小肠转移性肿瘤的临床特点

The clinical characteristics of metastatic tumors in small intestine

分析小肠转移性肿瘤的临床特点。回顾性分析郑州大学第一附属医院2018年1月1日至2022年12月31日收治的小肠转移性肿瘤患者的临床表现、影像学和内镜检查结果、治疗方法和随访情况。共纳入10例患者,男7例,女3例,年龄33~77(56.4±12.6)岁。主要临床表现为肠梗阻(腹痛、腹胀、恶心、呕吐、排气排便减少等症状,8例),部分患者出现肠套叠(腹痛、呕吐、黑便等症状,1例)或消化道出血(1例),早期症状隐匿。原发肿瘤包括胃癌(3例)、恶性黑色素瘤(2例)、卵巢癌(2例)、结肠癌(1例)、直肠癌(1例)及肺癌(1例)等,多为低分化(6例)或中-低分化(2例)。原发肿瘤手术后距离发现小肠转移的中位时间[M(Q_(1),Q_(3))]为22(18,28)个月。转移病灶可为单发(6例)或多发(4例);空肠及回肠均可出现。正电子发射计算机断层显像(PET-CT,3例)及小肠镜检查(2例)有助于检出小肠转移。治疗方法以手术切除为主(9例),辅以放疗、靶向药物、免疫治疗等。术后部分患者(5例)出现复发转移。患者多在确诊后4~29个月内死亡。小肠转移性肿瘤临床少见,早期症状不典型,常因出现肠梗阻等并发症而就诊,易出现诊断延迟,预后不良。

To investigate the clinical characteristics of metastatic tumors in small intestine.The clinical manifestations,imaging and endoscopic findings,treatment methods and follow-up of patients with small bowel metastatic tumors admitted to the First Affiliated Hospital of Zhengzhou University from January 1,2018 to December 31,2022 were retrospectively analyzed.A total of 10 patients were included,including 7 males and 3 females,aged 33-77(56.4±12.6)years.The main clinical manifestations were intestinal obstruction(8 cases),such as abdominal pain,abdominal distension,nausea,vomiting,and reduced defecation.Some patients had intussusception(abdominal pain,vomiting,black stool and other symptoms,1 case)or gastrointestinal bleeding(1 case)with early symptoms imperceptible.The primary tumors include gastric cancer(3 cases),malignant melanoma(2 cases),ovarian cancer(2 cases),colon cancer(1 case),rectal cancer(1 case),and lung cancer(1 case).Most of the primary tumors were poorly differentiated(6 cases)or moderately to poorly differentiated(2 cases).The median time from primary tumor surgery to detection of small bowel metastasis[M(Q_(1),Q_(3))]was 22(18,28)months.The metastatic lesions were single(6 cases)or multiple(4 cases),in both jejunum and ileum.Positron emission tomography-computed tomography(PET-CT,3 cases)and endoscopy(2 cases)were helpful for detection of small intestinal metastases.The main treatment methods were surgical resection(9 cases),supplemented by radiotherapy,targeted drugs,immunotherapy,etc.Postoperative recurrence and metastasis occurred in some patients(5 cases).Most patients died within 4 to 29 months after diagnosis.Metastatic tumors in small intestine are rare in clinical practice with atypical early symptoms.The patients often present with complications such as intestinal obstruction,which is prone to delayed diagnosis and poor prognosis.