多原发性大肠癌14例报告

目的:总结多原发性大肠癌诊治经验，提高多原发性大肠癌诊治水平。方法:回顾性分析23年来多原发性大肠癌14例临床资料。结果:14例中同时癌9例，异时癌5例。14例共37个癌灶，分布部位：乙状结肠8个，脾曲6个，横结肠6个，肝曲5个，升结肠3个，降结肠2个，直肠4个，盲肠3个。病理类型：腺癌19个，管状腺癌7个，黏液腺癌7个，乳头状腺癌2个，未分化癌1个，息肉恶变1个。Dukes分期：B期26个，C期10个，D期1个。14例中21例次手术，半结肠切除11例次，扩大左半结肠切除5例次，结肠次全切除2例次，全结肠切除2例次，姑息性切除1例次；无手术死亡。14例均随访1~19年，3例死于脑出血或自然死亡，11例至今生存4~17年。结论:多原发性大肠癌，只要及早发现，积极手术，预后好，异时癌比同时癌效果好。术式选择以半结肠或扩大半结肠切除为主，必要时才考虑全结肠切除。术后应定期结肠镜随访。

Multiple primary colorectal carcinoma:a report of 14 cases

Abstract:Objective:To summarize the experience of multiple primary colorectal carcinoma(MPCRC),to improve the level of diagnosis and treatment of MPCRC.Methods:The clinical data of 14 cases of MPCRC seen over a 23-year period were retrospectively analysed.Results:Amomg the 14 cases,9 cases were synchronous carcinomas and 5 cases were metachronous carcinomas.In the 14 patients,there were 37 carcinoma lesions and they were located as follows;8 lesions in the sigmoid colon,6 in the splenic flexure,6 in the transverse colon,5 in the hepatic flexure,3 in the ascending colon,9 in the desending colon,4 in the rectum and 3 in the cecum.Pathologic classification:19 were adenocarcinoma,7 were tubular adencarcinoma,7 were mucous adenocarcinoma,2 were papillary adenocarcinoma,1 was undifferentiated carcinoma,and 1 was polyp with malignant change.Duckes staging:stage B in 26 cancer lesions;stage C in 10 cancer lesions and stage D in 1 cancer lesion. A total of 21 operations were performed in the 14 patients,including hemicolectomy in 11 instances,extended hemicolectomy in 5,subtotal colectomy in 2,total colectomy in 2,and palliative resection in 1.There was no operative mortality.All 14 cases were followed up for 1~19 years;3 died of cerebral hemorrhage or natural causes.At present,11 patients have survived for 4~17 years.Conclusions:The prognosis of MPCRC is good,provided that it is detected early and operation is zealous.Metachronous carcinoma has a better result compared to synchronous carcinoma.The main operation of choice is hemicolectomy or extended hemicolectomy.Total colectomy is considered only when absolutely necessary.Regular postoperative colonoscopy followup should be done.