???????????(MBO)??????

1
???????????(MBO)??????

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2
Introduction Malignant bowel obstruction (MBO)

• MBO?????????????????
• ??????(50)????(542)
• MBO????????????????
• ?????????,????,???????,
• ???????????
• ??????,?????????1-3?,??????

A guide to understanding malignant bowel
obstruction. Int J Palliat Nurs. 2006
Apr12(4)164-6, 168-71 Predictors of survival in
patients with non-curative stage IV cancer and
malignant bowel obstruction. J Surg Oncol. 2010
Apr 1101(5)425-9.
3
???????????
Current concepts in malignant bowel obstruction
management. Curr Oncol Rep. 2009
Jul11(4)298-303.
4
??MBO

• MBO??????????
• MBO????
• MBO?????????-??-???????
• MBO??????????
• ???????????????????
• ??????
• ???????MBO??,MBO??????????????

• 2007???????MBO????

??NCCN????????MBO??
5
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????????????,????
6
(No Transcript)
7
MBO????

• ????
• ??MBO???????/??
• ????????,?????????
• ???????????
• ????????????????????????????????????????,???????
• ????
• ????
• Intervention (endoscopic ) stent
• ????
• ????????nasogastric tube,TPN

NCCN Practice Guidelines in Oncology
v.1.2010 Current concepts in malignant bowel
obstruction management. Curr Oncol Rep. 2009
Jul11(4)298-303.
8
Limits of Surgery and intervention

• ???????????????,????????????????? (gt60
  days).?????????????42-80
• ???????????MBO,?????????
• high 30-day mortality (21-40) and high
  complication rate (20-40) and high rate of
  re-obstruction within a short period of time.
• ?????????????????????????????

Management of malignant bowel obstruction. Eur J
Cancer. 2008 May44(8)1105-15. Epub 2008 Mar 21.
9
MBO???????????
???????????????

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• ????????????

British Journal of Surgery 2000871281-1283. Supp
ort Care Cancer 20019223-33
10
???????

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• ????????????????????????????????????????????????
  ????????
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• ???(?????????)
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11
MBO????

• MBO?????????MBO?????????
• MBO???????
• ????????
• ????????
• ???????

12
MBO????
13
?????????????
?????????????
???????
?????
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??
?????
????????
?????H20,Na,Cl-
?????? ??????
??????
?????
?????????? ????(PG) ??????(VIP) ????
??-??-????????
Support Care Cancer 20019223-33
14
??????????

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• ?????????????,?????????????????
• ??????????????????,?????????????????

15
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16
????????????(????)

• ????
• ??VIP, ??????????, ???????????,???????
• ??????
• ??????
• ??????
• ?????????????

???MBO??????????MBO??????????-??-?????????,???MBO
17
????????????(????)

• ????
• ???????????,???????
• ???????????????,????MBO??
• ???????(???????????????)?????????

18
??????????????

• ????
• ????????????
• ??????,?????????????????????????
• ??????????,??????,?????????????
• ???????????,?????????
• Ursula A. Matulonis?????????????????MBO???,???????
  ,????????????????????
• ???????????,????????1?????

19
???
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?????
?????
??
?????
????????
?????H20,Na,Cl-
?????? ??????
??????
?????
?????????? ????(PG) ??????(VIP) ????
Support Care Cancer 20019223-33
20
???
???????????
?????
????
?? ????????
????
????(VC) ???? ??? 5HT3
??? ?????(CTZ) ????? 5HT3
????
?????
??? -?????
Gastrointestinal Symptoms in terminal illness.
Denise I. Marshall, MD, CCFP
21
?????????

• ???????????,??????????
• ???????????(????????????????)?????(??????????)
• ????
• ?????????
• ?????

22
????????

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• ???????????,????????,??????????
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• ???????(?????)

23
???
??? D2????? H2????? ??????? 5-HT2??? 5-HT3??? 5-HT4???
????? - - -
???? - - - - -
???? - - - - -
???? - - - -
???? - - - - -
???? - - -
-??????????????????????100mg??5-HT3???
?
Palliative care - nausea/vomiting/malignant bowel
obstruction? http//www.prodigy.nhs.uk/palliative_
care_nausea_vomiting_malignant_bowel_obstruction/e
xtended_information/management_issues
24
????/?????
????
???
???? ?????? 40-120mg/d sc,iv ???????? 0.8-2.0mg/d
sc ????? 0.1-0.2mg tid sc ?iv
???? ????? 60-240mg/d sc ?????????????
????? ????5-15mg/d sc ??????6.25-50mg/d
sc ?????25mg,1?/8??,PR ????50-100mg,1?/8??,PR?IM
?
??????? ??? 0.20.6 mg/d SC ?????
20mg/?,1?/28?, ??2??,?????0.1mg
q8h, ???????????????,??????????1?????
???? ???? 100-150mg/d sc? 50mg 1?/8?? PR ????
50-100mg sd prn
Support Care Cancer 20019223-33
25
?????
?????????????
???????
?????
?????
??
?????
????????
?????H20,Na,Cl-
?????? ??????
??????
?????
?????????? ????(PG) ??????(VIP) ????
??????????(?)????? ???????????????? ?????????????
?,?MBO???,???????????????????
Support Care Cancer 20019223-33
26
???
?????????????
???????
?????
?????
??
?????
????????
?????H20,Na,Cl-
?????? ??????
??????
?????
?????????? ????(PG) ??????(VIP) ????
Support Care Cancer 20019223-33
27
???
?????????????,?????????????????????

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• ????
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• ?????????????,????????????????
• ??WHO?????

3
????? ??????? ????? ?????
2
????? ??????? ????? ?????
1
????? NSAID? ?????
Support Care Cancer 20019223-33
28
MBO????(1)-??????????
??MBO,????????????????????????,?????????????????
????? ????????????????????????????????????,????
-??-???????? -Sebastiano Mercadante, MD
THE JOURNAL OF SUPPORTIVE ONCOLOGY 2006483-84.
29
???????????MBO?????????????
Journal of Pain and Symptom Management
200428412-6
30
???????????????MBO????

• ?????????,??????
• -????1-5????,67?2????
• ??????
• -48???????
• ??????
• -???????????(75-187?)
• ??????
• -????,??????????????,???????????,??????
• ???????MBO??
• -3????????,????,???????????,????,???????

Journal of Pain and Symptom Management
200428412-6
31
????????MBO??

• ?????????,????????MBO????????????????????????????
  ????MBO?????????????????????????,??????

Journal of Pain and Symptom Management
200428412-6
32
???????????????MBO????

• 15???????MBO??
• ??????(IV)
• ???60 mg/?
• ???0.3 mg/?
• ????12 mg/?
• 50mL amidotrizoat

Journal of Pain and Symptom Management
200428412-6
33
???????MBO????1

• ?????????
• ???????0.3mg/?(0.1mgx3?????)
• ???60-120mg,???????
• ????4mg,3?/?,???????

???????????????????
Journal of Supportive Oncology 2004_2357-364
34
???????MBO????2

• ?????????-?????????
• ???0.3mg/?(tidx0.1mg)???????
• ????4mg tid,???????
• ???60-120mg,???????
• ????30-50ml,??

Journal of Supportive Oncology 2004_2357-364
35
???????MBO????3

• ???????????
• ????-???????????
• ?????
• ???0.3mg/?(tidx0.1mg)???????,???????????0.9mg/?
• ????2-5mg/?,???????
• ?????????????
• ?????????,???????

Journal of Supportive Oncology 2004_2357-364
36
MBO????????

• ??????????????
• ????MBO??,????????????
• ???????????????
• ????????????????
• ??????????24?????????,??????????????
• ????????????????
• ?????????????????

Support Care Cancer 20019223-33
37
??????

• MBO????????
• ??????????
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• ??????????????
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• MBO????????????????
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• ???????????

38
??

• MBO??????????????,??????????
• ???????????????
• ????????
• ????????????????????
• ?????MBO???????????
• ??????/?????
• ?????????????????????
• ????????
• ?????????
• ?????????-?????????

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