CAJ | 학술논문

目的探讨关于肿瘤相关胃结肠瘘的诊断及治疗.方法回顾性分析2008年8月-2014年2月首都医科大学附属北京友谊医院普外科诊治的4例肿瘤相关胃结肠瘘患者的临床资料.其中3例患者为女性,1例患者为男性,平均年龄61岁,4例术后病理证实为腺癌所致的胃结肠瘘.主要临床症状有腹泻3例、粪样呕吐3例、体重下降4例、腹痛4例.术前诊断胃结肠瘘的方法包括胃镜3例、结肠镜l例、钡灌肠1例、上消化道造影2例.结果 4例患者均施行了肿瘤及胃结肠瘘切除手术,2例根治性切除,2例姑息性切除.术后病理均提示低分化腺癌,3例患者进行了CDX-2,CK20免疫组化检查辅助判断肿瘤来源.术后1例患者出现胃排空障碍,DIC,心功能衰竭并死亡,2例出现吻合口瘘,存活患者均接受卡培他滨、奥沙利铂联合化疗.结论内镜检查及消化道造影是胃结肠瘘诊断主要依据,胃结肠瘘区域应完整切除,一期肠造口可能更加安全,但这一结论还需进一步研究.根据病理特点、免疫组化CDX-2 、CK20染色推断肿瘤来源,并进行辅助化疗.
목적 탐토관우종류상관위결장루적진단급치료.방법 회고성분석2008년8월-2014년2월수도의과대학부속북경우의의원보외과진치적4례종류상관위결장루환자적림상자료.기중3례환자위녀성,1례환자위남성,평균년령61세,4례술후병리증실위선암소치적위결장루.주요림상증상유복사3례、분양구토3례、체중하강4례、복통4례.술전진단위결장루적방법포괄위경3례、결장경l례、패관장1례、상소화도조영2례.결과 4례환자균시행료종류급위결장루절제수술,2례근치성절제,2례고식성절제.술후병리균제시저분화선암,3례환자진행료CDX-2,CK20면역조화검사보조판단종류래원.술후1례환자출현위배공장애,DIC,심공능쇠갈병사망,2례출현문합구루,존활환자균접수잡배타빈、오사리박연합화료.결론 내경검사급소화도조영시위결장루진단주요의거,위결장루구역응완정절제,일기장조구가능경가안전,단저일결론환수진일보연구.근거병리특점、면역조화CDX-2 、CK20염색추단종류래원,병진행보조화료.
Objective To explore the diagnosis and treatment of tumor associated gastrocolic fistula (GCF).Methods The records of the 4 patients with GCF between August 2008 to February 2014 were retrospectively analyzed.Three female and one male patients,those whose average age were 61 years,have been pathologically diagnosed postoperatively as gastrocolic fistula caused by malignant diseases.The main clinical symptoms were diarrhea (3 cases),fecal vomitus (3 cases),weight loss (4 cases),and abdominal pain (4 cases).Positive diagnostic tests for GCF included gastroscope (3 cases),colonoscope (1 case),barium enema (1 case),upper gastrointestinal contrast (2 cases).Results En-bloc resection of the involved gastrocolic region have been performed for all,2 patients underwent radical gastrectomy and colon resection and 2 patients were taken on palliative procedure.Pathology indicated adenocarcinoma all,Immunohistochemical detection for CK20,CDX-2 were applied for identifying the originations of tumors.Delayed gastric emptying and DIC occurred in one patient who died in 3 months after the operation,anastomotic leakages were found in 2 cases.The survival patients were all discharged and taken capecitabine combined with Oxaliplatin for chemotherapy.Conclusions Endaoscopy and gastrointestinal imaging are main evidences for diagnosis of GCF.En-bloc resection of the involved gastrocolic region were recommended,enterostomy was safer than entero-anastomosis in one stage procedure.The originations of tumors may be identifying according to the pathological characteristic and CDX-2,CK20 staining.Adjuvant chemotherapy should be applied.