多原发结直肠癌63例临床分析

目的探讨多原发结直肠癌(MPCC)的临床病理特点、诊断、治疗及预后。方法回顾性总结本院63例MPCC患者的临床资料,分析肿瘤发生、分布及治疗与预后。结果 MPCC占同期收治的结直肠癌的2.1%(63/3021),其中同时性结直肠癌(SC)31例(49.2%),异时性结直肠癌(MC)32例(50.8%)。男女比例为2.5∶1。癌灶分布以直肠、乙状结肠为多。病理类型以腺癌为多,占77.8%(105/135);黏液腺癌次之,占13.3%(18/135)。TNM分期以Ⅱ期最多,占47.4%(64/135)。术前纤维结肠镜诊断34例(54.0%)。SC组术前纤维结肠镜诊断12例(38.7%),术中探查诊断12例(38.7%);MC组术前纤维结肠镜诊断22例(68.7%),术中探查诊断2例(6.25%)。SC组术后5年生存率为45%(9/20),MC组首次癌术后5年生存率为72.4%(21/29)。结论 MPCC与结直肠腺瘤之间有密切关系,应重视纤维结肠镜随访,对合并的腺瘤或息肉,应及时治疗,防止腺瘤癌变,减少异时癌的发生。诊断上对于结直肠癌患者应着重强调术前纤维结肠镜活检;治疗上应争取早期行根治性切除术。

Clinical analysis of 63 cases of multiple primary colorectal carcinoma

Objective To investigate the clinicopathological features, diagnosis, treatment and prognosis of multiple primary colorectal carcinoma（MPCC）. Methods A retrospective analysis was made on 63 patients with MPCC admitted to our hospital from Jan. 1993 to Jan. 2007. Results 63 patients with MPCC accounted for 2. 1% （63/3 021） of the cases of colorectal carcinoma during the same period of time,including 31 cases with synchronous careinoma（SC） 49.2% and 32 cases with metachronous carcinoma（MC） 50.8%. The ratio between male and female was 2.5 ： 1. Most tumors were located in rectum and sigmoid colon. Pathological types of 77.8 % （105/135）were adenoearcinoma and 13.30//oo （18/135）were mucinous adenocarcinoma. The TNM stage of most tumors was stage 11 （64/ 135）. A total of 34 cases （54. 0%） were diagnosed by preoperative fiberoptic colonoscopy. In SC group, 12 cases （38.7%） were diagnosed by preoperative fiberoptic colonoscopy, 12 cases （38.7 % ） by intraoperative exploration; in MC group,22 cases （68.7%） were diagnosed by preoperative fiberoptic colonoscopy,and 2 cases （6.25%） by intrao- perative exploration. The overall 5-year survival rates of the patients in SC and MC groups were 45% （9/20） and 72. 4%（21/29） respectively. Conclusion MPCC has close relationship with colorectal adenoma,therefore follow-up by fiheroptie eolonoscopy should be attached and complicated adenoma or polypus should be treated timely to prevent malignant change so as to reduce MC incidence in the end. Preoperative fiberoptic colonoscopy and biopsy should be highlighted for patients with colorectal carcinoma in diagnosis. Radical excision should be performed timely in treatment.