘤快速进展而导致早期死亡的患者。 大约 接受 TPN 治疗的 MBO 患者出现并发症，包括导管插入部位感染（中心静脉导管）、血栓形成、电解质紊乱和液体过载；TPN 用于帮助维持患者的营养状态，最多可维持 2-3 个月，直至死亡。当肠道通行恢复、开始其他 MBO 治疗或患者有其他禁忌于全静脉支持的情况时，应停止 TPN 治疗，如难治性消瘦、临终过程活跃、或 MBO 的更广泛危急情况未经彻底调查。在这些情况下，建议停止全静脉支持，并与患者和家属讨论。最后，只有 存活超过 3 个月的患者能从 TPN 中受益。因此，在 MBO 治疗中不应常规使用。
Recommendation: The objective of TPN, in the context of MBO, is the maintenance or recovery of the nutritional status of patients who are candidates for surgery. The indication of TPN in advanced cancer patients with inoperable MBO remains controversial. 推荐：在 MBO 的背景下，TPN 的目标是维持或恢复需要手术的患者的营养状况。对于晚期癌症患者中不适合手术的 MBO，TPN 的适应症仍存在争议。
Evidence level: II; Recommendation degree: B. 证据等级：II；推荐程度：B。
3.7 | Evaluation and management of MBO 3.7 | MBO 的评估和管理
There is no high evidence describing an ideal therapeutic approach for most patients who present with MBO, although surgical evaluation must be guaranteed for possible complications (e.g., ischemia and perforation). Even in cases of surgical emergencies, a nonoperative approach can still be selected if the patient's overall disease prognosis or treatment goals are inconsistent with more aggressive measures. The surgical approach depends on the extent and location of the disease, general prognosis, nutritional status, and recent use of steroids/chemotherapy. The multiple warnings and illdefined recommendations for appropriate surgical intervention further highlight the need for a multidisciplinary approach and the importance of early management planning. Careful selection of patients is imperative. The literature documents that increasing age, advanced disease, deteriorating general health, and malnutrition are primary factors associated with poor prognosis in cases where surgery can be avoided. Several studies have focused on identifying some prognostic factors for selecting patients who can benefit from surgery that seems to be useful for those with a life expectancy of 目前没有高度证据描述大多数 MBO 患者的理想治疗方法，尽管必须确保手术评估以防可能的并发症（例如缺血和穿孔）。即使在手术紧急情况下，如果患者的整体疾病预后或治疗目标与更积极的措施不一致，仍然可以选择非手术方法。手术方法取决于疾病的范围和部位、一般预后、营养状况以及最近使用的类固醇/化疗药物。对于适当的手术干预，存在多个警告和模糊的建议，进一步凸显了需要多学科方法和早期管理规划的重要性。患者的谨慎选择是必不可少的。文献记录显示，年龄增长、疾病进展、一般健康恶化和营养不良是与手术可避免的病例中预后不良相关的主要因素。一些研究已经着重于确定一些预后因素，以选择可以从手术中受益的患者，这对于那些有望延长生命的患者似乎是有用的。
对于那些预期寿命为 對於那些預期壽命為
more than 2 months. Previous studies have identified age, ascites, previous radiotherapy, intestinal obstruction in multiple sites, carcinomatosis, palpable masses, and a short interval from diagnosis to obstruction as clinical indicators of poor surgical prognosis. PS is a measure of a patient's functional capacity. The two most common measurement systems used are as follows: ECOG and the Karnofsky Performance Scale. In addition, PS is an important prognostic indicator in patients with MBO. The survival of patients with ECOG PS scores of 0-1 was 222 days, while those with ECOG PS scores of 2 and 3-4, were 63 and 27 days, respectively. In the study published by Perri et al., four variables were correlated with the overall survival times of 30 and 60 days after palliative surgery for MBO: age years, ascites greater than , nonovarian primary tumor, and albumin of . However, the PS was not evaluated. With regard to the underlying primary disease process and the general outcome of the management, no significant difference was observed between patients with gastrointestinal and those with gynecological diseases. In a palliative setting, the patient's expectations as they are subjective. 超过 2 个月。先前的研究已经确定年龄、腹水、先前放疗、多个部位的肠梗阻、癌症转移、可触及的肿块以及从诊断到梗阻的时间间隔短等临床指标是手术预后不良的指标。PS 是患者功能能力的衡量标准。最常用的两种测量系统分别是：ECOG 和 Karnofsky 绩效评分。此外，PS 在 MBO 患者中是一个重要的预后指标。ECOG PS 评分为 0-1 的患者的存活时间为 222 天，而 ECOG PS 评分为 2 和 3-4 的患者分别为 63 天和 27 天。在 Perri 等人发表的研究中，与 MBO 姑息手术后 30 天和 60 天的总体存活时间相关的四个变量是：年龄 岁、腹水大于 、非卵巢原发肿瘤和白蛋白 。然而，PS 没有被评估。关于潜在的原发疾病过程和治疗的一般结果，胃肠疾病患者和妇科疾病患者之间没有观察到显著差异。 在姑息治疗环境中，患者的期望是主观的。
For these reasons, patients and their families must be informed, in addition to the current morbidity condition about their life expectancy. 出于这些原因，患者及其家人必须被告知，除了当前的发病情况外，还要了解他们的预期寿命。
Recommendation: In carefully selected patients, symptom relief after palliative surgery can be expected, but new or recurrent symptoms limit their duration. The potential benefits, in addition to minimizing postoperative complications, will be less predictable for patients with low PS, malnutrition, and no previous treatment for the neoplasm. 建议：在精心选择的患者中，可望在姑息手术后获得症状缓解，但新的或复发的症状会限制其持续时间。除了减少术后并发症外，对于身体状况差、营养不良且之前未接受肿瘤治疗的患者，潜在的好处将更难以预测。
Evidence level: IV; Recommendation degree: D. 证据等级：IV；推荐程度：D。
The nasogastric tube can promote temporary decompression of the gastrointestinal tract and reduce nausea, vomiting, and pain. However, it is not a realistic long-term solution considering the discomfort it causes, frequent obstructions requiring replacement, and the risk of more serious events, including aspiration pneumonitis, mucosal ulceration, pharyngitis, and sinusitis. Thus, the insertion of a probe is indicated in selected patients, to control vomiting refractory caused by drug treatment and should be removed as soon as possible. The probe should be removed if it drains lower than . When removal is not feasible, placement of decompressive gastrostomy (via endoscopic or interventional radiological guidance) is a reasonable long-term alternative. 鼻胃管可以促进胃肠道的暂时减压，减少恶心、呕吐和疼痛。然而，考虑到它引起的不适、频繁的阻塞需要更换以及更严重事件的风险，包括吸入性肺炎、粘膜溃疡、咽炎和鼻窦炎，它并不是一个现实的长期解决方案。因此，在选择的患者中插入探针是合适的，以控制因药物治疗引起的难治性呕吐，并应尽快拔除。如果探针排出液体低于 ，应拔除探针。当无法拔除时，通过内窥镜或介入放射学引导进行减压胃造瘘是一个合理的长期替代方案。
Recommendation: The use of a nasogastric tube should be a temporary measure indicated in selected patients to control vomiting caused by drug treatment. 建议：使用鼻胃管应该是一种临时措施，适用于特定患者，以控制药物治疗引起的呕吐。
Evidence level: II; Recommendation degree: B. 证据等级：II；推荐程度：B。
Pharmacological management of patients focuses on adequate control of pain, nausea, vomiting, and dehydration. In inoperable patients, it provides symptomatic relief in of patients with MBO and aims to reduce inflammation and peritumoral intestinal edema (glucocorticoids), as well as intraluminal secretions and peristaltic movements (anticholinergic agents and octreotide). 8 患者的药物管理侧重于充分控制疼痛、恶心、呕吐和脱水。对于无法手术的患者，它为 的 MBO 患者提供症状缓解，并旨在减少炎症和周围肿瘤肠道水肿（糖皮质激素），以及肠腔分泌物和蠕动（抗胆碱药物和奥曲肽）。
Opioids: The basic analgesic approach involves the use of opioids due to their safety profile, multiple possible administration routes, wide therapeutic range, and good efficacy against most pain mechanisms (somatic, visceral, and neuropathic). Morphine is the opioid of choice, and it can be used intravenously or subcutaneously. 阿片类药物：基本镇痛方法涉及使用阿片类药物，因为它们具有安全性、多种可能的给药途径、广泛的治疗范围以及对大多数疼痛机制（体表、内脏和神经病理性）的良好疗效。吗啡是首选的阿片类药物，可以静脉或皮下使用。
Somatostatin analogs (octreotide): inhibit gastric, pancreatic, and intestinal secretions; reduce gastrointestinal motility; and may relieve pain and other symptoms of intestinal obstruction. Although existing data are conflicting, some studies demonstrate therapeutic success in more than of patients and superiority over an isolated anticholinergic agent in the symptomatic management of MBO. Octreotide is used at a dose of (divided into 2-3doses/day, administered subcutaneously). Patients who respond to the treatment may receive a depot injection of longacting octreotide (Sandostatin LAR) or monthly lanreotide for maintenance therapy. Antiemetics: haloperidol (dose: , , intravenously or day in continuous infusion), a selective dopamine (D2) receptor antagonist, is the primary antiemetic drug used for patients with MBO. 生长抑素类似物（奥曲肽）：抑制胃、胰腺和肠道分泌物；减少胃肠道蠕动；可能缓解疼痛和其他肠梗阻症状。尽管现有数据存在矛盾，但一些研究表明在超过 的患者中取得治疗成功，并在症状性管理 MBO 方面优于单独的抗胆碱药物。 奥曲肽剂量为 （分为 2-3 次/天，皮下注射）。对治疗有反应的患者可以接受长效奥曲肽（Sandostatin LAR）的深部注射或每月兰雷肽进行维持治疗。 抗恶心药物：氟哌啶（剂量： ， ，静脉注射或 日持续输注），一种选择性多巴胺（D2）受体拮抗剂，是用于 MBO 患者的主要抗恶心药物。
Prokinetic agents such as metoclopramide ( day) may be tried for partial obstructions, but are contraindicated if there is complete mechanical or colonic obstruction. However, findings of previous studies regarding the effectiveness of antagonists remain inconsistent. 促动力药物如美托普拉米（ 天）可用于部分梗阻，但如果存在完全机械性或结肠梗阻则禁忌使用。然而，关于 拮抗剂有效性的先前研究结果仍不一致。
Anticholinergics: Scopolamine butylbromide (hyoscine) is a preferred first-line antisecretory drug for the treatment of inoperable bowel obstruction. The dose usually prescribed is day, administered intravenously, or hypodermoclysis. 抗胆碱药物：丁溴铵东莨菪碱（颠茄碱）是治疗无法手术的肠梗阻的首选一线抗分泌药物。通常开的剂量是 天，静脉注射或皮下输液。
Glucocorticoids: the use of dexamethasone ( day) may be helpful in patients who do not respond to antisecretory therapy with an antiemetic. 糖皮质激素：地塞米松（ 天）的使用可能有助于那些对抗分泌抑制疗法和止吐药无效的患者。
In the context of partial intestinal obstruction, in which the physiopathologic mechanism is functional and can be reversible if treatment is started early, the combination of propulsion and antisecretory agents can act synergistically to allow the rapid recovery of the intestinal transit. 在部分肠梗阻的背景下，生理病理机制是功能性的，如果早期开始治疗，可以是可逆的，推进和抗分泌药物的结合可以协同作用，促使肠道传输迅速恢复。
Recommendation: In the symptomatic control of intestinal obstruction, especially nausea and vomiting, medications that reduce gastrointestinal secretions such as anticholinergics (scopolamine), somatostatin (octreotide), and antiemetics (metoclopramide or haloperidol) are used. Among the antisecretory drugs, scopolamine is used; for patients who are not responsive to this drug, octreotide can be used. Corticosteroids can be prescribed, to reduce loop edema, tumor mass, and local inflammatory factors. 建议：在症状控制肠梗阻，尤其是恶心和呕吐方面，通常会使用降低胃肠分泌的药物，如抗胆碱药（东莨菪碱）、生长抑素（奥曲肽）和抗恶心药（甲氧氯普胺或氟哌啶）。在抗分泌药物中，通常使用东莨菪碱；对于对该药物无反应的患者，可以使用奥曲肽。可开具皮质类固醇，以减少回肠水肿、肿瘤体积和局部炎症因子。
超过 2 个月。以前的研究已经确定了年龄、腹水，之前的放疗，肠道 阻碍 在多个 网站癌症转移、可触及肿块，以及从诊断到现在的短时间间隔作为不良手术预后的临床指标的阻塞。PS 是一个患者功能能力的衡量。两种最常见的使用的测量系统包括: ECOG 和 Karnofsky 性能量表。此外，PS 是一个重要的预后指标。患者 MBO 的指标。具有 ECOG 的患者的生存情况。 评分为 0-1 的为 222 天，而 ECOG PS 评分为 2 和 3-4 分别是 63 天和 27 天。在发表的研究中根据 Perri 等人的研究，四个变量与总生存期有关联。 MBO 姑息手术后 30 天和 60 天: 年龄 岁年，腹水超过 2 升，非卵巢原发性肿瘤，及白蛋白低于 2.5 克/分升。然而，PS 未进行评估。与关于基础的主要疾病过程和一般情况管理结果，没有观察到明显差异胃肠道疾病患者和妇科疾病患者之间疾病。在姑息治疗中，患者的期望
3.10 | Impact of chemotherapy on MBO 3.10 | 化疗对 MBO 的影响
Although systemic therapies are the mainstays of treatment for patients with metastatic cancer, the use of this strategy in patients with MBO is limited, as previous retrospective studies showed conflicting. 尽管系统疗法是治疗转移性癌症患者的主要支柱，但在 MBO 患者中使用这种策略受到限制，因为先前的回顾性研究显示了矛盾的结果。
In a study involving patients aged years with gastrointestinal, gynecological, or genitourinary cancer, chemotherapy improved the survival of patients with colorectal, pancreatic, and ovarian tumors. Furthermore, the use of chemotherapy after surgery was associated with longer survival compared with surgery alone (hazard ratio: 2.97, confidence interval: 在一项涉及年龄为 岁的胃肠道、妇科或泌尿系统癌症患者的研究中，化疗改善了结肠癌、胰腺癌和卵巢肿瘤患者的生存率。此外，与单纯手术相比，手术后使用化疗与更长的生存期相关（危险比：2.97， 置信区间： ）。
A previous Canadian retrospective analysis of patients with gynecological cancer ( ovarian cancer) demonstrated greater use of palliative chemotherapy ( vs. ) in patients assisted through a multidisciplinary program for managing MBO compared with that in patients who received usual care. In this sense, chemotherapy has shown a positive impact on cancer outcomes in selected groups of patients. 一项加拿大既往的回顾性分析显示，与接受常规护理的患者相比，通过多学科管理 MBO 的患者在妇科癌症（ 卵巢癌）治疗中更多地使用姑息化疗（ vs. ）。从这个意义上讲，化疗已经显示出对特定患者群体的癌症结果产生积极影响。
By contrast, a retrospective study conducted on patients ( with gastrointestinal tumors) unsuitable for surgery and candidates for palliative chemotherapy ( treatment-naive) demonstrated that the use of systemic treatment significantly increased the risk of toxicities, without improving the patient's survival. Another study demonstrated the low efficacy and high morbidity and mortality risk of systemic chemotherapy combined with parenteral nutrition in patients with small bowel intestinal obstruction. In this sense, given the uncertain benefits of chemotherapy in patients with intestinal obstruction, this should be an exception strategy guided by a multidisciplinary discussion, taking into account the tumoral biology and clinical status of the patient. 相比之下，对患有胃肠肿瘤（ ）且不适合手术、适合接受姑息化疗（ 治疗原始）的患者进行的一项回顾性研究表明，系统性治疗的使用显著增加了毒性风险，但并未改善患者的生存率。 另一项研究表明，在患有小肠梗阻的患者中，系统化疗与全静脉营养结合使用的疗效低，且有较高的发病率和死亡风险。 因此，考虑到化疗在患有肠梗阻的患者中的不确定益处，这应该是一种由多学科讨论指导的例外策略，考虑到肿瘤生物学和患者的临床状况。
Recommendation: Palliative chemotherapy for MBO should not be routinely recommended; when performed, it should be discussed in a multidisciplinary meeting, taking into account the tumor biology, clinical status of the patient, and patient's prognosis. 建议：对于 MBO 的姑息化疗不应该被常规推荐；如果进行，应该在多学科会议上讨论，考虑肿瘤生物学、患者的临床状况和预后。
Evidence level: II; Recommendation degree: B. 证据等级：II；推荐程度：B。
In cases of MBO due to a locally advanced or non-metastatic primary bowel tumor, surgical intervention with curative intent remains the main first line of treatment. However, for patients who present with obstruction due to advanced incurable disease, the factors that affect the final treatment plan include care goals established by the patient and their family, with the guidance of the surgeon and oncologist. It is beneficial to involve a palliative care specialist at this time as well. The patient's type of primary malignancy, cancer staging, previous treatment (surgery, radiotherapy, or chemotherapy), the patient's clinical condition, and comorbidities all play a key role in selecting the approach. Properly identifying which patients will benefit from surgical treatment is crucial, as the morbidity and mortality risks of a surgical procedure in this population are significantly high. An initial decompression through the insertion of a nasogastric tube was attempted for in patients without peritonitis or those who did not show worsening of clinical condition. Patients who showed persistent obstructive symptoms after this time period underwent definitive surgical intervention if they were considered suitable surgical candidates: the indications for surgical intervention should be substantiated with the " 30 -day mortality predictors" in these patients. Once the decision to operate has been made, the type of surgical procedure necessary to treat the obstruction is should be selected. Palliative surgery was associated with 30 -day mortality ranging from to and morbidity from to ; the primary complications include formation of fistulas, sepsis, and early reobstruction. Specifically in patients with MBO due to recurrent ovarian cancer, the most recent series reported the median survival times of 11.4-12.6 months for patients undergoing surgery for MBO and 3.7-3.9 months for nonsurgical patients. As reported, two essential factors, pain reduction, and reobstruction, were significantly improved by surgical palliation. 在由于局部晚期或非转移性原发性肠道肿瘤导致的 MBO 病例中，手术干预具有治愈意图仍然是主要的一线治疗。然而，对于因晚期不可治愈疾病导致梗阻的患者，影响最终治疗方案的因素包括患者及其家人确定的护理目标，以及外科医生和肿瘤学家的指导。此时也有益于纳入姑息护理专家。患者的原发性恶性肿瘤类型、癌症分期、先前治疗（手术、放疗或化疗）、患者的临床状况和合并症都在选择方法方面起着关键作用。正确识别哪些患者将从手术治疗中受益至关重要，因为在这一人群中手术风险和死亡风险显著高。对于没有腹膜炎或临床状况未恶化的患者，尝试通过插入鼻胃管进行初始减压。 在此时间段后表现出持续阻塞性症状的患者，如果被认为适合手术的候选者，则接受明确的手术干预：手术干预的指征应该通过这些患者的“30 天死亡预测因子”来证实。一旦决定进行手术，应选择必要的手术程序来治疗阻塞。姑息手术与 30 天死亡率范围从 到 ，发病率从 到 相关；主要并发症包括瘘管形成、败血症和早期再阻塞。特别是对于因复发性卵巢癌引起 MBO 的患者，最近的系列报道显示，接受 MBO 手术的患者的中位生存时间为 11.4-12.6 个月，非手术患者为 3.7-3.9 个月。据报道，手术姑息治疗显著改善了两个关键因素，即疼痛减轻和再阻塞。
Recommendation: The decision of which techniques to use is based on the location of the obstruction, the patient's comorbidities, and the overall prognosis. Surgical management consists of less invasive and more conservative interventions to alleviate symptoms and restore bowel function when possible. 建议：选择使用哪些技术取决于梗阻的位置、患者的合并症和整体预后。手术治疗包括较少侵入性和更保守的干预措施，以尽可能缓解症状并恢复肠功能。
Evidence level: II; Recommendation degree: B. 证据等级：II；推荐程度：B。
Consensus level: agreement-100%. 共识水平：一致-100%。
4 | CONCLUSION 4 | 结论
The BSSO assembled a group of experienced cancer surgeons and searched the medical literature for precedent to outline strategies for MBO management. This condition frequently occurs in patients with gastrointestinal or gynecologic cancers and is prevalent worldwide. Therefore, we emphasized that the selection of MBO treatment, for any surgical condition, especially in this context, should be based on principles, well-described surgical procedures, and robust evidence in the literature. BSSO 组织了一组经验丰富的癌症外科医生，并搜索医学文献以制定 MBO 管理策略的先例。这种情况经常发生在患有胃肠或妇科癌症的患者身上，并且在全球范围内普遍存在。因此，我们强调，对于任何外科疾病的 MBO 治疗选择，特别是在这种情况下，应基于原则、详细描述的外科手术程序和文献中的可靠证据。
Gustavo A. Laporte (D) http://orcid.org/0000-0002-5363-1055 Gustavo A. Laporte (D) http://orcid.org/0000-0002-5363-1055
古斯塔沃·A·拉波特（D）http://orcid.org/0000-0002-5363-1055
REFERENCES 参考资料
Dolan EA. Malignant bowel obstruction: a review of current treatment strategies. Am J Hosp Palliat Care. 2011;28(8):576-582. Dolan EA. 恶性肠梗阻：当前治疗策略综述。美国医院姑息护理杂志。2011;28(8):576-582。
Franke AJ, Iqbal A, Starr JS, Nair RM, George TJ. Management of malignant bowel obstruction associated with cancers. J Oncol Pract. 2017;13(7):426-434. Franke AJ, Iqbal A, Starr JS, Nair RM, George TJ. 恶性肠梗阻的管理与 癌症相关。J Oncol Pract. 2017;13(7):426-434.
Tuca A, Guell E, Martinez-Losada E, Codorniu N. Malignant bowel obstruction in advanced cancer patients: epidemiology, management, and factors influencing spontaneous resolution. Cancer Manag Res. 2012;4:159-169. Tuca A, Guell E, Martinez-Losada E, Codorniu N. 晚期癌症患者恶性肠梗阻：流行病学、管理和影响自发缓解的因素。癌症管理研究。2012;4:159-169。
Huang X, Xue J, Gao M, et al. Medical management of inoperable malignant bowel obstruction. Ann Pharmacother. 2020;55(9):1134-1145. 黄 X，薛 J，高 M 等。无法手术的恶性肠梗阻的医学管理。Ann Pharmacother。2020;55(9):1134-1145。
Soriano A, Davis MP. Malignant bowel obstruction: individualized treatment near the end of life. Cleve Clin J Med. 2011;78(3):197-206. 索里亚诺 A，戴维斯 MP。恶性肠梗阻：临终期个体化治疗。克利夫兰临床医学杂志。2011;78(3):197-206。
Lee YC, Jivraj N, O'Brien C, et al. Malignant bowel obstruction in advanced gynecologic cancers: an updated review from a multidisciplinary perspective. Obstet Gynecol Int. 2018;2018:1867238. 李 YC，吉夫拉吉 N，奥布莱恩 C 等。晚期妇科癌症恶性肠梗阻：多学科视角的最新综述。产科妇科国际。2018;2018:1867238。
Laval G, Marcelin-Benazech B, Guirimand F, et al. Recommendations for bowel obstruction with peritoneal carcinomatosis. J Pain Symptom Manage. 2014;48(1):75-91. Laval G，Marcelin-Benazech B，Guirimand F 等。腹膜癌症性肠梗阻的建议。疼痛和症状管理杂志。2014;48(1):75-91。
Obita GP, Boland EG, Currow DC, Johnson MJ, Boland JW. Somatostatin analogues compared with placebo and other pharmacologic agents in the management of symptoms of inoperable malignant bowel obstruction: a systematic review. J Pain Symptom Manage. 2016;52(6):901-919.e1. Obita GP，Boland EG，Currow DC，Johnson MJ，Boland JW。索马托斯汀类似物与安慰剂及其他药物在无法手术治疗的恶性肠梗阻症状管理中的比较：系统评价。J Pain Symptom Manage。2016;52(6)：901-919.e1。
Minoura T, Takeuchi M, Morita T, Kawakami K. Practice patterns of medications for patients with malignant bowel obstruction using a nationwide claims database and the association between treatment outcomes and concomitant use of -blockers/proton pump inhibitors and corticosteroids with octreotide. J Pain Symptom Manage. 2017;55(2):413-419.e2. Minoura T，Takeuchi M，Morita T，Kawakami K。使用全国性索赔数据库的恶性肠梗阻患者药物治疗模式及治疗结果与 -受体阻滞剂/质子泵抑制剂和皮质类固醇与奥曲肽的联合使用之间的关联。J Pain Symptom Manage。2017;55(2)：413-419.e2。
Mercadante S, Porzio G. Octreotide for malignant bowel obstruction: twenty years after. Crit Rev Oncol Hematol. 2012;83(3):388-392. Mercadante S, Porzio G. 恶性肠梗阻的奥曲肽治疗：二十年后。Crit Rev Oncol Hematol. 2012;83(3):388-392.
Currow DC, Quinn S, Agar M, et al. Double-blind, placebocontrolled, randomized trial of octreotide in malignant bowel obstruction. J Pain Symptom Manage. 2014;49(5):814-821. Currow DC，Quinn S，Agar M 等。八肽胃素治疗恶性肠梗阻的双盲、安慰剂对照、随机试验。《疼痛和症状管理杂志》。2014；49（5）：814-821。
de Boer NL, Hagemans JAW, Schultze BTA, et al. Acute malignant obstruction in patients with peritoneal carcinomatosis: the role of palliative surgery. Eur J Surg Oncol. 2018;45(3):389-393. de Boer NL，Hagemans JAW，Schultze BTA 等。腹膜癌症患者急性恶性梗阻：姑息手术的作用。欧洲外科肿瘤学杂志。2018;45(3)：389-393。
Paul Olson TJ, Pinkerton C, Brasel KJ, Schwarze ML. Palliative surgery for malignant bowel obstruction from carcinomatosis: a systematic review. JAMA Surg. 2014;149(4):383-392. 保罗·奥尔森 TJ，平克顿 C，布拉塞尔 KJ，施瓦兹 ML。癌症性肠梗阻的姑息手术：系统性综述。JAMA Surg。2014 年；149（4）：383-392。
Badgwell BD, Smith K, Liu P, Bruera E, Curley SA, Cormier JN. Indicators of surgery and survival in oncology inpatients requiring surgical evaluation for palliation. Support Care Cancer. 2009;17(6): 727-734. Badgwell BD，Smith K，刘 P，Bruera E，Curley SA，Cormier JN。需要手术评估以缓解癌症患者的手术和生存指标。支持护理癌症。2009;17(6):727-734。
Yu K, Liu L, Zhang X, et al. Surgical and conservative management of malignant bowel obstruction: outcome and prognostic factors. Cancer Manag Res. 2020;12:7797-7803. 于 K，刘 L，张 X 等。恶性肠梗阻的手术和保守治疗：结果和预后因素。癌症管理研究。2020;12:7797-7803。
Miner TJ, Brennan MF, Jaques DP. A prospective, symptom related, outcomes analysis of 1022 palliative procedures for advanced cancer. Ann Surg. 2004;240(4):719-726. Miner TJ，Brennan MF，Jaques DP。1022 例晚期癌症患者的前瞻性、症状相关、结果分析。Ann Surg。2004；240（4）：719-726。
Henry JC, Pouly S, Sullivan R, et al. A scoring system for the prognosis and treatment of malignant bowel obstruction. Surgery. 2012;152(4):747-756. Henry JC，Pouly S，Sullivan R 等。 恶性肠梗阻预后和治疗评分系统。 外科手术。 2012;152（4）：747-756。
Ferguson HJ, Ferguson Cl, Speakman J, Ismail T. Management of intestinal obstruction in advanced malignancy. Ann Med Surg (Lond). 2015;4(3):264-270. Ferguson HJ，Ferguson Cl，Speakman J，Ismail T。晚期恶性肿瘤肠梗阻的管理。Ann Med Surg（伦敦）。2015;4（3）：264-270。
Thampy S, Najran P, Mullan D, Laasch HU. Safety and efficacy of venting gastrostomy in malignant bowel obstruction: a systematic review. J Palliat Care. 2019;35(2):93-102. Thampy S, Najran P, Mullan D, Laasch HU. 恶性肠梗阻中胃造口通气的安全性和有效性：系统评价。J Palliat Care. 2019;35(2):93-102.
Alyami M, Hübner M, Grass F, et al. Pressurised intraperitoneal aerosol chemotherapy: rationale, evidence, and potential indications. Lancet Oncol. 2019;20(7):e368-e377. Alyami M, Hübner M, Grass F 等。腹腔内压力喷雾化疗法：原理、证据和潜在适应症。《柳叶刀肿瘤学》。2019；20（7）：e368-e377。
Kuncewitch M, Levine E, Shen P, Votanopoulos K. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for appendiceal tumors and colorectal adenocarcinomas. Clin Colon Rectal Surg. 2018;31(5):288-294. Kuncewitch M, Levine E, Shen P, Votanopoulos K. 细胞减少手术和腹腔热疗化疗在阑尾肿瘤和结肠腺癌中的作用。临床结肠直肠外科。2018;31(5):288-294。
Ray MD, Dhall K. Hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of peritoneal surface malignancies-an evidence-based review. Curr Probl Cancer. 2021;45(6):100737. Ray MD，Dhall K。腹腔内热化疗（HIPEC）在腹膜表面恶性肿瘤管理中的应用-基于证据的回顾。Curr Probl Cancer。2021;45（6）：100737。
Kitai T. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the treatment of peritoneal carcinomatosis: a systematic review including evidence from Japan. Surg Today. 2021;51(7):1085-1098. Kitai T. 细胞减灭手术和腹腔热疗化疗在腹膜癌症治疗中的作用：一项系统性回顾，包括来自日本的证据。Surg Today. 2021;51(7):1085-1098.
Steffen T, Eden J, Bijelic L, et al. Patient selection for hyperthermic intraperitoneal chemotherapy in patients with colorectal cancer: consensus on decision making among international experts. Clin Colorectal Cancer. 2020;19(4):277-284. Steffen T, Eden J, Bijelic L 等人。对于结直肠癌患者进行热化腹膜腔内化疗的患者选择：国际专家在决策制定上的共识。《临床结直肠癌》。2020 年;19(4):277-284。
Steffen T, Häller L, Bijelic L, et al. Decision-making analysis for hyperthermic intraperitoneal chemotherapy in ovarian cancer: a survey by the Executive Committee of the Peritoneal Surface Oncology Group International (PSOGI). Oncology. 2020;99(1):41-48. Steffen T, Häller L, Bijelic L 等人。卵巢癌热化腹膜腔内化疗的决策分析：Peritoneal Surface Oncology Group International（PSOGI）执行委员会的调查。《肿瘤学》。2020 年；99（1）：41-48。
Lin YL, Xu DZ, Li XB, et al. Consensuses and controversies on pseudomyxoma peritonei: a review of the published consensus statements and guidelines. Orphanet J Rare Dis. 2021;16(1):85. 林 YL，徐 DZ，李 XB 等。关于假黏液腹水的共识与争议：对已发表的共识声明和指南的回顾。 Orphanet J Rare Dis. 2021;16(1):85。
Daniele A, Ferrero A, Fuso L, et al. Palliative care in patients with ovarian cancer and bowel obstruction. Support Care Cancer. 2015;23(11):3157-3163. Daniele A, Ferrero A, Fuso L 等。卵巢癌和肠梗阻患者的姑息治疗。支持护理癌症。2015;23(11):3157-3163。
Rami Reddy SR, Cappell MS. A systematic review of the clinical presentation, diagnosis, and treatment of small bowel obstruction. Curr Gastroenterol Rep. 2017;19(6):28. Rami Reddy SR，Cappell MS。小肠梗阻的临床表现、诊断和治疗的系统综述。Curr Gastroenterol Rep。2017;19(6):28。
Jeurnink SM, Steyerberg EW, van Hooft JE, et al. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2009;71(3): 490-499. Jeurnink SM，Steyerberg EW，van Hooft JE 等。手术胃空肠吻合术或内镜支架置入用于恶性胃出口梗阻的姑息治疗（SUSTENT 研究）：多中心随机试验。胃肠道内镜。2009;71（3）：490-499。
Ripamonti , Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008;44(8):1105-1115. Ripamonti ，Easson AM，Gerdes H。恶性肠梗阻的管理。欧洲癌症杂志。2008;44(8):1105-1115。
Pothuri B, Montemarano M, Gerardi M, et al. Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma. Gynecol Oncol. 2005;96(2):330-334. Pothuri B, Montemarano M, Gerardi M, 等。在卵巢癌引起的恶性肠梗阻患者中进行经皮内窥镜胃造瘘管置入。《妇科肿瘤学》。2005;96(2):330-334。
Campagnutta E, Cannizzaro R, Gallo A, et al. Palliative treatment of upper intestinal obstruction by gynecological malignancy: the usefulness of percutaneous endoscopic gastrostomy. Gynecol Oncol. 1996;62(1):103-105. Campagnutta E, Cannizzaro R, Gallo A 等。妇科恶性肿瘤引起的上消化道梗阻的姑息治疗：经皮内窥镜胃造瘘的实用性。妇科肿瘤学。1996;62(1)：103-105。
Singal AK, Dekovich AA, Tam AL, Wallace MJ. Percutaneous transesophageal gastrostomy tube placement: an alternative to percutaneous endoscopic gastrostomy in patients with intraabdominal metastasis. Gastrointest Endosc. 2010;71(2):402-406. Singal AK，Dekovich AA，Tam AL，Wallace MJ。经皮食管胃造瘘管置入：对腹腔转移患者的经皮内窥镜胃造瘘的替代方法。胃肠内镜。2010;71(2):402-406。
Banting SP, Waters PS, Peacock O, et al. Management of primary and metastatic malignant small bowel obstruction, operate or palliate. A systematic review. ANZ J Surg. 2020;91(3):282-290. 班廷 SP，沃特斯 PS，皮科克 O 等。原发性和转移性恶性小肠梗阻的管理，手术或姑息治疗。系统性综述。ANZ J Surg。2020;91（3）：282-290。
布鲁诺.德阿维拉.维迪加尔 https://orcid.org/0000-0002-9262-5176 赫伯萨尔瓦多.德卡斯特罗.里贝罗 https://orcid.org/0000-0002-
源文: Minoura T, Takeuchi M, Morita T, Kawakami K. Practice patterns of medications for patients with malignant bowel obstruction using a nationwide claims database and the association between treatment outcomes and concomitant use of -blockers/proton pump inhibitors and corticosteroids with octreotide. J Pain Symptom Manage. 源文: Minoura T, Takeuchi M, Morita T, Kawakami K. Practice patterns of medications for patients with malignant bowel obstruction using a nationwide claims database and the association between treatment outcomes and concomitant use of -blockers/proton pump inhibitors and corticosteroids with octreotide. J Pain Symptom Manage.
Translation Text: 民浦 T，竹内 M，森田 T，川上 K。使用全国性索赔数据库的恶性肠梗阻患者药物治疗模式及治疗结果与同时使用 -阻滞剂/质子泵抑制剂和皮质类固醇与奥曲肽的关联。疼痛症状管理。
2017;55(2):413-419.e2. 2017 年;55(2):413-419.e2。
译文: Minoura T, Takeuchi M, Morita T, Kawakami K. 利用全国性索赔数据库 译文：Minoura T, Takeuchi M, Morita T, Kawakami K. 利用全国性索赔数据库
Mercadante S, Porzio G. 奥曲肽治疗恶性肠梗阻: 二十年后。肿瘤学和血液学评论。2012;83(3):388-392。
Currow DC, Quinn S, Agar M, 等。奥曲肽在恶性肠梗阻中的双盲、安慰剂对照、随机试验。疼痛症状管理杂志。2014;49(5):814-821。
de Boer NL, Hagemans JAW, Schultze BTA 等。腹膜癌症患者急性恶性梗阻:姑息手术的作用。欧洲外科肿瘤杂志。2018;45(3):389-393。
Upchurch E, Ragusa M, Cirocchi R. Stent placement versus surgical palliation for adults with malignant gastric outlet obstruction. Cochrane Database Syst Rev. 2018;5:CD012506.
Watt AM, Faragher IG, Griffin TT, Rieger NA, Maddern GJ. Selfexpanding metallic stents for relieving malignant colorectal obstruction: a systematic review. Ann Surg. 2007;246(1):24-30.
Khot UP, Lang AW, Murali K, Parker MC. Systematic review of the efficacy and safety of colorectal stents. Br J Surg. 2002;89(9): 1096-1102.
Anthony T, Baron T, Mercadante S, et al. Report of the clinical protocol committee: development of randomized trials for malignant bowel obstruction. J Pain Symptom Manage. 2007;34(suppl 1):S49-S59.
Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M. Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol. 2004;99(10):2051-2057.
Bozzetti F. The role of parenteral nutrition in patients with malignant bowel obstruction. Support Care Cancer. 2019;27(12):4393-4399.
Disney BR, Karthikeyakurup A, Ratcliffe J, et al. Palliative parenteral nutrition use in patients with intestinal failure as a consequence of advanced pseudomyxoma peritonei: a case series. Eur J Clin Nutr 2015;69(8):966-968.
Sowerbutts AM, Lal S, Sremanakova J, et al. Home parenteral nutrition for people with inoperable malignant bowel obstruction. Cochrane Database Syst Rev. 2018;8:CD012812.
Perri T, Korach J, Ben-Baruch G, et al. Bowel obstruction in recurrent gynecologic malignancies: defining who will benefit from surgical intervention. Eur J Surg Oncol. 2013;40(7):899-904. Perri T, Korach J, Ben-Baruch G, 等。复发性妇科恶性肿瘤的肠梗阻：确定谁将从手术干预中受益。欧洲外科肿瘤学杂志。2013;40(7)：899-904。
Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. Use of Palliative Performance Scale in end-of-life prognostication. J Palliat Med. 2006;9(5):1066-1075. Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. 在临终预后中使用姑息表现量表。《姑息医学杂志》。2006 年;9(5):1066-1075。
Wright FC, Chakraborty A, Helyer L, Moravan V, Selby D. Predictors of survival in patients with non-curative stage IV cancer and malignant bowel obstruction. J Surg Oncol. 2010;101(5):425-429. Wright FC，Chakraborty A，Helyer L，Moravan V，Selby D。非治愈性第四期癌症和恶性肠梗阻患者生存预测因子。J Surg Oncol。2010;101(5):425-429。
Romeo M, de Los LLanos Gil M, Cuadra Urteaga JL, et al. Outcome prognostic factors in inoperable malignant bowel obstruction. Support Care Cancer. 2016;24(11):4577-4586. Romeo M, de Los LLanos Gil M, Cuadra Urteaga JL 等。不可手术的恶性肠梗阻的预后预测因素。支持护理癌症。2016;24(11):4577-4586。
Sigmon DF, An J. Nasogastric Tube. StatPearls [Internet]. StatPearls Publishing; May 2, 2022. Sigmon DF，An J。鼻胃管。StatPearls [互联网]。StatPearls 出版社；2022 年 5 月 2 日。
Davis MP, Hallerberg G. A systematic review of the treatment of nausea and/or vomiting in cancer unrelated to chemotherapy or radiation. J Pain Symptom Manage. 2010;39(4):756-767. 戴维斯 MP，哈勒伯格 G。对非化疗或放疗相关的癌症恶心和/或呕吐治疗的系统综述。疼痛和症状管理杂志。2010;39(4):756-767。
Quigley C. Opioids in people with cancer-related pain. BMJ Clin Evid. 2008;2008:2408. Quigley C. 癌症相关疼痛患者的阿片类药物。BMJ Clin Evid. 2008;2008:2408.
Mystakidou K, Tsilika E, Kalaidopoulou O, Chondros K, Georgaki S, Papadimitriou L. Comparison of octreotide administration vs conservative treatment in the management of inoperable bowel obstruction in patients with far advanced cancer: a randomized, double- blind, controlled clinical trial. Anticancer Res. 2002;22(2B):1187-1192. Mystakidou K，Tsilika E，Kalaidopoulou O，Chondros K，Georgaki S，Papadimitriou L。比较八肽素给药与保守治疗在晚期癌症患者不可手术肠梗阻管理中的作用：一项随机、双盲、对照临床试验。抗癌研究。2002 年;22(2B):1187-1192。
Peng X, Wang P, Li S, Zhang G, Hu S. Randomized clinical trial comparing octreotide and scopolamine butylbromide in symptom control of patients with inoperable bowel obstruction due to advanced ovarian cancer. World J Surg Oncol. 2015;13:50. 彭 X，王 P，李 S，张 G，胡 S。随机临床试验比较奥曲肽和丁溴铵东莨菪碱在晚期卵巢癌不可手术性肠梗阻患者症状控制中的效果。世界外科肿瘤学杂志。2015;13:50。
Mariani P, Blumberg J, Landau A, et al. Symptomatic treatment with lanreotide microparticles in inoperable bowel obstruction resulting from peritoneal carcinomatosis: a randomized, double-blind, placebo-controlled phase III study. J Clin Oncol. 2012;30(35): 4337-4343. Mariani P, Blumberg J, Landau A 等。对于由腹膜癌症引起的无法手术的肠梗阻，使用利伦肽微粒进行症状治疗：一项随机、双盲、安慰剂对照的 III 期研究。J Clin Oncol。2012;30(35)：4337-4343。
Murray-Brown F, Dorman S. Haloperidol for the treatment of nausea and vomiting in palliative care patients. Cochrane Database Syst Rev. 2015;2015(11):CD006271. Murray-Brown F, Dorman S. Haloperidol 用于姑息护理患者恶心和呕吐的治疗。Cochrane 数据库系统评论。2015;2015(11):CD006271。
Glare PA, Dunwoodie D, Clark K, et al. Treatment of nausea and vomiting in terminally ill cancer patients. Drugs. 2008;68(18): 2575-2590. Glare PA，Dunwoodie D，Clark K 等。终末期癌症患者恶心和呕吐的治疗。药物。2008; 68（18）：2575-2590。
Feuer DJ, Broadley KE. Corticosteroids for the resolution of malignant bowel obstruction in advanced gynaecological and gastrointestinal cancer. Cochrane Database Syst Rev. 2000;2000(2): CD001219 Feuer DJ，Broadley KE。糖皮质激素用于治疗晚期妇科和胃肠癌恶性肠梗阻的解决。Cochrane 数据库 Syst Rev。2000;2000（2）：CD001219
Bateni SB, Gingrich AA, Kirane AR, et al. Chemotherapy after diagnosis of malignant bowel obstruction is associated with superior survival for medicare patients with advanced malignancy. Ann Surg Oncol. 2021;28(12):7555-7563. Bateni SB，Gingrich AA，Kirane AR 等。诊断恶性肠梗阻后化疗与晚期恶性疾病的医疗保险患者的优越生存相关。Ann Surg Oncol。2021;28(12)：7555-7563。
Lee YC, Jivraj N, Wang L, et al. Optimizing the care of malignant bowel obstruction in patients with advanced gynecologic cancer J Oncol Pract. 2019;15(12):e1066-e1075. 李 YC，Jivraj N，王 L 等。优化晚期妇科癌症患者恶性肠梗阻护理。J Oncol Pract。2019;15（12）：e1066-e1075。
Caparica R, Amorim L, Amaral P, et al. Malignant bowel obstruction: effectiveness and safety of systemic chemotherapy. BMJ Support Palliat Care. 2020. doi:10.1136/bmjspcare-2020-002656 Caparica R, Amorim L, Amaral P, 等。恶性肠梗阻：全身化疗的有效性和安全性。BMJ 支持姑息护理。2020。doi:10.1136/bmjspcare-2020-002656
Chouhan J, Gupta R, Ensor J, et al. Retrospective analysis of systemic chemotherapy and total parenteral nutrition for the treatment of malignant small bowel obstruction. Cancer Med. 2015;5(2):239-247. Chouhan J，Gupta R，Ensor J 等。恶性小肠梗阻的全身化疗和全静脉营养的回顾性分析。癌症医学。2015;5(2):239-247。
Bower KL, Lollar DI, Williams SL, Adkins FC, Luyimbazi DT, Bower CE. Small bowel obstruction. Surg Clin North Am. 2018;98(5): 945-971. Bower KL，Lollar DI，Williams SL，Adkins FC，Luyimbazi DT，Bower CE。小肠梗阻。Surg Clin North Am。2018;98(5)：945-971。
Bleicher J, Lambert LA, Scaife CL, Colonna A. Current management of malignant bowel obstructions: a survey of acute care surgeons and surgical oncologists. Trauma Surg Acute Care Open. 2021;6(1): e000755. Bleicher J, Lambert LA, Scaife CL, Colonna A. 恶性肠梗阻的当前管理：对急诊外科医生和外科肿瘤学家的调查。创伤外科急诊开放。2021;6(1):e000755。
How to cite this article: Zanatto RM, Lisboa CN, Oliveira JCd, et al. Brazilian Society of Surgical Oncology guidelines for malignant bowel obstruction management. J Surg Oncol. 如何引用本文：Zanatto RM，Lisboa CN，Oliveira JCd 等。巴西外科肿瘤学会对恶性肠梗阻管理的指南。J Surg Oncol。
Perri T, Korach J, Ben-Baruch G 等。复发性妇科恶性肿瘤中的肠梗阻：确定哪些人将受益于手术干预。Eur J Surg Oncol。2013；40(7)：899-904。
Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. 姑息治疗表现量表在临终预测中的应用。J Palliat Med. 2006;9(5):1066-1075。 Lau F, Downing GM, Lesperance M, Shaw J, Kuziemsky C. 姑息治療表現量表在臨終預測中的應用。J Palliat Med. 2006;9(5):1066-1075。
Wright FC, Chakraborty A, Helyer L, Moravan V, Selby D. 非治愈性 IV 期癌症和恶性肠梗阻患者的生存预测因素。J Surg Oncol。2010;101(5):425-429。
Romeo M、de Los LLanos Gil M、Cuadra Urteaga JL 等。无法手术的恶性肠梗阻的结果预后因素。
