原发性空、回肠癌的诊治:附14例报告

Diagnosis and management of primary jejuno-ileal carcinoma: a report of 14 cases

目的探讨原发性空、回肠癌的临床特点及诊治,分析其主要预后因素。方法回顾性分析401医院2000年1月—2008年1月收治的14例空、回肠癌患者的临床特点、病理及术后随访资料。结果空、回肠癌男女均可发病,全组男∶女为1∶6;临床以腹痛、腹胀、便血、贫血、腹部包块及肠梗阻等症状为其主要表现。全组空肠癌9例,回肠癌5例,13例行癌肿切除术,其中5例行术后化疗2～6个周期,1例伴肝转移并腹水,仅行活检术并术后支持治疗。全组术前诊断率低于50%,术后3年生存率为50.0%;肿瘤分化程度越高、淋巴转移越少、距屈氏韧带越远,其术后生存率越高,反之则越低。结论空、回肠癌的术前诊断困难,需要B超,CT,内镜等辅助检查,手术切除仍是其主要治疗手段,肿瘤切除术后生存率高。

Objective To study the clinical features,diagnosis and management of primary jejuno-ileal carcinoma and to analyze its main prognostic factors. Methods The clinical,pathological and follow-up data of 14 patients with primary jejuno-ileal carcinoma,admitted to our hospital from January 2000 to January 2008,were retrospectively analyzed. Results Carcinoma of the jejunum and ileum occurred in both men and women,and the ratio of men to women in our data was 1∶6.The main clinical symptoms of the patients comprised abdominal pain,abdominal distension,hematochezia,anemia,abdominal mass and intestinal obstruction.Of the patients,9 cases had jejunal carcinoma and 5 cases had ileal carcinoma.Thirteen cases underwent tumor resection,of which 5 cases received 2-to 6-cycle of postoperative chemotherapy.One case,who had liver metastases and ascites,only underwent biopsy and subsequent supportive therapy.Of the whole group,the preoperative diagnotic rate was less than 50% and the 3-year survival rate was 50%.The better chance of survival of the patients after surgery was associated with better differentiated tumor type,less involvement of lymph nodes,and lesions distant from the ligament of Treitz,and vice versa. Conclusions The preoperative dagnosis of carcinoma of the jejunam and ileum is difficult and requires the B-ultrasounic,CT and endoscopic examinations.Surgical resection is still the main treatment method of this disease and the patients may have a better chance of survival after surgery.