克罗恩病合并小肠癌的临床特征分析及文献复习

Analysis of clinical characteristics of Crohn′s disease complicated with small intestinal cancer and literature review

目的总结分析克罗恩病(CD)合并小肠癌患者的临床特征。方法回顾性收集并分析2018年5月至2022年9月于浙江大学医学院附属邵逸夫医院诊治的CD合并小肠癌患者的临床资料,包括一般资料、临床特点(包括病变部位、疾病行为和并发症等)、CD相关病史、肿瘤特征、诊断、治疗和预后。通过检索PubMed数据库截止至2022年3月发表的CD合并小肠癌的病例,并进行文献复习及总结。结果纳入7例CD合并小肠癌患者,其中男性5例,女性2例。7例患者中6例病理类型为小肠腺癌,1例为高级别上皮内瘤变。病变均累及回肠并发生狭窄。仅有2例影像学检查发现肿瘤。小肠癌确诊前7例患者CD相关治疗用药及时长不一,小肠癌治疗以手术为主,化疗及CD相关治疗为辅。5例患者经治疗后未发现肿瘤复发,1例患者术后7个月肿瘤复发,第2次术后3年疑似肿瘤再发;1例患者失访。共检索到文献7篇。结论 CD合并小肠癌多为男性患者、回肠受累多见,肿瘤类型以小肠腺癌和淋巴瘤最为常见,影像学检查发现CD合并小肠癌的能力有限。

Objective To summarize and analyze the clinical characteristics of patients with Crohn′s disease(CD)complicated with small intestinal cancer(SBC).Methods Clinical data of patients with CD complicated with SBC treated in Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from May 2018 to September 2022 were collected and analyzed retrospectively,including general data,clinical features(lesion location,disease behavior and complications,etc.),CD-related history,tumor features,diagnosis,treatment and prognosis.The cases of CD complicated with SBC published in PubMed database up to March 2022 were searched,and the literatures were reviewed and summarized.Results There were 7 patients with CD complicated with SBC in our hospital,including 5 males and 2 females.Of the 7 patients,6 patients were small intestinal adenocarcinoma and 1 patient was high-grade intraepithelial neoplasia.All the lesions involved ileum with stenosis.Tumors in only 2 cases of tumors were found by imaging examination.Before the diagnosis of SBC,the drugs and duration of CD-related treatment were different in 7 patients.SBC was mainly treated by surgery,supplemented by chemotherapy and CD-related treatment.No tumor recurrence was found in 5 patients after treatment,1 patient had tumor recurrence 7 months after operation,and suspected tumor recurrence 3 years after the second operation.One patient ws lost during follow-up.Seven literatures were retrieved.Conclusion Most of the patients with CD complicated with PBC are male,and ileal involvement is more common.Small intestinal adenocarcinoma and lymphoma are the most common tumor types.The ability of imaging examination to detect CD-SBC is limited.