青年人大肠癌71例临床分析
|
摘要
目的:结合文献探讨青年人(≤35岁)大肠癌的临床特征,为青年人大肠癌的早期诊治提供理论依据。
方法:回顾性分析1995年至2005年我院收治的71例青年人大肠癌手术病人的临床特点、诊治情况及随访资料,随访其三年生存率,分析它们之间的关系。
结果:(1)本组71例病人均为手术病人,其中行根治性手术切除47例(66.2%),行姑息性手术24例(33.8%)。(2)癌肿好发部位为直肠和乙状结肠,显示出向低位大肠高度集中的趋势。(3)临床表现以便血或粘液血便、大便习惯改变、腹部疼痛不适多见。(4)病理类型以管状腺癌、粘液腺癌多见,共55例,占77.5%。(5) Dukes分期以C、D期多见,共46例,占64.8%。(6)术后随访54例,总的3年生存率为59.3%。
结论:青年人大肠癌临床症状不典型,分化程度低,恶性程度高,进展快,易误诊、漏诊,手术根治率和生存率低,预后差。如何早发现、早诊断和早治疗(如提高对青年人大肠癌的认识,预防致癌因素,高发地区及人员定期做好普查工作等)是提高手术根治率从而提高生存率的关键。
0bjective: To explore clinical character of colorectal carcinoma in young patients(≤35years).
Methods: Data of 71 cases treated in our hospital from 1995 to 2005 was analysed retrospectively.
Results: All the 71 cases were treated by operation.Radical resection were performed 47 cases(66.2%) , palliative resection to 24 cases(33.8%).Rectum and sigmoid colon are the common sites of colorectal carcinoma in young patients.Main clinical symptoms are changes in hematochezia or blood mucus-stool、bowel movement habit and bellyache.The proportion of adenocarcinoma and mucinous carcinoma was 77.5% . The Dukes stages C and D in this group was 46 cases(64.8% ).54 cases were followed up, the 3-year overall survial rate is 60%.
Conclusion:Colorectal carcinoma in young patients has the following features:atypical clinical symptoms,higher malignant degree,being misdiagnosed and missed diagnosed easily,lower rates of radical operation and surviva1.Early detection,diagnosis and treatment are the key of increasing rates of radical operation and surviva1.
方法:回顾性分析1995年至2005年我院收治的71例青年人大肠癌手术病人的临床特点、诊治情况及随访资料,随访其三年生存率,分析它们之间的关系。
结果:(1)本组71例病人均为手术病人,其中行根治性手术切除47例(66.2%),行姑息性手术24例(33.8%)。(2)癌肿好发部位为直肠和乙状结肠,显示出向低位大肠高度集中的趋势。(3)临床表现以便血或粘液血便、大便习惯改变、腹部疼痛不适多见。(4)病理类型以管状腺癌、粘液腺癌多见,共55例,占77.5%。(5) Dukes分期以C、D期多见,共46例,占64.8%。(6)术后随访54例,总的3年生存率为59.3%。
结论:青年人大肠癌临床症状不典型,分化程度低,恶性程度高,进展快,易误诊、漏诊,手术根治率和生存率低,预后差。如何早发现、早诊断和早治疗(如提高对青年人大肠癌的认识,预防致癌因素,高发地区及人员定期做好普查工作等)是提高手术根治率从而提高生存率的关键。
0bjective: To explore clinical character of colorectal carcinoma in young patients(≤35years).
Methods: Data of 71 cases treated in our hospital from 1995 to 2005 was analysed retrospectively.
Results: All the 71 cases were treated by operation.Radical resection were performed 47 cases(66.2%) , palliative resection to 24 cases(33.8%).Rectum and sigmoid colon are the common sites of colorectal carcinoma in young patients.Main clinical symptoms are changes in hematochezia or blood mucus-stool、bowel movement habit and bellyache.The proportion of adenocarcinoma and mucinous carcinoma was 77.5% . The Dukes stages C and D in this group was 46 cases(64.8% ).54 cases were followed up, the 3-year overall survial rate is 60%.
Conclusion:Colorectal carcinoma in young patients has the following features:atypical clinical symptoms,higher malignant degree,being misdiagnosed and missed diagnosed easily,lower rates of radical operation and surviva1.Early detection,diagnosis and treatment are the key of increasing rates of radical operation and surviva1.
引文
[1]钟旭辉,许岸高,余志金.中国青年大肠癌临床特征系统研究[J].实用医学杂志,2006,22(17):2028-2030.
[2]张亚力,聂军,周杰,等.中国青年大肠癌的发病特点及地理分布[J].中华消化内镜杂志,l997,14(1):l1~l4.
[3] Eisenberg B,Decosse JJ,Harford F,et a1.Carcinoma of the colon and rectum: The natural history reviewed in 1704 patients[J].Cancer,1982,49(6):l131~1134.
[4]莫善兢,主编.大肠癌[M].上海:上海科学技术文献出版社,1986.1~21.
[5]大肠癌病理与预后关系研究协作组.国人青年大肠癌的特点和预后—319例病理分析[J].中华肿瘤杂志,1986,8(2):146~148.
[6]孙亮,锟缪,吕秀珍,等.青年人大肠癌临床与病理特点[J].江苏医药,1997,23(12):854~855.
[7]杨磊,丁彦青.青年大肠癌264例临床病理分析[J].中国肿瘤临床,2004,31(2):109~110.
[8]于皆平.纤维结肠镜临床应用技术[M].长沙:湖南科技出版社,l990.186~l90.
[9]卜建石.青年期直肠癌61例分析[J].第四军医大学学报,1995,16(6):473.
[10]张兆祥.25岁内青少年大肠癌48例临床病理观察[J].中国肿瘤临床与康复,1996,3(1):15.
[11]徐昕.直肠癌延误诊断原因探讨[J].中华肿瘤杂志,1985.7(2):86.
[12]陈万源,陈贤贵,李德川,等.青年人和老年人大肠癌的比较研究[J].实用癌症杂志,2001,16 (1):70~71.
[13]Wolmark N; The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer [M];Ann Surg; 1984,199:375.
[14]Iassacson P ; The demonstration of carcinoembryonic antigen in colorectal carcinoma and colonic polyps using immunoperoxidase technique [M];Cancer; 1976,38:1348.
[15]牛坚,钱海鑫.青少年大肠癌48例临床及病理特征分析[J].苏州大学学报(医学版),2004,24(5):738.
[16]Cusack JC,Giacco GG,Cleary K,et al.Survival factors in 186 patients younger than 40 years old with coloretal adenocarcinoma,[J] Am Coll Surg,1996,183(2):105.
[17]大肠癌病理与预后关系研究协作组.国人青年大肠癌的特点和预后.中华肿瘤杂志.1986.8 (2):146.
[18]马素真.大肠腺瘤流行病学与大肠癌[J].医师进修杂志,1994,17(10):3.
[19]易秉强摘译.术前对进展期直肠癌放化疗可使肿瘤分期下降,出现完全性病理反应,降低局部复发率并提高无瘤生存期[J].大肠肛门病外科杂志,2003,9(2):87.
[20]彭健,张阳德,李年丰.青年人大肠癌(附23例病例分析)[J].中国现代医学杂志.2003,13(13):13~14.
[1] Eisenberg B,Decosse JJ,Harford F,et a1.Carcinoma of the colon and rectum: The natural history reviewed in 1704 patients[J].Cancer,1982,49(6):l131~1134.
[2]莫善兢,主编.大肠癌[M].上海:上海科学技术文献出版社,1986.1~2l.
[3]张亚力,聂军,周杰,等.中国青年大肠癌的发病特点及地理分布[J].中华消化内镜杂志,l997,14(1):l1~l4.
[4]大肠癌病理与预后关系研究协作组.国人青年大肠癌的特点和预后—3l9例病理分析[J].中华肿瘤杂志,1986,8(2):146~148.
[5]孙亮,锟缪,吕秀珍,等.青年人大肠癌临床与病理特点[J].江苏医药,1997,23(12):854~855.
[6] Cusack JC,Giacco GG,Cleary K,et al.Survival factors in 186 patients younger than 40 years old with coloretal adenocarcinoma,J Am Coll Surg,1996,183(2):105.
[7]ASGE guideline.colorectal cancer screening and surveilliance, Gastrointestinal Endoscopy,20O6;634:546-557
[8]徐福星.大肠癌研究现状[J].国际消化病杂志,2006,26(6):366.
[9]顾晋,路阳,冷希圣,等.电子计算机体层摄影在急性肠梗阻病因诊断中的意义.中华普通外科杂志, 1998,13(1):26
[10]顾晋.大肠癌的诊治进展[J].中国实用外科杂志,2002,22(6):371.
[11]易秉强摘译.术前对进展期直肠癌放化疗可使肿瘤分期下降,出现完全性病理反应,降低局部复发率并提高无瘤生存期[J].大肠肛门病外科杂志,2003,9(2):87.
[12]彭健,张阳德,李年丰.青年人大肠癌(附23例病例分析).中国现代医学杂志.2003,13(13):13~14.
[2]张亚力,聂军,周杰,等.中国青年大肠癌的发病特点及地理分布[J].中华消化内镜杂志,l997,14(1):l1~l4.
[3] Eisenberg B,Decosse JJ,Harford F,et a1.Carcinoma of the colon and rectum: The natural history reviewed in 1704 patients[J].Cancer,1982,49(6):l131~1134.
[4]莫善兢,主编.大肠癌[M].上海:上海科学技术文献出版社,1986.1~21.
[5]大肠癌病理与预后关系研究协作组.国人青年大肠癌的特点和预后—319例病理分析[J].中华肿瘤杂志,1986,8(2):146~148.
[6]孙亮,锟缪,吕秀珍,等.青年人大肠癌临床与病理特点[J].江苏医药,1997,23(12):854~855.
[7]杨磊,丁彦青.青年大肠癌264例临床病理分析[J].中国肿瘤临床,2004,31(2):109~110.
[8]于皆平.纤维结肠镜临床应用技术[M].长沙:湖南科技出版社,l990.186~l90.
[9]卜建石.青年期直肠癌61例分析[J].第四军医大学学报,1995,16(6):473.
[10]张兆祥.25岁内青少年大肠癌48例临床病理观察[J].中国肿瘤临床与康复,1996,3(1):15.
[11]徐昕.直肠癌延误诊断原因探讨[J].中华肿瘤杂志,1985.7(2):86.
[12]陈万源,陈贤贵,李德川,等.青年人和老年人大肠癌的比较研究[J].实用癌症杂志,2001,16 (1):70~71.
[13]Wolmark N; The prognostic significance of preoperative carcinoembryonic antigen levels in colorectal cancer [M];Ann Surg; 1984,199:375.
[14]Iassacson P ; The demonstration of carcinoembryonic antigen in colorectal carcinoma and colonic polyps using immunoperoxidase technique [M];Cancer; 1976,38:1348.
[15]牛坚,钱海鑫.青少年大肠癌48例临床及病理特征分析[J].苏州大学学报(医学版),2004,24(5):738.
[16]Cusack JC,Giacco GG,Cleary K,et al.Survival factors in 186 patients younger than 40 years old with coloretal adenocarcinoma,[J] Am Coll Surg,1996,183(2):105.
[17]大肠癌病理与预后关系研究协作组.国人青年大肠癌的特点和预后.中华肿瘤杂志.1986.8 (2):146.
[18]马素真.大肠腺瘤流行病学与大肠癌[J].医师进修杂志,1994,17(10):3.
[19]易秉强摘译.术前对进展期直肠癌放化疗可使肿瘤分期下降,出现完全性病理反应,降低局部复发率并提高无瘤生存期[J].大肠肛门病外科杂志,2003,9(2):87.
[20]彭健,张阳德,李年丰.青年人大肠癌(附23例病例分析)[J].中国现代医学杂志.2003,13(13):13~14.
[1] Eisenberg B,Decosse JJ,Harford F,et a1.Carcinoma of the colon and rectum: The natural history reviewed in 1704 patients[J].Cancer,1982,49(6):l131~1134.
[2]莫善兢,主编.大肠癌[M].上海:上海科学技术文献出版社,1986.1~2l.
[3]张亚力,聂军,周杰,等.中国青年大肠癌的发病特点及地理分布[J].中华消化内镜杂志,l997,14(1):l1~l4.
[4]大肠癌病理与预后关系研究协作组.国人青年大肠癌的特点和预后—3l9例病理分析[J].中华肿瘤杂志,1986,8(2):146~148.
[5]孙亮,锟缪,吕秀珍,等.青年人大肠癌临床与病理特点[J].江苏医药,1997,23(12):854~855.
[6] Cusack JC,Giacco GG,Cleary K,et al.Survival factors in 186 patients younger than 40 years old with coloretal adenocarcinoma,J Am Coll Surg,1996,183(2):105.
[7]ASGE guideline.colorectal cancer screening and surveilliance, Gastrointestinal Endoscopy,20O6;634:546-557
[8]徐福星.大肠癌研究现状[J].国际消化病杂志,2006,26(6):366.
[9]顾晋,路阳,冷希圣,等.电子计算机体层摄影在急性肠梗阻病因诊断中的意义.中华普通外科杂志, 1998,13(1):26
[10]顾晋.大肠癌的诊治进展[J].中国实用外科杂志,2002,22(6):371.
[11]易秉强摘译.术前对进展期直肠癌放化疗可使肿瘤分期下降,出现完全性病理反应,降低局部复发率并提高无瘤生存期[J].大肠肛门病外科杂志,2003,9(2):87.
[12]彭健,张阳德,李年丰.青年人大肠癌(附23例病例分析).中国现代医学杂志.2003,13(13):13~14.