右半结肠合并直肠重复癌时的术式选择附四例报告

Surgical options of multiple primary colorectal cancer in right colon and rectum(4 cases)

回顾分析2016年9月至2017年8月收治的4例右半结肠合并直肠癌患者的临床资料。4例均符合右半结肠合并直肠重复性癌的诊断标准,其中3例为同时性多原发癌(SCRC),1例为异时性多原发癌(MCRC)。4例患者中,3例SCRC患者均行两个部位的联合根治性手术,在右半结肠根治术中均保留中结肠动脉左支和左结肠动脉;MCRC患者第一次行扩大右半结肠切除术时未保留中结肠动脉左支,第二次行保留左结肠动脉的直肠癌根治术。4例患者术后均未发生吻合口漏等相关并发症,术后随访至今,平均随访时间为8.75±4.57个月,未发生转移或复发。对于右半结肠癌合并直肠癌行右半结肠癌加直肠癌根治性手术时,应保留中结肠动脉的左支及/或左结肠动脉,避免出现剩余结肠发生缺血坏死,出现吻合口漏和狭窄。

The clinical data of 4 cases of multiple primary colorectuml cancer in right colon and rectum from September 2016 to August 2017 were retrospectively analysed. All four patients met the diagnosis criteria for multiple primary colorectuml cancer in right colon and rectum. Three of all participants were synchronous colorectal cancer and another one was metachronous colorectal cancer. Three SCRC patients underwent combined radical surgery in the two parts and left branches in middle colic artery of these three participants were retained in right hemicolectomy. The MCRC patient underwent extend right hemicolectomy at the ？rst time and radical anterior resection at the second time. In addition, no associated postsurgical complication was observed in all three subjects. Among the four patients, 100% survived with a mean follow-up time of 8.75±4.57 months. No transfer and recrudescence were observed in the two SCRC patients. When radical surgery for multiple primary colorectal cancer in right colon and rectum is conducted, it is recommended to retain left colic artery and/or left branches of middle colic artery to ensure the blood supply of descending colon and of left part of transverse colon, and to avoid total celectomy caused by the ischemia of remain colon and avoid the constriction and leakage of intestinal stomas due to the ischemia.