多原发大肠癌临床病理特点及诊治分析  

Clinicopathological characteristics and treatment of multiple primary colorectal carcinoma

作　　者：郭春梅 吴静 刘红 王亚丹 宿慧 Guo Chunmei;Wu Jing;Liu Hong;Wang Yadan;Su Hui(Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China)

机构地区：[1]首都医科大学附属北京世纪坛医院消化内科,100038

出　　处：《中华消化内镜杂志》2019年第10期731-736,共6页Chinese Journal of Digestive Endoscopy

基　　金：北京市科技计划课题(Z161100000116084).

摘　　要：目的探讨多原发大肠癌(MPCC)的临床病理特点及诊治。方法回顾性分析2008年1月至2017年3月首都医科大学附属北京世纪坛医院收治的42例MPCC患者的病历资料,对其临床病理特点及诊治进行总结。结果MPCC占同期大肠癌患者的7.1%(42/592),其中同时性多原发癌(SC)32例(76.2%)64处癌灶,异时性多原发癌(MC)10例(23.8%)20处癌灶,首发癌灶与再发癌灶间隔时间18~105个月。SC患者中高、中分化腺癌比例高于MC患者(P<0.05),而含黏液分泌腺癌比例低于MC患者(P<0.05)。2组患者肿瘤大小、发病部位、是否合并腺瘤、TNM分期、淋巴结转移及DNA错配修复状态,差异均无统计学意义(P>0.05)。42例患者均行根治性手术治疗,10例肠梗阻患者中,6例接受结肠支架桥接一期根治手术。结论MPCC以双发癌为主,主要分布在直肠、乙状结肠。对于MPCC患者中的低分化、结直肠黏液腺癌、合并结肠腺瘤者,应予结肠镜密切随访。结肠支架置入桥接一期切除术可提高SC的检出。Objective To investigate clinicopathological characteristics, diagnosis and treatment of multiple primary colorectal carcinoma (MPCC). Methods From January 2008 to March 2017, 42 patients diagnosed with MPCC underwent surgery at Beijing Shijitan Hospital, Capital Medical University. Their clinicopathological features, diagnosis and treatment were analyzed. Results These 42 MPCC patients accounted for 7.1%(42/592) colorectal cancer patients in the same period. There were 64 intestinal cancer lesions in 32 patients (76.2%) with synchronous carcinoma (SC), and 20 intestinal cancer lesions in 10 patients (23.8%) with metachronous carcinoma(MC), where the interval between the first and the recurrent was 18-105 months. The proportion of patients in the SC group with highly to moderately differentiated adenocarcinoma was significantly higher compared with that of the MC group (P<0.05), while the incidence of mucinous carcinoma was lower than that of the MC group(P<0.05). No significant differences were found with regard to tumor size, location, complications with adenoma, TNM stages, lymph nodes metastases or DNA mismatch repair between the SC group and the MC group(all P>0.05). Among 42 patients undergoing radical operation, 6 received colonic metallic stent implantation as a bridge to elective resection in 10 patients with colonic obstruction. Conclusion MPCC, mainly two-lesion cancer, is most commonly found in sigmoid colon and rectum. Those with poorly differentiated cancer, mucinous carcinoma and those complicated with adenoma should be closely followed up with colonoscopy. Colonic metallic stent implantation as a bridge to elective resection may improve the detection rate of SC.

关 键 词：结直肠肿瘤 肿瘤 多原发性 脱氧核糖核酸错配修复 同时性多原发癌 异时性多原发癌 

分 类 号：R735[医药卫生—肿瘤]