多原发结直肠癌168例临床分析

Clinical analysis of 168 cases of multiple primary colorectai carcinoma

目的分析研究多原发结直肠癌（MPCC）在结直肠癌中的发生率及其临床病理特征，分析其漏诊原因。方法对1985年1月至2003年12月收治的168例MPCC病例的临床和病理资料进行回顾性分析。结果168例MPCC占同期手术治疗结直肠癌的4．6％。其中同时多原发癌（SC）81例，异时多原发癌（MC）72例，SC并MC者15例。首次诊断结直肠癌的年龄为20～82岁，中位年龄58岁。168例中共发生结直肠癌393处（平均每例2．3处），病灶于直肠和乙状结肠多见，占61．6％。其中18例（10．7％）明确为遗传性非息肉病性结直肠癌（HNPCC），9例（5．4％）高度怀疑HNPCC。14例（8．3％）合并其他器官癌，72例（42．9％）为腺瘤癌变，另有41例（24．4％）同时合并腺瘤。96例SC中，术前行纤维肠镜检查91例，65例（71．4％）获得确诊。所有MC病例均为术后纤维肠镜检查发现。全组总体5年生存率为69．8％。结论纤维结肠镜检查在MPCC的诊断和随访中意义重大，有助于减少SC的漏诊和及时发现MC。对腺瘤的积极治疗有助于减少MPCC的发生。在MPCC中应重视HNPCC的检测和其他器官癌的监测。由于MPCC可以获得和首发癌相同的疗效，应重视积极的、规范化的手术治疗。

Objective To study the incidence rate of multiple primary colorectal carcinomas （MPCC） in colorectal carcinoma and to evaluate its clinical and pathological characteristics. Methods One hundred and sixty-eight （ 4. 6% ） patients from 3663 cases with colorectal carcinoma were diagnosed with MPCC from January 1985 to December 2003. The clinical data of the patients were collected retrospectively to investigate the diagnosis and treatment of MPCC. Results Of the 168 patients, 81 were diagnosed as synchronous colorectal carcinoma （SC） , 72 with metachronous colorectal carcinoma （MC） , 15 with both SC and MC. The median age at time of diagnosis of colorectal carcinoma was 58 years old （ range from 20 to 82 years old）. Three hundred and ninety-three cancer lesions were detected in these 168 cases （mean, 2. 3 lesions/case）. The rectum and sigmoid colon were the most involved sites （61.6%）. Eighteen cases （ 10. 7% ） were verified with hereditary non-polyposis colorectal cancer （ HNPCC ） while another 9 cases were highly suspected. Fourteen patients （8. 3% ） were found with other malignancies out of large intestine, 41 patients （24. 4% ） with colorectal adenomas, 72 （42.9%） with adenoma carcinogenesis. Among the 96 SC patients, 91 were given preoperative colonoscopy and 65 （71.4%） got the diagnosis. All the MC patients were diagnosed by postoperative colonoscopy. The overall 5-year survival rate of the 168 patients was 69. 8%. Conclusions MPCC should be paid more attention in colorectal cancer management. Colonoscopic surveillance is much more important in diagnosis and follow-up of MPCC for reducing the misdiagnosis of SC and detecting more MC in time. Prompt treatment of adenoma can reduce the occurrence of MPCC, and active and standard surgical treatment should be done for MPCC.