一 73岁男性患者因腹痛加重 ,短期的大便习惯改变 (无便血 )及渐进意识障碍 2周而入院。既往史包括慢性阻塞性肺病和高血压。体检发现肛管一3cm光滑质软肿物及皮下一 4cm× 5 cm坚硬肿物并于局麻下活检。胸片、肝脏 B超及头部 CT显示多处肿瘤转移灶。患者意识障碍逐渐加重 ,病 A 73-year-old man was admitted to hospital for increased abdominal pain, short-term changes in bowel habits (no bloody stools) and progressive disturbance of consciousness for 2 weeks. Past history includes chronic obstructive pulmonary disease and hypertension. Physical examination found a 3cm smooth and soft anus of the soft tissue and subcutaneous 4cm × 5cm hard tumor biopsy under local anesthesia. Chest radiographs, liver B-ultrasound, and head CT showed multiple tumor metastases. Patients with progressive disturbance of consciousness, disease