摘要
目的总结多原发结直肠癌(MPCC)的临床病理学特点、诊断、治疗及预后。方法回顾性分析1993年8月至2009年3月期间于中国医科大学附属第四医院和中国医科大学附属第一医院诊治的41例MPCC患者的临床资料。结果 41例MPCC患者占同期收治的结直肠癌患者的1.8%(41/2 340)。同时性MPCC(SCC)患者29例,其中经术前纤维结肠镜检查确诊者15例(51.7%),经术前纤维结肠镜、腹部CT及钡灌肠检查确诊者9例(31.0%),经术中探查及术中纤维结肠镜检查确诊者5例(17.2%);异时性MPCC(MCC)患者12例,次原发癌均经纤维结肠镜检查和CT检查确诊。41例MPCC患者合并腺瘤性息肉者19例,其中息肉恶变10例次;SCC患者的肿瘤部位倾向于从近端盲肠到远端直肠,而MCC患者的肿瘤部位恰好相反;病理组织学类型主要为管状或乳头状腺癌,占77.4%(65/84),以高中分化腺癌为主,占66.7%(56/84);TNM分期以Ⅱ或Ⅲ期为主,占85.7%(72/84)。37例行根治性手术,4例行姑息性手术,术后均无严重并发症发生。术后随访3～5年,平均3.6年,3年总生存率为48.8%(20/41),其中SCC为48.3%(14/29),MCC为50.0%(6/12);5年总生存率为34.1%(14/41),其中SCC为31.0%(9/29),MCC为41.7%(5/12)。结论 MPCC病因不清,但其发生可能与腺瘤性息肉有关。SCC患者应重视纤维结肠镜、腹部CT及钡灌肠检查相结合,必要时术中行纤维结肠镜检查;MCC患者应加强术后纤维结肠镜的随访。治疗上应争取早期行根治性切除术。
Objective To investigate the pathological features,diagnosis,treatment,and prognosis of multiple primary colorectal cancer（MPCC）.Methods Clinical data of 41 patients with MPCC treated in The Fourth Affiliated Hospital and The First Affiliated Hospital of China Medical University from Aug.1993 to Mar.2009 were retrospectively analyzed.Results Forty one patients with MPCC,including 29 patients with synchronous colorectal cancer（SCC） and 12 patients with metachronous colorectal cancer（MCC）,accounted for 1.8%（41/2 340） of colorectal cancer during the same period of time,and with adenomatous polyps in 19 cases and polyps canceration in 10 cases.Among 29 patients with SCC,15 cases（51.7%） were diagnosed by preoperative fiberoptic colonoscopy,9 cases（31.0%） were diagnosed by preoperative fiberoptic colonoscopy,abdomen CT,and barium enema,5 cases（17.2%） were diagnosed by intraoperative exploration and intraoperative fiberoptic colonoscopy,respectively.All of the 12 patients with MCC were diagnosed by preoperative fiberoptic colonoscopy and abdomen CT.For 29 patients with SCC,tumor locations were from proximal appendix to distal rectum,but 12 patients with MCC were adverse.Sixty-five（77.4%） tumors were tubular or papillary adenocarcinoma,and 56（66.7%） tumors were well and moderately differentiated adenocarcinoma.The TNM stage of most tumors（72） was stageⅡ or Ⅲ phase,account for 85.7%.Radical surgeries were performed in 37 patients and palliative surgeries in 4 patients,and there were no complications after operation.During the follow-up for 3-5 years（mear 3.6 years）,the overall survival rate of 3-and 5-year were 48.8%（20/41） and 34.1%（14/41）,respectively.In detail,3-year survival rate of SCC group and MCC group were 48.3%（14/29） and 50.0%（6/12）,respectively; 5-year survival rate were 31.0%（9/29） and 41.7%（5/12）,respectively.Conclusion sCause of MPCC has not been clear,but it has possible relationship with adenomatous polyps.Preoperative fiberoptic colonoscopy,abdomen CT,and barium enema are very important for patients with SCC,and intraoperative fiberoptic colonoscopy is also necessary.Patients with MCC should enhance postoperative follow-up with fiberoptic colonoscopy.Further more,radical resection should be performed as early as possible.
出处
《中国普外基础与临床杂志》
CAS
2012年第12期1323-1326,共4页
Chinese Journal of Bases and Clinics In General Surgery
关键词
多原发结直肠癌
诊断
治疗
预后
Multiple primary colorectal cancer
Diagnosis
Treatment
Prognosis
