多原发大肠癌的临床诊断和外科治疗

目的 探讨多原发大肠癌的临床特点、诊断和治疗方法.方法 对1998-2007年收治的47例同时性多原发大肠癌和20例异时性多原发大肠癌患者的临床病理资料进行回顾性分析.结果 67例多原发大肠癌中同时性多原发大肠癌47例(占70%),其中直肠癌占39%.Dukes分期(以病理分期最晚的一个为准):A期6例,B期22例,C期15例,D期4例.67例中伴有淋巴结转移者20例,肠腔内伴有息肉者21例,无息肉者26例.行全结肠切除术3例,结肠次全切除术10例,根治性手术加肠段联合切除术34例.异时性多原发癌20例(占30%),共有癌灶44个,以结肠癌多见,共31例(占70%),二原发癌17例,三原发癌2例,四原发癌1例.与原发癌间隔时间7个月至19年,其中<2年者7例,2～5年者5例,>5年者8例.20例异时性多原发癌的初发癌均行根治性手术,14例二次癌和2例三次癌均行根治性切除术.同时性多原发大肠癌和异时性多原发癌初发癌根治术后5年生存率分别为74%和78%.结论 治疗大肠癌切忌满足于单一肠段或单个肿瘤的诊断和治疗,应利用结肠镜对全肠道进行仔细地检查,以便于及时发现大肠的多原发肿瘤;在根治性切除肠道肿瘤的同时应尽可能多地保留残存的正常肠道,从而更好地改善患者术后的生活质量.

Multiple primary colorectal carcinoma

Objective To investigate the diagnosis and surgical therapy of multiple primary colorectal carcinoma. Methods From 1998 to 2007, 47 patients with synchronous multiple primary colorectal carcinoma and 20 cases with metachronous carcinoma were treated in our hospital. Results In these 67 cases of multiple primary colorectal carcinoma, synchronous carcinoma (SC) accounted for 70% (47 cases) including 37 rectal cancer with a total of 95 larger bowel cancer lesions. There were 6 cases with Dukes A stage, 22 cases with Dukes B stage, 15 cases with Dukes C stage and 4 cases with Dukes D stage. In this whole group there were 20 cases with lymph node metastasis, 21 cases with adenoma and multiple polyps in SC. Three cases received total coloectomy, 10 cases did subtotal coloectomy, 34 cases were treated by radical resection and intestine segment resection. In 20 metachronous carcinoma cases, there were 31 colon cancer(70%) with a total of 44 intestinal cancer lesions. Altogether, there were 17 cases with two tumors, 2 cases with three tumors, one case with four tumors. The duration between the first and the last carcinoma was from 7 months to 19 years, including less than two years in 7 cases, from two to five years in 5 cases, and more than five years in 8 cases. In all 20 MC cases the first (primary) carcinoma received radical resection, while radical resection was performed for the secondary carcinoma in 14 cases and for the third carcinoma in 2 cases. In the SC and the primary carcinoma of MC patients who received radical resection, the 5-year survival rates were 74% and 78% respectively. Conclusion In cases of colonic carcinoma we shouldn't be satisfied with the diagnosis of single colon tumor before a thorough screening of the whole colon was made. In radical resection surgery for SC or MC cases an attempt to preserve enough residual intestinal tract should be made in order to improve the life quality of post-operative patients.