| 50 | 0 | 47 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 对2019年制定的《中国癌症症状管理实践指南》(以下简称“指南”)中腹泻部分进行更新。方法 2024年8月—2025年8月，严格遵循国际指南更新流程，并以WHO标准指南制订方法学为依据进行指南更新。系统检索专业网站及数据库获取癌症患者腹泻症状管理的最佳证据。证据分级及推荐意见的制定采用推荐分级的评估、制定与评价(grading of recommendations assessment, development and evaluation, GRADE)方法学，通过专家共识法形成更新版指南。结果 更新版指南新增2条推荐意见，修改1条，并删除2条，共包括16条推荐意见，涵盖全面评估与监测、饮食指导、口服益生菌、口服硒补充剂、维生素E与维生素C补充等方面内容。结论 本指南的更新汇总了目前关于癌症患者腹泻症状管理的最新证据，可为临床医务人员和患者提供最新的循证决策依据，促进癌症治疗相关腹泻的规范化、精准化管理。
Abstract：Objective To update the diarrhea section of the Chinese Cancer Symptom Management Practice Guidelines developed in 2019(hereinafter referred to as the "Guidelines"). Methods From August 2024 to August 2025,the update of the Guideline was conducted in strict accordance with international guideline update procedures and based on the WHO standard guideline development methodology. Professional websites and databases were systematically searched to identify the best available evidence for the management of diarrhea in patients with cancer. Evidence grading and the formulation of recommendations followed the grading of recommendations assessment, development and evaluation(GRADE) methodology, and the updated Guidelines were finalized through an expert consensus process.Results The updated Guidelines added 2 new recommendations, revised 1 recommendation, and deleted 2 recommendations, resulting in a total of 16 recommendations. These recommendations covered comprehensive assessment and monitoring, dietary guidance, oral probiotics, oral selenium supplementation, and supplementation with vitamins E and C, among other aspects. Conclusion This update of the Guideline synthesizes the most recent evidence on the management of diarrhea in patients with cancer and provides up-to-date evidence-based decision-making support for healthcare professionals and patients, thereby promoting standardized and precise management of cancer treatment-related diarrhea.
[1] World Health Organization.Diarrhoeal disease.Fact sheet [EB/OL].(2024-03-07) [2025-01-22].https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease.
[2] BENSON A B 3rd,AJANI J A,CATALANO R B,et al.Recommended guidelines for the treatment of cancer treatment-induced diarrhea[J].Journal of Clinical Oncology,2004,22(14):2918-2926.
[3] STEIN A,VOIGT W,JORDAN K.Chemotherapy-induced diarrhea:pathophysiology,frequency and guideline-based management[J].Therapeutic Advances in Medical Oncology,2010,2(1):51-63.
[4] WANG L N,WANG X H,ZHANG G W,et al.The impact of pelvic radiotherapy on the gut microbiome and its role in radiation-induced diarrhoea:a systematic review[J].Radiation Oncology,2021,16(1):187.
[5] ALEEM A,SARIHAN M C,OKHUYSEN P C,et al.The impact of cancer-related diarrhea on changes in cancer therapy[J].Supportive Care in Cancer,2024,32(10):668.
[6] BOSSI P,ANTONUZZO A,CHERNY N I,et al.Diarrhoea in adult cancer patients:ESMO Clinical Practice Guidelines[J].Annals of Oncology,2018,29(S4):iv126-iv142.
[7] PETERSON D E,BOERS-DOETS C B,BENSADOUN R J,et al.Management of oral and gastrointestinal mucosal injury:ESMO Clinical Practice Guidelines for diagnosis,treatment,and follow-up[J].Annals of Oncology,2015,26:v139-v151.
[8] SLEIMAN J,WEI W,SHAH R,et al.Incidence of immune checkpoint inhibitor-mediated diarrhea and colitis (imDC) in patients with cancer and preexisting inflammatory bowel disease:a propensity score-matched retrospective study[J].Journal for Immunotherapy of Cancer,2021,9(6):e002567.
[9] VERNOOIJ R W,ALONSO-COELLO P,BROUWERS M,et al.Reporting items for updated clinical guidelines:checklist for the reporting of updated guidelines (CheckUp)[J].PLoS Medicine,2017,14(1):e1002207.
[10] GRAHAM R W.Clinical practice guidelines we can trust [M].Washington (DC):National Academies Press,2011.
[11] World Health Organization.WHO Handbook for Guideline Development[M].2nd ed.Gemeva:World Health Organization,2014.
[12] GUYATT G,OXMAN A,KUNZ R,等.GRADE:从证据到推荐[J].中国循证医学杂志，2009,9(3):257-259.GUYATT G,OXMAN A,KUNZ R,et al.GRADE:going from evidence to recommendations[J].Chinese Journal of Evidence-Based Medicine,2009,9(3):257-259.
[13] BROUWERS M C,KHO M E,BROWMAN G P,et al.AGREE II:advancing guideline development,reporting and evaluation in health care[J].Journal of Clinical Epidemiology,2010,63(12):1308-1311.
[14] CHEN Y L,YANG K H,MARUŠIC A,et al.A reporting tool for practice guidelines in health care:the RIGHT statement[J].Annals of Internal Medicine,2017,166(2):128-132.
[15] 张方圆，沈傲梅，曾宪涛，等.系统评价方法学质量评价工具AMSTAR 2解读[J].中国循证心血管医学杂志，2018,10(1):14-18.ZHANG F Y,SHEN A M,ZENG X T,et al.An Introduction to AMSTAR 2:a critical appraisal tool for systematic reviews[J].Chinese Journal of Evidence-Bases Cardiovascular Medicine,2018,10(1):14-18.
[16] HIGGINS J P,ALTMAN D G,G∅TZSCHE P C,et al.The Cochrane Collaboration's tool for assessing risk of bias in randomised trials[J].BMJ,2011,343:d5928.
[17] WELLS G A,SHEA B J,O'CONNELL D,et al.The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis[J].Appl Eng Agric,2014,18(6):727-734.
[18] JAESCHKE R,GUYATT G H,DELLINGER P,et al.Use of GRADE grid to reach decisions on clinical practice guidelines when consensus is elusive[J].BMJ,2008,337:a744.
[19] WANG Q,HE M X,LIANG J,et al.Chinese guidelines for integrated diagnosis and treatment of intestinal microecology technologies in tumor application (2024 Edition)[J].Journal of Cancer Research and Therapeutics,2024,20(4):1130-1140.
[20] National Comprehensive Cancer Network.NCCN Clinical Practice Guideline in Oncology:management of immunotherapy-related toxicities [EB/OL].(2025-10-23) [2026-02-03].https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf.
[21] HAANEN J,OBEID M,SPAIN L,et al.Management of toxicities from immunotherapy:ESMO Clinical Practice Guideline for diagnosis,treatment and follow-up[J].Annals of Oncology,2022,33(12):1217-1238.
[22] 张慧，章真，袁双虎.放射性直肠损伤的预防与治疗临床实践指南[J].中华肿瘤防治杂志，2023,30(5):245-259.ZHANG H,ZHANG Z,YUAN S H.Clinical practice guide for prevention and treatment of radiation-induced rectal injury[J].Chinese Journal of Cancer Prevention and Treatment,2023,30(5):245-259.
[23] Oncology Nursing Society.Putting Evidence into practice:chemotherapy-induced diarrhea and radiation-induced diarrhea,2019 [EB/OL].(2024-01-01) [2025-01-22].https://www.ons.org/pep/chemotherapy-induced-diarrhea.
[24] 中华医学会外科学分会结直肠外科学组，中国医师协会外科医师分会结直肠外科医师委员会，中国抗癌协会大肠癌专业委员会，等.中国放射性直肠损伤多学科诊治专家共识(2021版)[J].中华胃肠外科杂志，2021,24(11):937-949.The Colorectal Surgery Group of the Surgical Branch of the Chinese Medical Association,The Committee of Colorectal Surgeons,Division of General Surgery of Chinese Medical Doctor Association,The Colorectal Cancer Professional Committee of the Chinese Anti-Cancer Association,et al.Chinese expert consensus on multidisciplinary diagnosis and treatment of radiation rectal injury(2021 edition)[J].Chinese Journal of Gastrointestinal Surgery,2021,24(11):937-949.
[25] 中国消化杂志编委会.双歧杆菌三联活菌散/胶囊应用于消化系统疾病的中国专家共识(2021版)[J].胃肠病学，2022,27(8):470-485.Editorial Board of Chinese Journal of Digestion.Chinese expert consensus on application of live combined bifidobacterium,lactobacillus and enterococcus powder/capsule in digestive system diseases(version 2021)[J].Chinese Journal of Gastroenterology,2022,27(8):470-485.
[26] 中国抗癌协会肿瘤营养专业委员会，中华医学会肠外肠内营养学分会.肿瘤相关性腹泻的营养治疗专家共识[J].肿瘤代谢与营养电子杂志，2023,10(6):738-742.Chinese Society of Nutritional Oncology Chinese Society for Parenteral and Enteral Nutrition,Chinese Society of Nutritional OncologyChinese Society for Parenteral and Enteral Nutrition.Expert consensus on tumor-associated diarrhea[J].Electronic Journal of Metabolism and Nutrition of Cancer,2023,10(6):738-742.
[27] Blood,Marissa.Chemotherapy:diarrhea management [EB/OL].(2022-12-20) [2025-01-22].http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=jbi&NEWS=N&AN=JBI965.
[28] YAO Z Q,XU Z B,XU T L,et al.Moxibustion for alleviating chemotherapy-induced gastrointestinal adverse effects:a systematic review of randomized controlled trials[J].Complementary Therapies in Clinical Practice,2022,46:101527.
[29] CHITAPANARUX I,CHITAPANARUX T,TRAISATHIT P,et al.Randomized controlled trial of live lactobacillus acidophilus plus bifidobacterium bifidum in prophylaxis of diarrhea during radiotherapy in cervical cancer patients[J].Radiation Oncology,2010,5(1):31.
[30] DELIA P,SANSOTTA G,DONATO V,et al.Use of probiotics for prevention of radiation-induced diarrhea[J].World Journal of Gastroenterology,2007,13(6):912-915.
[31] DEMERS M,DAGNAULT A,DESJARDINS J.A randomized double-blind controlled trial:impact of probiotics on diarrhea in patients treated with pelvic radiation[J].Clinical Nutrition,2014,33(5):761-767.
[32] GIRALT J,REGADERA J P,VERGES R,et al.Effects of probiotic lactobacillus casei DN-114 001 in prevention of radiation-induced diarrhea:results from multicenter,randomized,placebo-controlled nutritional trial[J].International Journal of Radiation Oncology Biology Physics,2008,71(4):1213-1219.
[33] CASTRO M G,SANCHEZ P X,GLASBERG J,et al.p112 effects of probiotic in prevention of radiation-induced diarrhea[J].Clinical Nutrition Supplements,2009,4(2):72-73.
[34] LACOUTURE M E,KEEFE D M,SONIS S,et al.A phase Ⅱ study (ARCHER 1042) to evaluate prophylactic treatment of dacomitinib-induced dermatologic and gastrointestinal adverse events in advanced non-small-cell lung cancer[J].Annals of Oncology,2016,27(9):1712-1718.
[35] OKAWA T,NIIBE H,ARAI T,et al.Effect of LC9018 combined with radiation therapy on carcinoma of the uterine cervix.A phase Ⅲ,multicenter,randomized,controlled study[J].Cancer,1993,72(6):1949-1954.
[36] SALMINEN E,ELOMAA I,MINKKINEN J,et al.Preservation of intestinal integrity during radiotherapy using live Lactobacillus acidophilus cultures[J].Clinical Radiology,1988,39(4):435-437.
[37] MEGO M,CHOVANEC J,VOCHYANOVA-ANDREZALOVA I,et al.Prevention of irinotecan induced diarrhea by probiotics:a randomized double blind,placebo controlled pilot study[J].Complementary Therapies in Medicine,2015,23(3):356-362.
[38] ÖSTERLUND P,RUOTSALAINEN T,KORPELA R,et al.Lactobacillus supplementation for diarrhoea related to chemotherapy of colorectal cancer:a randomised study[J].British Journal of Cancer,2007,97(8):1028-1034.
[39] 敖苗，刘玉峰.不同剂型益生菌预防儿童急性淋巴细胞白血病化疗所致腹泻的比较[J].临床儿科杂志，2012,30(10):932-934.AO M,LIU Y F.The preventive effect of different types of probiotics on chemotherapy-induced diarrhea in children with acute lymphocytic leukemia[J].Journal of Clinical Pediatrics,2012,30(10):932-934.
[40] 方立萍，吴紫权，宋晨，等.双歧杆菌活菌胶囊预防CPT-11引起的化疗相关性腹泻的疗效观察[J].中国微生态学杂志，2011,23(3):241-242.FANG L P,WU Z Q,SONG C,et al.A clinical trial on preventive efficacy on CPT-11-induced diarrhea by bifidobacterium capsules[J].Chinese Journal of Microecology,2011,23(3):241-242.
[41] 刘基巍，周涛，张洁，等.双歧杆菌DM-8504活菌制剂预防化疗引起的腹泻疗效观察[J].中国微生态学杂志，2000,12(3):178-179.LIU J W,ZHOU T,ZHANG J,et al.Prophalyxis of chemotherapy-induced diarrea by bifidobacterium agent[J].Chinese Journal of Microecology,2000,12(3):178-179.
[42] 庄贤栩，裴仁治，陆滢，等.双歧杆菌三联活菌胶囊对白血病化疗所致腹泻患者肠黏膜屏障功能的影响及疗效观察[J].中国医药导报，2015,12(3):110-113.ZHUANG X X,PEI R Z,LU Y,et al.Influence and curative effect observation of Bifid Triple Viable Capsules on intestinal mucous membrane barrier function of patients with leukemia chemotherapy induced diarrhea[J].China Medical Herald,2015,12(3):110-113.
[43] 张素芳.益生菌治疗消化道肿瘤化疗相关性腹泻的疗效观察[J].中国实用医药，2014,9(30):138-139.ZHANG S F.Observation on the therapeutic effect of probiotics on chemotherapy-related diarrhea of digestive tract tumor[J].China Practical Medicine,2014,9(30):138-139.
[44] 谭国柱，杨福利，刘强.枯草杆菌肠球菌二联活菌胶囊治疗化疗相关性腹泻疗效观察[J].山东医药，2010,50(26):59.TAN G Z,YANG F L,LIU Q.Clinical observation on the treatment of chemotherapy-related diarrhea with Bacillus subtilis enterococcus bifidus capsules[J].Shandong Medical Journal,2010,50(26):59.
[45] 宁方颖.双歧杆菌三联活菌胶囊对化疗相关性腹泻患者肠黏膜屏障功能的保护作用[J].中国微生态学杂志，2014,26(7):812-814.NING F Y.Protective effect of Bifid Triple Viable Capsules on intestinal mucosal barrier function in patients with chemotherapy-induced diarrhea[J].Chinese Journal of Microecology,2014,26(7):812-814.
[46] 张冬梅，陈嫒，王蓉，等.益生菌治疗化疗相关性腹泻的前瞻性研究[J].临床消化病杂志，2013,25(1):20-22.ZHANG D M,CHEN A,WANG R,et al.Prospective study of the effect of probiotic on chemotherapy-induced diarrhea[J].Chinese Journal of Clinical Gastroenterology,2013,25(1):20-22.
[47] WANG Y H,YAO N,WEI K K,et al.The efficacy and safety of probiotics for prevention of chemoradiotherapy-induced diarrhea in people with abdominal and pelvic cancer:a systematic review and meta-analysis[J].European Journal of Clinical Nutrition,2016,70(11):1246-1253.
[48] URBANCSEK H,KAZAR T,MEZES I,et al.Results of a double-blind,randomized study to evaluate the efficacy and safety of Antibiophilus in patients with radiation-induced diarrhoea[J].European Journal of Gastroenterology & Hepatology,2001,13(4):391-396.
[49] HENRIKSSON R,FRANZÉN L,SANDSTRÖM K,et al.Effects of active addition of bacterial cultures in fermented milk to patients with chronic bowel discomfort following irradiation[J].Supportive Care in Cancer,1995,3(1):81-83.
[50] REDMAN M G,WARD E J,PHILLIPS R S.The efficacy and safety of probiotics in people with cancer:a systematic review[J].Annals of Oncology,2014,25(10):1919-1929.
[51] MUECKE R,MICKE O,SCHOMBURG L,et al.Impact of treatment planning target volumen (PTV) size on radiation induced diarrhoea following selenium supplementation in gynecologic radiation oncology-a subgroup analysis of a multicenter,phase III trial[J].Radiation Oncology,2013,8(1):72.
[52] KENNEDY M,BRUNINGA K,MUTLU E A,et al.Successful and sustained treatment of chronic radiation proctitis with antioxidant vitamins E and C[J].The American Journal of Gastroenterology,2001,96(4):1080-1084.
[53] NIKI E,NOGUCHI N,TSUCHIHASHI H,et al.Interaction among vitamin C,vitamin E,and beta-carotene[J].The American Journal of Clinical Nutrition,1995,62(6):1322S-1326S.
[54] LAWRIE T A,GREEN J T,BERESFORD M,et al.Interventions to reduce acute and late adverse gastrointestinal effects of pelvic radiotherapy for primary pelvic cancers[J].Cochrane Database of Systematic Reviews,2018,1(1):CD012529.
[55] SHUKLA P,GUPTA D,BISHT S S,et al.Circadian variation in radiation-induced intestinal mucositis in patients with cervical carcinoma[J].Cancer,2010,116(8):2031-2035.
[56] CHANG L,LI L,LI W H,et al.Research on radiotherapy at different times of the day for inoperable cervical cancer[J].International Journal of Clinical Pharmacology and Therapeutics,2016,54(11):856-864.
[57] 包婷婷，肖尧.艾灸联合洛哌丁胺治疗化疗相关性腹泻的临床观察[J].湖北中医杂志，2014,36(9):55.BAO T T,XIAO Y.Clinical observation on moxibustion combined with loperamide in the treatment of chemotherapy-related diarrhea[J].Hubei Journal of Traditional Chinese Medicine,2014,36(9):55.
[58] 陈彩凤.艾灸法治疗癌相关性腹泻18例[J].中国中西医结合消化杂志，2012,20(11):514-515.CHEN C F.Moxibustion therapy for 18 cases of cancer-related diarrhea[J].Chinese Journal of Integrated Traditional and Western Medicine on Digestion,2012,20(11):514-515.
[59] 朱莲玉，王红，李育军，等.灸法联合中药保留灌肠对胃肠道恶性肿瘤患者化疗相关性腹泻的护理研究[J].护士进修杂志，2016,31(13):1201-1202.ZHU L Y,WANG H,LI Y J,et al.Nursing study on moxibustion combined with traditional Chinese medicine retention enema for chemotherapy-related diarrhea in patients with gastrointestinal malignant tumor[J].Journal of Nurses Training,2016,31(13):1201-1202.
[60] BROWN M S,BUCHANAN R B,KARRAN S J.Clinical observations on the effects of elemental diet supplementation during irradiation[J].Clinical Radiology,1980,31(1):19-20.
[61] CRAIGHEAD P S,YOUNG S.Phase II study assessing the feasibility of using elemental supplements to reduce acute enteritis in patients receiving radical pelvic radiotherapy[J].American Journal of Clinical Oncology,1998,21(6):573-578.
[62] OKADA T,NAKAJIMA Y,NISHIKAGE T,et al.A prospective study of nutritional supplementation for preventing oral mucositis in cancer patients receiving chemotherapy[J].Asia Pacific Journal of Clinical Nutrition,2017,26(1):42-48.
[63] MCGOUGH C,WEDLAKE L,BALDWIN C,et al.Clinical trial:normal diet vs.partial replacement with oral E028 formula for the prevention of gastrointestinal toxicity in cancer patients undergoing pelvic radiotherapy[J].Alimentary Pharmacology & Therapeutics,2008,27(11):1132-1139.
[64] 梁平，王玉栋，侯娟，等.奥曲肽防治肿瘤放化疗相关性腹泻的系统评价[J].肿瘤，2015,35(12):1359-1367.LIANG P,WANG Y D,HOU J,et al.Prophylactic and therapeutic role of octreotide in controlling chemoradiotherapy-induced diarrhea:a systematic review[J].Tumor,2015,35(12):1359-1367.
基本信息:
DOI：10.16821/j.cnki.hsjx.2026.09.001
中图分类号:R473.73
引用信息:
[1]中国抗癌协会整合护理工作委员会 ,张柳柳,邾萍,等.《中国癌症症状管理实践指南》更新——腹泻[J].护士进修杂志,2026,41(09):897-905.DOI:10.16821/j.cnki.hsjx.2026.09.001.
基金信息:
江苏省肿瘤医院群峰计划项目(编号：DFXK202507); 江苏省卫生健康委科研课题(编号：BJ23023); 江苏省医院协会医院管理创新研究课题(编号：JSYGY-3-2025-321)
2026-05-15
2026-05-15