结直肠多原发癌的诊断及外科治疗

目的探讨结直肠多原发癌（MPCC）的诊断及治疗。方法对本院1997～2001年收治的1224例原发性结直肠癌病人中发现的28例（2.29%）MPCC病人的临床资料进行回顾性分析。结果本组28例MPCC中,同时多原发癌（SC）21例（1.72%）,异时多原发癌（MC）7例（0.57%）。共发现癌灶58处,癌灶部位以右半结肠、乙状结肠和直肠居多。21例SC中,术前行纤维结肠镜及钡灌肠检查发现12例,术中发现7例,术后3月内复查结肠镜发现2例。本组28例全部行手术治疗,其中行规范化的根治性手术22例,术后5年存活16例;6例行非根治性手术病人术后5年仅生存1例。结论术前行纤维结肠镜检查和术中仔细探查是提高SC发现率的重要手段,同时应强调结直肠单癌的术后随访以早期发现MC。早期诊断并行根治性切除是提高术后生存率的关键。

DIAGNOSIS AND SURGICAL TREATMENT OF MULTIPLE PRIMARY COLORECTAL CARCINOMA

Objective To explore the diagnosis and treatment of multiple primary colorectal carcinoma (MPCC). Methods A retrospective analysis was made on 28 patients with MPCC among 1 224 with colorectal carcinoma admitted from 1997 to 2001. Results Of 28 MPCC, 21 were synchronous carcinoma and seven were metachronous. A total of 58 foci of carcinoma was recorded, mostly lcated at right hemicolon, sigmoid colon or rectum. Of 21 cases of synchronous carcinoma, 12 were found by preoperative fibrocolonoscopy and barium enema, seven found during operation, and two found at three months by postoperative fibrocolonoscopy. All these 28 patients underwent operation; in which, a radical surgery was performed in 22, and 16 survived for five years; six underwent palliative resection with only one survived for five years. Conclusion Preoperative colonoscopy and careful intraoperative exploration are important in detection of synchronous carcinoma. A postoperative follow-up colonoscopy is essential to early detection of metachronous carcinoma. Early diagnosis and radical surgery is the key to improve the survival.