35例同时性多原发结直肠癌患者临床诊疗分析  

Clinical analysis of diagnosis and surgical treatment of 35 patients with synchronous colorectal cancer

作　　者：汪栋 金岚 姚宏伟 王今 赵晓牧 吴国聪 杨盈赤 张忠涛 Wang Dong;Jin Lan;Yao Hongwei;Wang Jin;Zhao Xiaomu;Wu Guocong;Yang Yingchi;Zhang Zhongtao(Sub-center of General Surgery of National Clinical Medicine Research Center of Digestive System Diseas;Department of General Surgery, Beijing Friendship Hospital, Capital Medical Universit;General Surgery Department, Capital Medical University, Beijing 100050, Chin)

机构地区：[1]国家消化系统疾病临床医学研究中心普外分中心首都医科大学附属北京友谊医院普外科首都医科大学普通外科学系,北京100050

出　　处：《首都医科大学学报》2018年第3期413-417,共5页Journal of Capital Medical University

基　　金：国家科技支撑计划课题(2015BAI13B09);北京市医管局临床医学发展专项经费资助(ZYLX201504);北京市卫生系统高层次卫生技术人才培养计划资助项目(2015-3-005)~~

摘　　要：目的探讨同时性多原发结直肠癌(synchronous colorectal cancer,SCRC)的诊断、病理特征、治疗及预后。方法回顾分析2008年1月至2016年12月期间首都医科大学附属北京友谊医院收治的同时性多原发结直肠癌患者的临床资料及病理特征,并结合随访资料进行预后分析。结果符合标准的同时性多原发结直肠癌患者共35例,双原发癌34例,三原发癌1例,34例为一次诊断,1例为术后3个月二次诊断。钡灌肠检查检出率为60.9%,结肠镜检出率为70%,结合影像学与结肠镜结果检出率为91.4%。71处瘤灶的病理分析显示,腺癌最多,占70.4%(50/71),其中中低分化腺癌占54.9%(39/71)。32例患者接受手术治疗,其中标准肠癌根治术5例,扩大肠癌根治术10例,分段肠癌根治术10例,全/次全结肠切除术7例。随访结果显示术后5年生存率为59.4%,复发率为28.1%。结论 SCRC多为双发癌,且瘤灶以腺癌居多,结肠镜配合多种影像检查可提高SCRC检出率。根据患者肿瘤具体情况,选择合适手术方式,可能取得较为满意的治疗效果。Objective To study the diagnosis,clinicopathological features,treatment,and prognosis of synchronous colorectal cancer（ SCRC）. Methods The clinical data and pathological features of the patients with SCRC admitted to Beijing Friendship Hospital,Capital Medical University from January 2008 to December 2016 were retrospectively analyzed. Results According to the inclusion criteria,35 cases with SCRC were enrolled. Of which,Thirty-four cases were double primary carcinoma and one was triple primary carcinoma. 34 cases were first diagnosed and one was second diagnosed on three months after surgery. The detection rate of barium enema examination and colonoscopy was 60. 9% and 70%,respectively while combination of colonoscopy and multiple imaging techniques increased the rate to 91. 4%. Pathological analysis of the 71 tumor lesions suggested that adenocarcinoma accounted for 70. 4%（ 50/71）and low/middle differentiated adenocarcinoma accounted for 54. 9%（ 39/71）. Thirty-two cases were treated with surgery,of which,5 cases were treated with standard radical resection,10 cases with extensive radical resection,10 cases with regional radical resection,and7 cases with total/subtotal colectomy. The postoperative 5 year survival rate was 59. 4% and recurrence rate was 28. 1%. Conclusion SCRC was mostly double primary carcinoma with adenocarcinoma as the dominative pathological type. Combining the results of multiple imaging examinations and colonoscopy may increase the detection rate of SCRC. Choosing appropriate surgical methods according to the specific situations of SCRC may improve the therapeutic efficacy of the patients.

关 键 词：同时性多原发结直肠癌 诊断 病理特征 外科治疗 预后 

分 类 号：R735[医药卫生—肿瘤]