【摘要】：目的:探討多原發(fā)大腸癌的發(fā)病特點、臨床特點、診斷、治療、預后和隨訪,為臨床醫(yī)師掌握該病的診治提供參考。方法:回顧性分析大連醫(yī)科大學附屬第一醫(yī)院普外科2012年1月1日-2017年1月1日收治的52例多原發(fā)大腸癌的臨床資料。分析多原發(fā)大腸癌患者的發(fā)病情況(年齡、性別、發(fā)病率、合并相關疾病等)、腫瘤特點(病變部位、病理類型、形態(tài)、大小、基因表達等)、疾病分期(Dukes分期、TNM分期)、診斷情況(間隔時間、檢查方法、誤診情況)、治療方法(手術(shù)方式、化療)、預后生存期和隨訪等。結(jié)果:1、一般情況:多原發(fā)大腸癌(multiple primary colorectal carcinoma,MPCC)占同期收治大腸癌的3.27%,其中同時癌(synchronous carcinoma,SC)占1.95%,異時癌(metachronous carcinoma,MC)占1.32%。男性發(fā)病率高于女性,以60歲以上老年人多見,且隨著年齡增長,發(fā)病率越高。SC和MC在性別和年齡上均無統(tǒng)計學差異(P0.05);2、癌灶部位:癌灶分布多位于相同腸段或者相鄰腸段,以乙狀結(jié)腸+直腸病例最為常見。按癌灶發(fā)生部位:右半結(jié)腸左半結(jié)腸直腸;3、病理與分型:腫瘤平均直徑(4.33±2.37)cm。腫瘤大體分型以潰瘍型為主,其次是隆起型和浸潤型。組織學分型以管狀腺癌最常見,其次是乳頭狀腺癌、腺瘤癌變、粘液腺癌、印戒細胞癌和其它癌。MPCC合并腺瘤者占55.77%,其中17例腺瘤癌變,占伴腺瘤者的58.62%;4、疾病分期:Dukes分期最多見是B期,依次是C期、D期、A期。TNM分期以中期病例(Ⅱ期+Ⅲ期)最多,占82.69%;5、DNA錯配修復基因(mismatchrepair,MMR)與臨床病理特征的關系:免疫組化檢測術(shù)后腫瘤組織基因MLH1、PMS2、MSH2、MSH6的蛋白表達顯示,與患者的性別、年齡、Dukes分期、TNM分期均無統(tǒng)計學差異(P均0.05),與腫瘤發(fā)病部位有統(tǒng)計學差異(P0.05);6、時間間隔:MC中癌灶確診時間間隔為8個月-15年,平均時間間隔為(47.00±42.54)個月,其中以時間間隔在1年-3年的癌灶最多;7、診斷:術(shù)前纖維結(jié)腸鏡+病理檢查診斷率為75.00%,術(shù)前漏診率高達25.00%。免疫血清學檢查僅小部分增高,CEA增高者占42.31%,CA19-9增高者僅占17.31%;8、治療:SC根治性手術(shù)切除率為77.42%,MC患者第一癌均行根治性手術(shù),第二癌根治性切除率85.71%。52例MPCC需要化療的患者39例,僅22例患者接受化療;9、預后和隨訪:MPCC總的3年、5年生存率分別為70.00%、46.00%,其中SC 3 年、5 年生存率為 66.67%、46.67%,MC 3 年、5 年生存率為 75.00%、45.00%,SC和MC兩組生存率無統(tǒng)計學差異(P0.05)。結(jié)論:1、MPCC在臨床并不少見,診斷大腸癌的同時應警惕是否存在其它癌灶,特別是伴有多發(fā)腺瘤性息肉、中老年患者;2、MPCC術(shù)前漏診率較高,臨床以中晚期患者為主,診斷要以纖維結(jié)腸鏡+病理為金標準,綜合臨床癥狀、鋇劑灌腸、CT、MRI、腫瘤標記物等全面分析;3、MPCC以手術(shù)治療為主,術(shù)后輔助化療等的綜合治療;4、MPCC預后與普通單發(fā)大腸癌無差異。加強術(shù)后隨訪,對MC患者第二癌的診斷尤為關鍵。
[Abstract]:Objective: to investigate the characteristics, clinical features, diagnosis, treatment, prognosis and follow-up of multiple primary colorectal cancer, so as to provide reference for clinicians to master the diagnosis and treatment of the disease. Methods: the clinical data of 52 patients with multiple primary colorectal cancer treated in General surgery Department of the first affiliated Hospital of Dalian Medical University from January 1, 2012 to January 1, 2017 were retrospectively analyzed. To analyze the incidence of multiple primary colorectal cancer (age, sex, incidence, associated diseases, etc.), tumor characteristics (lesion location, pathological type, morphology, size, etc.), Gene expression, Dukes staging, diagnosis (interval, examination, misdiagnosis), treatment (operation, chemotherapy), prognosis, survival and follow-up. Results: in general, (multiple primary colorectal carcinoma of multiple primary colorectal carcinoma accounted for 3.27% in the same period, of which synchronous carcinoma SC accounted for 1.95%, and metachronous carcinomaMC accounted for 1.32%. The incidence rate of male was higher than that of female, and the incidence was higher than that of female (P0.05). The distribution of cancer foci was located in the same intestinal segment or adjacent intestinal segment. Sigmoid colon rectum is the most common case. According to the location of cancer focus: right colon, left colon and rectum, pathology and classification: mean diameter of tumor was (4.33 鹵2.37) cm. The main types of tumor were ulcer type, followed by protruding type and infiltrating type. Tubular adenocarcinoma was the most common histological classification, followed by papillary adenocarcinoma, adenoma carcinogenesis, mucinous adenocarcinoma, signet ring cell carcinoma and other carcinomas. MPCC combined with adenoma accounted for 55.777.17 of them had adenoma carcinogenesis. The proportion of patients with adenoma was 58.62%. Stage B was the most common stage of disease stage Dukes, followed by stage C / D / stage A. TNM staging was most common in intermediate stage (stage 鈪，

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