晚期妇科肿瘤患者恶性肠梗阻的多学科治疗

IF 1.3 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2025-08-16 DOI:10.1016/j.jemermed.2025.04.040

Vikas Garg , Nazlin Jivraj , Bojan Macanovic , Pamela Soberanis Pina , Brooke Grant , Crystal Wang , Arundhati Shukla , Azieb Tesfu , Oyinlade Odujoko , Ainhoa Madariaga , Yeh Chen Lee , Lisa Wang , Ana Veneziani , Valerie Bowering , Robert C Grant , Neesha C. Dhani , Amit M. Oza , Stephanie Lheureux

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引用次数: 0

摘要

恶性肠梗阻（MBO）是晚期妇科癌症中一种使人衰弱的并发症，通常导致频繁的急诊就诊、长期住院和较差的生存结果。方法采用基于临床风险的分诊系统（包括标准化的肠道功能评估工具、肠道管理制度和患者和护士教育工具），开展一项前瞻性研究，评估主动MBO护理模式（MOC）的实施情况。管理遵循定义的算法，由一个由肿瘤学家、肿瘤学专科护士、外科医生、胃肠病学家、放射科医生、姑息治疗专家和营养师组成的跨学科团队（IDT）提供支持。“有MBO风险”的患者在长达4周的时间内接受RN主动电话治疗以控制症状。MBO患者，IDT告知治疗决策，包括住院干预或门诊管理，持续8周的RN主动电话管理。目的是优化MBO的跨学科管理。结果我们纳入了92例患者，其中49% （n=45）表现为MBO， 51% （n=47）被归类为“危险”。注册护士积极的门诊管理使93%的“高危”患者的症状得到缓解，7%的患者病情进展。在整个研究中，62% （n=57）的患者经历了MBO，其中93% （n=53）需要住院治疗。所有患者均在IDT查房中进行讨论。11% （n=6）的患者接受了手术干预，77% （n=44）的患者接受了化疗。42% （n=24）的患者在60天内出现MBO缓解。11% （n=6）经历了复发性MBO发作，58% （n=33）有持续症状。在MBO诊断后的前30天和60天内，中位住院时间分别为7天（范围0-30）和12.5天（范围0-57）。60天内存活天数与出院天数之比为0.3（范围0 ~ 19）。本研究证明了主动MBO MOC在门诊环境中的可行性，大多数患者作为门诊患者在跨学科支持下得到有效管理，从而减少住院率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Multidisciplinary Management of Malignant Bowel Obstruction in Patients with Advanced Gynecological Cancers

Background

Malignant bowel obstruction (MBO) is a debilitating complication in advanced gynecological cancers, often leading to frequent emergency visits, prolonged hospitalization and poor survival outcomes.

Methods

A prospective study was conducted to assess implementation of a proactive MBO model of care (MOC) using a clinical risk-based triage system which includes standardized bowel function assessment tools, a bowel management regime, and education tools for patients and nurses. Management followed a defined algorithm, supported by an interdisciplinary team (IDT) comprising of oncologists, specialized oncology nurses (RN), surgeons, gastroenterologists, radiologists, palliative care specialists, and dietitians. Patients “at risk” of MBO received RN proactive phone calls to manage symptoms for up to 4 weeks. Patients with MBO, IDT informed treatment decisions, including inpatient interventions or ambulatory management, with continued RN proactive phone call management for 8 weeks. The objective was to optimize interdisciplinary management of MBO.

Results

We enrolled 92 patients, with 49% (n=45) presenting with MBO and 51% (n=47) classified as "at risk". Proactive outpatient management by RN led to symptom resolution in 93% of "at-risk" patients, with 7% progressing. Throughout the study, 62% (n=57) of patients experienced MBO, of which 93% (n=53) required inpatient management. All patients were discussed in IDT rounds. Surgical intervention was performed in 11% (n=6) of patients, and 77% (n=44) received chemotherapy. MBO resolution occurred in 42% (n=24) of patients within 60 days. 11% (n=6) experienced recurrent MBO episodes, and 58% (n=33) had persistent symptoms. The median hospitalization durations were 7 days (range, 0–30) and 12.5 days (range, 0–57) within the first 30 and 60 days after MBO diagnosis respectively. The ratio of days alive and out of the hospital within 60 days was 0.3 (range, 0–19).

Conclusions

This study demonstrates the feasibility of a proactive MBO MOC in an ambulatory setting, with most patients effectively managed as an outpatient with interdisciplinary support, resulting in reduced hospitalization.

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来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine