CAJ | 학술논문

目的：总结溃疡性结肠炎相关结直肠癌（UC-CRC）的临床特点及内镜表现。方法回顾性总结4例UC-CRC病例，记录临床诊疗经过、内镜表现并随访术后转归。结果4例UC-CRC中3例为男性，1例女性；UC-CRC诊断年龄距UC诊断时间为14～21年；UC-CRC部位分别为直肠、乙状结肠、横结肠、升结肠；既往UC均为全结肠炎、慢性复发型。内镜下UC-CRC表现为癌变病变部位均有溃疡形成和不同程度的肠腔狭窄，其他肠段呈活动性UC表现。病理诊断均为腺癌，分化程度以中-低分化为主，其中1例术后病理发现两个部位癌灶。4例均接受手术治疗，CRC分期为T4N1M1，T3N1M0，T2N0M0，T4N1M0；2例患者术后5个月、27个月死于CRC广泛转移；另2例术后随访8个月、44个月健康生存。结论 UC-CRC的诊断较晚，预后差；内镜下不规则的溃疡和狭窄可能提示CRC病变；UC-CRC可呈多灶性，规律的UC治疗和内镜随访对于早期发现CRC病变改善预后非常重要。
목적：총결궤양성결장염상관결직장암（UC-CRC）적림상특점급내경표현。방법회고성총결4례UC-CRC병례，기록림상진료경과、내경표현병수방술후전귀。결과4례UC-CRC중3례위남성，1례녀성；UC-CRC진단년령거UC진단시간위14～21년；UC-CRC부위분별위직장、을상결장、횡결장、승결장；기왕UC균위전결장염、만성복발형。내경하UC-CRC표현위암변병변부위균유궤양형성화불동정도적장강협착，기타장단정활동성UC표현。병리진단균위선암，분화정도이중-저분화위주，기중1례술후병리발현량개부위암조。4례균접수수술치료，CRC분기위T4N1M1，T3N1M0，T2N0M0，T4N1M0；2례환자술후5개월、27개월사우CRC엄범전이；령2례술후수방8개월、44개월건강생존。결론 UC-CRC적진단교만，예후차；내경하불규칙적궤양화협착가능제시CRC병변；UC-CRC가정다조성，규률적UC치료화내경수방대우조기발현CRC병변개선예후비상중요。
Objective To study the clinical characters and endoscopic manifestation of ulcerative colitis associated colorectal cancer (UC-CRC). Methods Retrospectively review the medical records of UC cases which developed colorectal cancer and underwent surgery in two general referral hospitals. Results Total 4 cases (3 male, 1 female) were diagnosed as UC-CRC. All 4 cases was diagnosed as chronic recurrent UC and pancolitis. The time between UC onset to CRC diagnosis were 14-21 years. The location of UC-CRC was at rectum, sigmoid colon, ascending colon and transverse colon respectively. There were irregular ulcers with local stricture in endoscopic manifestation. In all 4 cases accompanied active UC findings. All were adenoma in pathology, 2 with low differentiation and 1 with high differentiation. All 4 cases received surgery for UC-CRC and were diagnosed as T4N1M1, T3N1M0, T2N0M0 and T4N1M0 in stage of cancer respectively. 2 cases were died from liver metastasis 5 months and 27 months after first UC-CRC surgery respectively. The case in stage T2N0M0 has been surviving healthily without other medication till now 8 months after surgery;he was regularly follow-up by endoscopy and found dysplasia 2 years before cancer. The pathology showed multifocal canceration in his colon, one in sigmoid colon corresponding with endoscopic ulcer, and another was found in flat mucosa 30cm from the ulcer in descending colon and which was confirmed as early cancer only 2mm within mucosa. Conclusions The prognosis of UC-CRC is relative poor if diagnosed not earlier. The irregular ulcer with stricture in endoscope might be characteristic manifestation. The canceration in UC-CRC can be multifocal.