5例结肠镜发现的肿块型回肠肿瘤临床诊治分析  

Clinical analysis of 5 cases of massive ileal tumor diagnosed by colonoscopy

作　　者：王苗苗 林琳[1] 刘红[1] 魏南[1] 姜国俊[1] 孟明明 吴静[1,2] WANG Miaomiao;LIN Lin;LIU Hong;WEI Nan;JIANG Guojun;MENG Mingming;WU Jing(Department of Gastroenterology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038;Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Di-gestive Diseases,Beijing Digestive Disease Center,Beijing Key Laboratory for Precancerous Lesion of Digestive Diseases,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,北京100038 [2]首都医科大学附属北京友谊医院消化内科,国家消化系统疾病临床医学研究中心,北京市消化疾病中心,消化疾病癌前病变北京市重点实验室

出　　处：《胃肠病学和肝病学杂志》2022年第3期285-289,共5页Chinese Journal of Gastroenterology and Hepatology

基　　金：北京市医院管理局消化内科学科协同发展中心专项经费资助(XXZ0105)

摘　　要：目的分析首都医科大学附属北京世纪坛医院结肠镜发现的肿块型回肠肿瘤的临床诊治情况。方法通过电子病历系统检索收集2010年1月至2019年12月在首都医科大学附属北京世纪坛医院住院的、诊治资料完整的、经结肠镜发现的回肠肿瘤患者(肿块型),共5例。收集所有患者的年龄、性别、临床表现、既往史、体征、实验室检查、腹部影像学检查、结肠镜结果、手术和术后病理、其他治疗和随访等,并进行分析。结果5例患者中,男3例,女2例,年龄28~58岁。腹痛、便血、排气排便减少、大便习惯改变为主要临床表现。4例腹部CT提示小肠-结肠型肠套叠,1例提示回盲部占位、伴肝转移。结肠镜提示:1例于回肠末端见一4 cm×3 cm大小分叶肿物,色稍红,于回盲瓣和小肠内滑进滑出;2例提示结肠肝曲肿物,头端2~4 cm大小,色红,表面黏液附着,可见“长蒂”(小肠绒毛)连接至回盲部,活检病理1例提示非霍奇金淋巴瘤、1例提示炎症;1例提示一累及回盲部和升结肠的巨大肿物,根部可见小肠绒毛样结构,活检病理提示炎症;1例提示回肠末端肿物,约占据1/2管腔,活检病理提示炎症。5例患者均经腹腔镜手术切除肿物,术后病理分别提示脂肪瘤、高级别B细胞淋巴瘤、炎症性肌纤维母细胞瘤、促纤维组织增生性小圆细胞肿瘤和神经纤维瘤。结论结肠镜发现的肿块型回肠肿瘤临床和内镜表现均无特征性,部分可出现小肠-结肠型肠套叠,腹部CT是重要的术前诊断方法,手术是重要的诊治手段,确诊需手术病理。Objective To analyze the clinical diagnosis and treatment of massive ileal tumors diagnosed by colonos-copy in Beijing Shijitan Hospital,Capital Medical University.Methods A total of 5 patients with massive ileal tumor diagnosed by colonoscopy in Beijing Shijitan Hospital,Capital Medical University from Jan.2010 to Dec.2019 were collected by electronic medical record system.The age,sex,clinical manifestation,past history,signs,laboratory ex-amination,abdominal imaging examination,colonoscopy results,surgery,histopathology,other treatment and follow-up were collected and analyzed.Results Among the 5 patients,there were 3 males and 2 females,ranging in age from 28 to 58 years old,with a median age of 55 years old.Abdominal pain,hematochezia,reduction of exhaust and defecation and change of defecation habits were the main clinical manifestations.Abdominal CT revealed intestinal-colon intussus-ception in 4 cases,and ileocecal mass with liver metastasis in 1 case.Colonoscopy revealed a lobulated mass of 4 cm×3 cm at the end of the ileum in one case,slipping in and out of the ileocecal valve and small intestine;in two cases,mass at the end of the colon with the size of 2-4 cm,red color,surface mucus attachment,″long pedicle″(intestinal villi)connected to the ileocecal part,biopsy pathology showed non-Hodgkin’s lymphoma in one case and inflammation in another;one case showed a huge tumor involving the ileocecum and ascending colon,the villous structure of the small intestine could be seen in the root,and the biopsy showed inflammation;and one tumor at the end of the ileum occupied about half a lumen,and the biopsy suggested inflammation.All the patients underwent a laparoscopic surgery to resect the tumor,and postoperative histopathology revealed lipoma,high-grade B-cell lymphoma,inflammatory myofibroblas-toma,desmoplastic small round cell tumor and neurofibroma.Patients with high-grade B-cell lymphoma received regular chemotherapy for half a year and achieved complete remission;patients with desmoplastic small r

关 键 词：小肠肿瘤 回肠 结肠镜 手术 肠套叠 

分 类 号：R735[医药卫生—肿瘤]