结直肠多原发癌的诊治

The diagnosis and treatment of multiple primary colorectal carcinoma

目的 探讨结直肠多原发癌的诊断与治疗。方法 通过4例病例并结合文献报道,讨论结直肠多原发癌的发病率、高危因素、诊断及治疗。结果 同时性结直肠多原发癌约占大肠癌2 %～6 % ,异时性结直肠多原发癌的发病率为0 . 6 %～9% ;其高危因素包括手术、放疗、遗传性非息肉病性结直肠癌和大肠多发腺瘤等;同时性结直肠多原发癌应避免漏诊,异时性结直肠多原发癌应避免误诊;常见手术方式有根治术、扩大根治术和全结肠切除术。结论 对该病应重视高危人群的监测,根治术加术后结肠镜长期随访是处理的适当选择。

Objective To discuss the diagnosis and treatment of multiple primary colorectal carcinoma(MPCC).Methods By studying of four cases with MPCC in our hospital and the papers published about this disease,we reviewed the incidence,high risk factors,diagnostic methods and therapeutic procedures of MPCC.Results The incidences of synchronous and metachronous multiple primary carcinoma were 2%～6%,0.6%～9%,respectively.The high risk factors of MPCC included surgical operation,radiotherapy,hereditary nonpolyposis colorectal cancer and multiple adenoma of large intestine.Synchronous multiple primary carcinoma was very easy to be missed-diagnosis and metachronous multiple primary carcinoma was likely to be misdiagnosis.Radical resection,extended radical resection and total colectomy were three main surgical operations.Conclusions It was very important to inspect the high risk population for early diagnosis of MPCC,and the radical resection and the long term follow-up using colonoscopy after operation were the proper management procedures of the disease.