Malignant bowel obstruction (MBO) is a critical complication occurring in patients with advanced malignancy. Current treatments are both surgical and non-surgical, the latter including medical, endoscopic, and percutaneous approaches. Surgery is still the treatment of choice for MBO. However, almost 50% of patients are unfit for surgery because of poor performance status. Given the high post-operative mortality rate and the frailty of MBO patients, the least invasive surgical intervention is recommended. Therefore, recent multidisciplinary recommendations have suggested considering less invasive interventions instead of palliative surgery. Medical therapy, aiming to alleviate symptoms, is usually only a part of the therapeutic strategy when managing patients with MBO. Percutaneous techniques, including both interventional radiology and endoscopic procedures, are safe and effective for symptom relief, but often do not allow oral diet resumption. Endoscopic techniques are achieving a more relevant role for MBO treatment, as supported by the widening of the indication to colonic intraluminal stenting in the latest update of the European guidelines. Current data support the use of colonic stenting as both a bridge to surgery and the definitive treatment of malignant colonic obstruction. The development of endoscopic ultrasound-guided anastomotic techniques may offer the possibility of widening its applications to endoscopic treatment of MBO, allowing stenosis to be overcome, and reestablishing the continuity of the gastrointestinal tract in small bowel obstructions as well. The introduction of new interventional endoscopic techniques and their progressive diffusion will add the possibility to adopt minimally invasive solutions to treat a critical condition such as MBO.
恶性肠梗阻是晚期恶性肿瘤患者发生的一种严重并发症。当前治疗手段包括手术与非手术两类，后者涵盖药物、内镜及经皮介入等方法。手术仍是恶性肠梗阻的首选治疗方案。然而，近半数患者因体能状态不佳无法耐受手术。鉴于术后高死亡率及患者虚弱状态，建议采用创伤最小的外科干预方式。因此，近期多学科诊疗指南提出应考虑采用微创介入替代姑息性手术。旨在缓解症状的药物治疗通常仅是恶性肠梗阻综合治疗策略的组成部分。经皮介入技术（包括介入放射学与内镜操作）能安全有效地缓解症状，但常无法恢复经口进食。随着欧洲指南最新版将结肠腔内支架置入术的适应证扩大，内镜技术在恶性肠梗阻治疗中正发挥日益重要的作用。现有数据支持结肠支架置入术既可作为手术过渡桥梁，也可作为恶性结肠梗阻的确定性治疗。超声内镜引导下吻合技术的发展有望拓展内镜技术在恶性肠梗阻治疗中的应用范围，既能突破狭窄限制，也能在小肠梗阻中重建消化道连续性。新型介入内镜技术的引入及其逐步推广，将为恶性肠梗阻这类危重病症提供更多微创治疗方案选择。
Malignant Bowel Occlusion: An Update on Current Available Treatments
肿瘤(癌症)患者之家