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題 名 | 以Octreotide治療晚期胃癌病人胃腸道阻塞的經驗=Palliative Treatment of Intestinal Obstruction in Advanced Gastric Cancer Using Octreotide |
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作 者 | 李冠德; 莊采蓉; 夏和雄; 姚乃舜; 彭汪嘉康; 陳立宗; | 書刊名 | 內科學誌 |
卷 期 | 10:4 1999.08[民88.08] |
頁 次 | 頁153-158 |
分類號 | 415.527 |
關鍵詞 | 胃癌; 腸阻塞; 癌性腹膜炎; 姑息治療; 體抑素; Gastric cancer; Intestinal obstruction; Peritoneal carcinomatosis; Palliative treatment; Somatostatin; |
語 文 | 中文(Chinese) |
中文摘要 | 癌症病人腸阻塞的治療在過去30年並無重大改變,包括鼻胃管引流配合靜脈輸 液及藥物治療。當內科方法失敗,通常會考慮以姑息性腸道吻合或人工造口手術來解決。 但由於癌症病人的腸阻塞以多處的部份阻塞(multiple partial obstruction)居多,加 上開刀無法有效延長存活期,術後發生再阻塞的機率高,手術並非此類病人治療之良好選 擇,因此尋求其它有效的姑息治療(palliative treatment)是臨床醫師重要的課題。 Octreotide 是天然體抑素(somatostatin)的類化物,能減少腸液、胰液、膽汁的分泌 ,並抑制消化道激素VIP的分泌,近幾年才被嘗試用來治療腸阻塞,雖然只有少數國外的 臨床報告,但效果均十分顯著。本文報告9例晚期胃癌發生胃腸道阻塞的病人,在鼻胃管 引流及傳統藥物治療效果不佳後改用octreotide,結果胃腸道阻塞症狀在使用後得以完全 緩解者5位,部份緩解者3位,只有1位症狀無改善。病人于症狀緩解時,再接受同步的化 學治療(concomitant chemotherapy),結果9位病人中,有6位得以穩定出院並繼續於門 診接受化學治療。因此對於癌性腹膜炎(carcinomatosis)所造成的腸阻塞,當傳統治療反 應不好時,octreotide是簡單又有效的選擇,唯價格昂貴是必須考慮的因素。 素。 |
英文摘要 | The primary treatment of intestinal obstruction, including nasogastric drainage, intravenous fluid and conventional drugs, has not changed significantly in the past 30 years. Palliative surgery was usually taken when the medical treatment was unsuccessful. However, malignant bowel obstruction is usually multiple sites of partial obstruction. Operation may not be a good choice as the duration of survival was not increased significantly and reobstruction rate was high after laparotomy. Therefore, it is important for clinicians to find an effective palliative treatment. Octreotide, a somatostatin analogue, reduces intestinal, biliary, and pancreatic secretion, and inhibits the secretion of vasoactive intestinal pepetide (VIP). Its effectiveness in palliating malignant bowel obstruction has been demonstrated recently in few foreign literatures. In this paper, we reported 9 metastatic gastric cancer patients with carcinomatosis and intestinal obstruction had poor response to conventional treatment. After subcutaneous or intravenous infusion of octreotide, five patients had complete relief of their symptoms, while 3 had partial relief and only one case was unresponsive. When obstructive symptoms were alleviated, they received further palliative chemotherapy. Six of 9 patients had sustained response and were able to leave the hospital in stable condition. We concluded that octreotide is a simple and effective adjunct to standard treatment in malignant bowel obstruction. (J Intern Med Taiwan 1999;10: 153-158) |
本系統中英文摘要資訊取自各篇刊載內容。