大肠非上皮来源恶性肿瘤诊治及疗效分析

Diagnosis and treatment of colorectal non-epithelial malignancies

目的 探讨大肠非上皮来源恶性肿瘤的临床病理学特征 ,以提高其诊治水平。方法回顾分析 1975～ 1996年间收治的大肠非上皮来源恶性肿瘤的临床病理学特征、治疗及预后。结果(1)本病缺乏特异临床表现 ,无典型脓血便、粘液血便等症状。 (2 )X线及内窥镜检查时无明显的粘膜破坏 ,往往仅提示外压性改变。 (3)诊断须依靠病理与临床相结合的方法确定。 (4)扩散方式以血行转移及局部复发为主 ,15例平滑肌肉瘤以及 6例淋巴肉瘤均有局部复发。 (5 )本病应以手术切除为主 ,局部复发者多数可再次甚至多次手术切除 ,除淋巴肉瘤外 ,对放、化疗不敏感。 (6 )生存率明显低于大肠癌。结论 本病缺乏特异性临床表现 ,往往易误诊、漏诊 ,术后易局部复发及血行转移。

Objective To summarize the experience in the diagnosis and treatment of colorectal malignancies of non epithelial origin. Methods Seventy five cases of colorectal non epithelial malignancy who had undergone treatment in our hospital from 1975 to 1996 were retrospectively analysed with their clinicopathologic characteristics, treatment and prognosis. Results Patients usually had no specific clinical manifectation, such as bloody purulent stool or mucous stool. No apparent mucosa darnage other than changes due to pressure from without was found on x ray and colonoscopic examinations. Diagnosis depended on pathology and clinical manifestations. Metastasis occurred mainly by hematogenous spread and local invasion. In this series, 21 cases (6 liomyosarcomas; 15 lymphosarcoma) had local recurrence. The principle treatment was operation, which was performed two or several times in patients with local recurrences. Except lymphosarcoma, the disease was not sensitive to chemotherapy or radiotherapy. The survival rate was significantly lower than that of colorectal cancers. Conclusion The disease is apt to be misdiagnosed or missed because it lacks specific symptoms. Local recurrence and hematogenous metastasis are common.