器官移植术后结直肠癌的临床病理特征分析(附7例病例)

Clinical and pathological characteristics of 7 cases of colorectal cancer in organ transplant recipients

目的分析器官移植术后结直肠癌的临床病理特征,为临床诊断和治疗提供参考。方法收集2002年9月至2021年9月在海军军医大学第一附属医院肛肠外科进行根治性手术、术后病理证实为结直肠腺癌,且既往接受过器官移植术的7例患者的临床资料进行回顾性分析。总结分析器官移植术后结直肠癌的临床病理特征。结果首诊症状为便血3例,腹痛1例,腹泻1例,腹胀、呕吐1例,体检(结肠镜检查)异常1例。术前血清CEA水平为1.61~123.20 ng/mL、中位血清CEA水平为5.12(1.76,10.28)ng/mL,术前血清CA199水平为4.79~184.96 U/mL、中位血清CA199水平为18.59(9.37,135.60)U/mL,其中3例患者术前血清CEA水平处于正常范围,5例患者术前血清CA199水平处于正常范围。肿瘤位于升结肠1例,降结肠1例,乙状结肠1例,直乙交界1例,直肠3例。TNMⅢ期结直肠癌患者3例,Ⅱ期结直肠癌3例,Ⅰ期结直肠癌1例;分化程度为低分化3例,中—低分化1例,中分化3例;肿瘤占肠腔周径<1周2例,占肠腔周径1周5例。结论器官移植术后结直肠癌的发病时间多在5年以内,肿瘤多位于直肠,就诊时多处于局部进展期。因此,对于接受过器官移植术的人群,建议加强结直肠癌的早期诊断与治疗,以改善预后。

Objectives To analyze the clinical and pathological characteristics of colorectal cancer in organ transplant recipients and provide references for clinical diagnosis and treatment.Methods Retrospective analysis of 7 organ transplant recipients con⁃firmed with colorectal adenocarcinoma who underwent radical surgery at the Department of Colorectal Surgery of the First Affiliat⁃ed Hospital of Naval Medical University from September 2002 to September 2021 was performed.Clinical and pathological char⁃acteristics of colorectal cancer in organ transplant recipients were summarized and analyzed.Results The initial symptoms were hematochezia in 3 cases,abdominal pain in 1 case,diarrhea in 1 case,abdominal distension and vomiting in 1 case,and abnor⁃mal colonoscopy in 1 case.The preoperative serum levels of CEA were 1.61 to 123.20 ng/mL,the median serum CEA level was 5.12(1.76,10.28)ng/mL;the preoperative serum levels of CA199 were 4.79 to 184.96 U/mL,and the median serum CA199 level was 18.59(9.37,135.60)U/mL.Three patients had normal preoperative serum CEA,and five had normal preoperative serum CA199.The tumor was located in the ascending colon in 1 case,descending colon in 1 case,sigmoid colon in 1 case,rectosig⁃moid junction in 1 case,and rectum in 3 cases.Among them,3 cases at stageⅢ,3 cases at stageⅡ,and 1 case at stageⅠ;3 cases were poorly differentiated,1 case was moderately to poorly differentiated,and 3 cases were moderately differentiated;The tumor occupied less than the entire intestinal circumference in 2 cases and the entire intestinal circumference in 5 cases.Conclusion Colorectal cancer in organ transplant recipients tends to occur within five years,and the tumor is usually located in the rectum,with most patients diagnosed with locally advanced stage.Therefore,for individuals who have undergone organ transplantation,it is recommended to strengthen early diagnosis and treatment of colorectal cancer to improve prognosis.