同时性多原发结直肠癌临床诊治分析

Clinical analysis of synchronous multiple primary colorectal carcinomas

目的探讨同时性多原发结直肠癌的临床特征及诊治经验。方法回顾性分析我院2009年1月-2015年3月同时性多原发结直肠癌患者的临床资料。结果经计算机病案管理系统共检索出28例同时性多原发结直肠癌,其中男16例,女12例,平均发病年龄59.85岁;双原发癌19例,三原发癌6例,四原发癌3例;病理类型以腺癌为主;23例术前经全结肠镜检查后确诊,5例术中经补充诊断或术后病理确诊;所有病例均行一期手术切除:27例行根治性切除,1例行姑息性切除;共26例获得随访:24例随访时间达到1年,存活22例;19例随访时间达到2年,存活17例;13例随访时间达到3年,存活10例;5例随访时间达到5年,存活4例。结论临床上同时性多原发结直肠癌并不多见,有其独特的流行病学特征,术前全面详细的电子结肠镜检查,术中仔细探查及必要时冷冻活检有助于该病的最终确诊。根据肿瘤的位置、范围制订合理的手术方案,并于术后制订个性化辅助放化疗方案有助于降低术后复发率和提高总生存率。

Objective To investigate the clinical features,diagnosis and treatment of synchronous multiple primary colorectal carcinomas.Methods Clinical data about patients with synchronous multiple primary colorectal carcinomas admitted to our hospital from January 2009 to March 2015 were retrospectively analyzed.Results A total of 28 patients with synchronous multiple primary colorectal carcinomas were recruited including 16 males and 12 females with average age of 59.85 years.There were 19 cases with double primary malignancies,6 cases with triple primary malignancies and 3 cases with quadruplex primary malignancies.Adenocarcinoma was the main pathologic type.Twenty-three cases were confirmed by electronic colonoscopy before operation,and 5 cases through supplementary diagnosis during operation or postoperative pathological examination.All patients received first stage surgical treatment.Twenty-seven patients received radical resection and one received palliative resection.Overall survivals were 22 out of 24 in 1-year follow-up,17 out of 19 in 2-year follow-up,10 out of 13 in 3-year follow-up,and 4 out of 5 in 5-year followup.Conclusion Synchronous multiple primary colorectal carcinomas are not so prevalent in clinical practice.They have unique epidemiological characteristics.It suggests that comprehensive and detailed electronic colonoscopy examination before operation and exploration during operation should be emphasized.Suspected malignant lesions which cannot be completely excluded by preoperative biopsy,should be subjected to intraoperative frozen section examination.Making rational operation plan according to the location and scope of the tumor lesions as well as personalized radiotherapy and chemotherapy regimen can contribute to reducing postoperative relapse and improve overall survival rate of patients with synchronous multiple primary colorectal carcinomas.