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目的探讨多原发大肠癌的发病原因、诊治方法及预后。方法回顾性分析6年来收治的18例多原发大肠癌患者的临床资料。结果多原发大肠癌发病率占同期收治大肠癌的2.87%(18/627),同时癌(SC)13例(2.07%),异时癌(MC)5例(0.8%)。8例(44.4%)伴发大肠多发腺瘤。SC结肠镜检、钡灌肠及CT检查诊断率分别为81.8%,50%,57.1%。SC术前诊断率84.6%,术中诊断率15.4%。MC第二原发癌术前诊断率100%,两原发癌间隔时间2～20年,其中≤3年占60%。12例SC根治性切除,1例姑息性切除;5例MC第二原发癌3例行根治性切除,2例姑息性切除。8例DukesA,B期生存良好;5例DukesD期中2例死亡,3例姑息性手术,带瘤生存,预后差。结论多原发大肠癌发病与大肠多发性腺瘤密切相关。提高对其认识,加强术前、术中诊断,结肠镜检查最可靠、诊断率最高。其外科治疗遵循大肠癌根治原则。早发现,早手术,预后较好。
Objective To investigate the pathogenesis, diagnosis and treatment of multiple primary colorectal cancer and its prognosis. Methods The clinical data of 18 patients with multi-primary colorectal cancer admitted in the past 6 years were retrospectively analyzed. Results The incidence of multiple primary colorectal cancer accounted for 2.87% (18/627) of colorectal cancer in the same period. There were 13 cases (2.07%) of cancers (SC) and 5 cases (0.8%) of metachronous cancers. 8 cases (44.4%) with multiple adenoma. The diagnostic rates of SC colonoscopy, barium enema and CT examination were 81.8%, 50% and 57.1% respectively. The preoperative diagnosis rate of SC was 84.6% and the intraoperative diagnosis rate was 15.4%. MC second primary cancer preoperative diagnosis rate of 100%, two primary cancer interval of 2 to 20 years, of which ≤ 3 years accounted for 60%. 12 cases of SC radical resection, 1 case of palliative resection; 5 cases of MC second primary cancer in 3 cases of radical resection, 2 cases of palliative resection. 8 cases of DukesA, B of good survival; 5 DukesD period 2 died, 3 cases of palliative surgery, with tumor survival, poor prognosis. Conclusions The incidence of multiple primary colorectal cancer is closely related to multiple adenomas of the large intestine. Improve their understanding and strengthen preoperative and intraoperative diagnosis, colonoscopy is the most reliable, the highest diagnostic rate. The surgical treatment of colon cancer follow the principle of radical. Early detection, early surgery, the prognosis is better.