11例肺癌小肠转移致小肠穿孔病例回顾性分析  

Retrospective analysis of 11 cases of small intestinal perforation secondary to small intestinal metastasis of lung cancer

作　　者：闵令强 陆静 贺宏勇[1] MIN Ling-qiang;LU Jing;HE Hong-yong(Department of General Surgery/Emergency Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Nursing,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院普通外科/急诊外科,上海200032 [2]复旦大学附属中山医院护理部,上海200032

出　　处：《复旦学报（医学版）》2024年第4期588-593,共6页Fudan University Journal of Medical Sciences

基　　金：国家自然科学基金(82373417);上海市自然科学基金(23ZR1409900);复旦大学附属中山医院临床研究专项基金(ZSLCYJ202343)。

摘　　要：目的分析肺癌小肠转移致小肠穿孔急诊手术患者的临床病例资料,探讨肺癌小肠转移穿孔的临床特点、诊疗策略以及预防措施。方法选取2018年1月至2023年6月在复旦大学附属中山医院急诊外科行肺癌小肠转移穿孔手术的11例患者的临床病例资料进行回顾性分析。分析指标包括年龄、性别、临床表现、合并症、既往史、术前影像检查结果、术前血检结果、治疗情况、手术方式、转移部位、穿孔部位、病理类型、住院时间和预后结局等。结果11位患者均因腹痛急诊就诊,腹痛时间8~96 h;10位患者白细胞≥9.5×109/L;8位患者中性粒细胞百分比≥90%;10位患者降钙素原(procalcitonin,PCT)≥0.05 ng/mL;11位患者C反应蛋白(C-reactive protein,CRP)≥5 mg/L。11位患者中空肠穿孔7例,回肠穿孔4例;10位患者行小肠部分切除术+肠肠吻合术,1位患者行小肠穿孔修补及空肠造瘘术;10位患者手术前正在行抗肿瘤药物治疗,其中有7位患者单纯接受了靶向治疗,2位患者单纯接受了化疗,1位患者同时接受靶向治疗和化疗。术后住院时间为4~71天,其中3位患者死亡,8位患者顺利出院。结论肺癌小肠转移致小肠穿孔主要为空肠穿孔且多数患者接受了靶向治疗。晚期肺癌患者应定期全面检查,尽早发现远处转移,以便尽早干预,避免发生严重并发症。Objective To analyze the clinical data of patients undergoing emergency operation for small intestinal perforation secondary to small intestinal metastasis of lung cancer and explore the clinical characteristics,treatment strategies,and preventive measures.Methods The clinical data of 11 patients who underwent emergency operation for small intestinal perforation secondary to small intestinal metastasis of lung cancer at the Department of Emergency Surgery,Zhongshan Hospital,Fudan University from Jan 2018 to Jun 2023 were selected for retrospective analysis.Analysis factors included age,gender,clinical manifestations,comorbidities,past history,preoperative imaging results,preoperative blood test results,treatment,surgical methods,metastasis sites,perforation sites,pathological types,hospitalization time,and prognostic outcomes.Results All of the 11 patients went to the emergency room with abdominal pain,and their duration of abdominal pain ranged from 8 to 96 hours.There were white blood cells≥9.5×109/L in 10 patients,neutrophil percentages≥90%in 8 patients,procalcitonin(PCT)≥0.05 ng/mL in 10 patients,and C-reactive protein(CRP)≥5 mg/L in 11 patients.Among the 11 patients,7 cases had jejunal perforation and 4 cases had ileal perforation;10 patients underwent partial small bowel resection and enter-enterostomy,and 1 patient underwent small bowel perforation repairment and jejunostomy;10 patients were receiving anti-tumor drug treatment before operation,of which 7 patients received targeted therapy alone,2 patients received chemotherapy alone,and 1 patient received both targeted therapy and chemotherapy.Postoperative hospitalization time ranged from 4 to 71 days,of which 3 patients died and 8 patients were discharged successfully.Conclusion Jejunum is the main perforation site of small intestinal perforation secondary to small intestinal metastasis of lung cancer.Patients with advanced lung cancer should have regular comprehensive examinations to detect distant metastases early.Early detection enables timel

关 键 词：肺癌 小肠转移 穿孔 

分 类 号：R734.2[医药卫生—肿瘤] R656.7[医药卫生—临床医学]