多原发结直肠肿瘤的临床病理学分析

Clinical pathology analysis of 268 cases of multiple primary colorectal tumor

目的探讨多原发结直肠肿瘤的临床病理学特征。方法对1 749例结直肠癌患者中多原发结直肠肿瘤患者的268例进行回顾性分析。将这268例患者分为3组,即同时性多原发结直肠癌(SC)组,异时性多原发结直肠癌(MC)组,结直肠单发癌合并腺瘤性息肉组,对3组一般资料(年龄、性别)、临床病理学特征(包括肿瘤位置、肿瘤大体形态、组织病理学、肿瘤分期及浸润深度)进行分析。结果 268例患者中多原发结直肠癌共36例,占同期收治结直肠癌总数的2.05%(36/1 749),3组患者肿瘤位置、浸润深度、肿瘤分期差异无统计学意义(P>0.05)。癌灶好发部位为直肠及乙状结肠,同时性多原癌组低分化腺癌病例数明显高于其他2组,差异有统计学意义(P<0.05)。3组病理大体类型均以溃疡型为主,同时性多原癌浸润型癌灶数高于其他2组,差异有统计学意义(P<0.05)。腺瘤病理类型以管状腺瘤为主。结论多原发结直肠肿瘤以溃疡型多见,发病部位多位于直肠和乙状结肠,同时性多原发结直肠恶性肿瘤的恶性程度高,组织分化差,侵袭性强,多原发结直肠癌的发生与腺瘤性息肉关系密切。

Objective To analyze the clinical pathological features of multiple primary colorectal tumor. Methods Retrospec- tive analysis of 268 cases of muhiple primary colorectal tumors patients in our hospital between January 2007 and April 2012. The cases were divided into three groups：synchronous carcinoma group （SC） , synchronous carcinoma group （MC）, and colorectal single carcinoma with adenomatous polyp group. The general information （age, gender）, clinical pathological characteristic （including tumor location, tumor gross morphology, histopathology, tumor staging and infiltration depth） were analyzed. Results MPC were accounted for 2.05 % of the total number of colorectal cancer treated at the same period （36/1749）, three groups there were no significant difference （ P 〉 0.05 ） in tumor location, tumor staging and infiltration depth. The predilection site of cancer was rectum and sigmoid colon. The predilection site of adenomatous polyp was the sigmoid colon. Tumor stage of three groups was mainly in Dukes B period. In pathological type, cancer path- ological type was given priority to adeno - carcinoma, pathological types of adenomatous polyp with tubular adenoma and tubular avillous adenoma. About differentiation degree, three groups of cancer cases were given priority to moderately differentiated adenocarcinoma. Three groups of cases all merge adenomatous polyp in different level. Adenoma type was mainly about tubular adenoma. The poorly differentiated adenocarcinoma cases in group of SC were obviously higher than the other two groups （ P 〈 0.05 ）. Three groups of pathological types were mainly about ulcer type, and the cases of invasion type in the group of SC were higher than the other two groups （P 〈 0.05）. Conclusion The MPC occurs more in the rectum and sigmoid colon, the differentiated degree is main of moderately differentiated adeno- carcinoma, give priority to stage of Dukes B. SC malignant degree is higher than another two groups, Most cases of the MPC combine with adenomatous polyps, it is the independent risk factors of this disease. For multiple primary colorectal cancer should strengthen the preop- erative and intraoperative diagnosis, comprehensive evaluation,the application of multiple inspection electronic colonoscopy is the most re- liable, high diagnostic rate of examination means, but it must be combined with imaging,intraoperative comprehensive exploration, to pre- vent misdiagnosis. The patients with cancer merger adenomatous polyppostoperative need to regularly review the electronic colonoscopy af- ter operation, it must been treated if found adenomatous polyp early.