多发性原发性恶性肿瘤(以下简称多原癌)已有较多报告,但在临床上与癌复发或转移不易鉴别,因此常致误诊,影响治疗。我科近年来经治肠道多原癌5例,现报道如下: 例1 男,46岁。1972年7月因腹痛、腹泻5～7次/日、右下腹包块2个月,行右半结肠切除术(病理诊断为升结肠腺癌,无淋巴结转移)。术后恢复顺利,逐年随访。77年1月又出现大便次数增多,伴下腹隐痛。至8月份左上腹扪及直径4cm大包块,质硬,尚活动;钡灌肠检查见降结肠有8cm长环状狭窄,充盈缺损,诊断为降结肠癌。9月8日手术,见降结肠有4×4cm大肿瘤,已浸润至浆膜,肠系膜淋巴结不肿大,其它部位未见肿瘤。切除肿瘤段结肠。行横结肠、乙状结肠吻合。病理诊断为降结肠腺癌(Ⅱ级),未见淋巴结转移。术后用5—Fu化疗,总量5g。痊愈出院,参加全日工作。随访至今,未见复发。例2 男,51岁。80年8月开始感下腹隐痛。10月25日因肠梗阻,行剖腹探查,术中见距回肠末端50cm处小肠套叠,经手法复位后见套叠头部为一肿瘤,遂检查小肠全程。自屈氏韧带以下50cm至距回肠末端27cm处有大小不等肿瘤25个,直径在0.5～4.5cm之间,多呈浸润生长和结节样向肠腔内突出。肿瘤间肠管正常。小肠系膜及腹主动脉旁淋巴结明显肿大。姑息性切除肿瘤较密集处肠管4段,共长1.2m。术后用环磷酰胺化疗。病理报告:小肠多发性网织细胞肉瘤伴肠系膜淋巴结转移。出院后4个月死于肿瘤复发。 Multiple primary malignancies (abbreviated as polycarcinomas hereinafter) have been reported more frequently, but are not easily differentiated clinically from recurrence or metastasis of the cancer. Therefore, misdiagnosis often occurs and treatment is affected. In recent years, our department has treated 5 cases of multi-carcinoma of the intestine, and it is reported as follows: Example 1 Male, 46 years old. In July 1972, right hemicolectomy was performed due to abdominal pain, diarrhea 5 to 7 times per day, and mass in the right lower abdomen for 2 months (pathological diagnosis was ascending colonic adenocarcinoma and no lymph node metastasis). Postoperative recovery was smooth and follow-up year by year. In January of 2007, there was an increase in the frequency of bowel movements, with pain in the lower abdomen. Until August, the left upper quadrant abdominal hernia and large diameter 4cm masses were hard and firm, and barium enema examination showed that the descending colon had a 8cm long annular stenosis and filling defect and was diagnosed as descending colon cancer. On September 8th surgery, there was a 4×4cm large tumor in the descending colon, which had infiltrated into the serosa, and the mesenteric lymph nodes were not enlarged. No tumor was found in other sites. Remove the tumor segment colon. Transverse colon and sigmoid colon anastomosis. The pathological diagnosis was a descending colon adenocarcinoma (Grade II) with no lymph node metastasis. Postoperative 5-Fu chemotherapy, total 5g. He was discharged from hospital and participated in full-time work. Follow-up so far, no recurrence. Example 2 Male, 51 years old. August 80 began to feel abdominal pain. On October 25, due to intestinal obstruction, laparotomy was performed. During the operation, the intussusception was seen at a distance of 50 cm from the distal end of the ileum. After the reduction, the intussusception head was seen as a tumor. The hernia was examined throughout the entire intestine. There are 25 tumors ranging in size from 50 cm below the bend ligament to 27 cm from the end of the ileum. The diameter of the tumor is between 0.5 and 4.5 cm, and most of them are infiltrating and nodular. Normal intestinal tumors. The mesenteric and paraaortic lymph nodes were significantly enlarged. Palliative resection of the tumor is more concentrated in the intestine 4 segments, a total length of 1.2m. After chemotherapy with cyclophosphamide. Pathology report: multiple reticulocyte sarcoma in the small intestine with mesenteric lymph node metastasis. Four months after discharge, he died of tumor recurrence.