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该文收集多原发癌22例,其中SC17例,MC5例,平均年龄50.3岁。MC第一～第二癌时间为9个月～12年,其中3例发生在1.5年以内,共有癌灶49个,乙状结肠以下占62.6％(31/49)。多原发瘤中发现腺癌样息肉共31枚,位于横结肠以下部位,其中乙状结肠以下占70.9％(24/31);癌变息肉占61.2％(19/31),以直肠和乙状结肠多见;息肉大于1cm以上癌变15枚,另有不符合通常息肉恶变特点的2枚1cm以下息肉,活检证实为恶变,结果表明:大肠腺瘤与大肠癌关系十分密切,符合腺瘤—癌的顺序;腺瘤癌变传统特征有碍于大肠多原发癌的诊断,易导致漏诊或误诊;应重视结肠镜术中探查和术后定期复查和随访。作者认为对大肠癌不能满足一处癌灶的诊断。不以息肉大小和形态判断癌变可能性,对所发现的任何息肉均应活检和内镜下摘除,术中和术后应尽早复查,并提倡以3个月为宜,以后每隔半年1次,将有助于多原发癌的诊断和治疗。
This article collected 22 cases of multiple primary cancers, including 17 cases of SC and 5 cases of MC. The average age was 50.3 years. MC first to second cancer time was 9 months to 12 years, of which 3 cases occurred within 1.5 years, a total of 49 lesions, accounting for 62.6% (31/49) below the sigmoid colon. A total of 31 adenocarcinoma-like polyps were found in multiple primary tumors, located in the lower part of the transverse colon, which accounted for 70.9% (24/31) of the sigmoid colon; cancerous polyps accounted for 61.2% (19/31), more common in the rectum and sigmoid; polyps More than 1 cm above 15 cancers, and 2 polyps below 1 cm that do not meet the characteristics of malignant polyps, biopsy confirmed malignant transformation, the results show that: colorectal adenoma and colorectal cancer is very close, consistent with adenoma - cancer sequence; adenoma The traditional features of cancerous changes hinder the diagnosis of multiple primary cancers of the large intestine, which may lead to missed diagnosis or misdiagnosis; attention should be paid to exploration during colonoscopy and regular review and follow-up after surgery. The authors believe that the diagnosis of colorectal cancer cannot satisfy a cancerous lesion. The polyp size and morphology are not used to determine the possibility of carcinogenesis. Any polyps found should be biopsied and endoscopically removed. The intraoperative and postoperative follow-ups should be reviewed as soon as possible, and advisable for a period of 3 months, once every six months thereafter. It will help diagnose and treat multiple primary cancers.