Laparoscopy-assisted resection of simultaneous double primary carcinoma of gastrointestinal tract: a series of 11 cases
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摘要:
目的 研究探讨腹腔镜辅助下切除消化道同时性双原发癌的安全性和可行性。 方法 回顾分析内蒙古自治区人民医院2019年1月至2023年4月对消化道同时性双原发癌行腹腔镜切除的11例患者病例资料，并结合相关文献，讨论腹腔镜辅助治疗消化道同时性双原发癌的安全性及可行性。 结果 11例患者中男性10例，女性1例；平均年龄为63.4（44～81）岁；共有10例患者进行了同期双原发癌切除的腹腔镜治疗，1例患者在5个月内分2次完成手术。11例患者中胃癌合并结、直肠癌3例，结肠癌合并直肠癌5例，结肠癌合并结肠癌2例，小肠癌合并结肠癌1例。所有患者手术时间为（317±141）min，术中出血量（70±39）mL，术后住院时间（10.7±3.9）d，住院治疗费用61 291（39 767～117 196）元。所有患者采取手术治疗后均顺利出院，1例患者术后出现吻合口出血。患者随访时间为3～42个月，1例患者失访，1例患者在术后6个月发现肿瘤局部复发，其余患者均生存。 结论 多原发癌的治疗目前尚缺乏共识，当患者同时诊断出两种活动性恶性肿瘤时，找到抗癌治疗策略是临床面临的最大挑战。对同时性消化道多原发癌患者应尽量行同期的肿瘤根治术，减少手术带来的创伤并减少住院时间及治疗费用，为患者后续治疗争取时间。 Abstract:Objective To investigate the safety and feasibility of laparoscopy-assisted resection of simultaneous double primary carcinoma of the gastrointestinal tract. Methods To retrospectively analyze the data of 11 patients who underwent laparoscopic resection for concurrent double primary carcinoma of the gastrointestinal tract in Inner Mongolia People's Hospital between January 2019 and April 2023, and discuss the safety and feasibility of laparoscopic adjuvant treatment of concurrent double primary carcinoma of the gastrointestinal tract considering the relevant literature. Results The 10 males and one female had a mean age of 63.4 (44–81) years. Ten patients underwent laparoscopic treatment with the simultaneous resection of both primary cancers, while one underwent the procedure in two separate operations over a 5-month period. Overall, three patients had gastric cancer combined with colon and rectal cancer; five had colon cancer combined with rectal cancer; two had colon cancer combined with colon cancer; and one had small bowel cancer combined with colon cancer. The mean operative time was (317±141) min, mean intraoperative blood loss was (79±39) mL, mean postoperative hospital stay was (10.7±3.9) d, and median hospital treatment cost was 61,291 (39,767-117,196) Renminbi (RMB). All patients were successfully discharged after surgery; one patient experienced postoperative anastomotic bleeding. Patients were followed for (3-42) months: one was lost to follow-up, one developed local recurrence of the tumor at 6 months postoperative, and the rest survived with no significant signs of recurrence. Conclusions Uniform guidelines for the treatment of multiple primary tumors are lacking; thus, identifying an anti-cancer treatment strategy is the greatest challenge for practitioners when patients are diagnosed with two active malignancies. Patients with concurrent multiple primary cancers of the gastrointestinal tract should be treated with concurrent radical tumor resection whenever possible to reduce surgery-associated trauma, reduce the length of hospital stay and treatment costs, and buy time for follow-up treatment. -
Key words:
- laparoscope /
- double primary carcinoma /
- gastrointestinal tumor
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表 1 11例患者临床资料
病例 性别 年龄（岁） 就诊主要症状 术前合并症 肿瘤位置 1 男 76 乏力、消瘦 高血压、脑梗、房颤 横结肠、直肠 2 男 49 乏力、头晕 无 回盲部、乙状结肠 3 男 54 便血 冠心病、高血压、糖尿病 胃、乙状结肠 4 男 58 便血 无 乙状结肠、直肠 5 男 63 便血、腹泻 高血压、糖尿病 乙状结癌（双病灶）、直肠 6 男 44 排便习惯改变 无 回肠肿瘤、升结肠 7 男 65 便血 无 胃、直肠 8 男 66 排便习惯改变 无 横结肠、乙状结肠 9 男 69 便血、腹胀 全胃切除术后 横结肠、直肠 10 女 72 呕吐伴腹痛停止排便 高血压、肠梗阻 胃、降结肠 11 男 81 便血 无 升结肠、直肠 
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表 2 11例患者诊疗情况
患者 手术时间（min） 术中出血量（mL） 并发症 术后住院时间（d） 术后病理分期 住院费用（元） 随访时间（月） 是否转移 1 270 120 无 9 横结肠癌T3N0M0 63 601 36 无 直肠癌TisN0M0 2 360 100 无 12 回盲部癌T4N0M0 48 900 36 无 乙状结肠癌T1N0M0 3 300 30 无 9 胃癌T1N0M0 62 413 6 无 乙状结肠癌T3N1M0 4 240 20 吻合口出血 6 乙状结肠癌T3N0M0 51 669 33 无 直肠癌T1N0M0 5 285 80 无 10 乙状结肠癌T2N1M0 53 361 42 无 直肠癌T1N0M0 6 240 120 无 9 升结肠癌T4N2M0 52 097 18 第12个月淋巴结转移 小肠癌T4N1M0 7 610 80 无 21 胃癌T1N0M0 117 196 36 无 直肠癌T3N0M0 8 270 50 无 8 横结肠癌T3N0M0 66 930 4 无 乙状结肠癌T1N0M0 9 555 110 无 10 横结肠癌T4N1M0 49 058 6 无 直肠癌T3N2M0 10 150 20 无 11 胃间质瘤 39 767 9 第6个月复发 降结肠T4N1N0 11 210 40 无 13 升结肠癌T3N2M0 69 218 3 无 直肠癌T3N1M0
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