CAJ | 학술논문

目的通过对1例小儿肠神经元性发育异常症合并结肠癌病例的报道,结合复习相关文献,探讨两种疾病之间的关联,以提高对小儿结肠直肠癌的认识和重视对小儿慢性便秘的诊治.方法描述1例肠神经元性发育异常症小儿合并结肠癌病例的临床表现、病理特征和诊治状况,查阅近60多年来的医学文献中的小儿结肠直肠癌病例,并进行讨论.结果 1例肠神经元性发育异常症患儿因反复腹痛和呕吐3个月余入院,体检示腹部肿块而进行手术切除.术后病理结果为横结肠浸润性印戒细胞癌,肠神经元性发育异常症.阅查近60多年的医学文献,全世界10岁及10岁之内的小儿结肠直肠癌仅为11例,大多有家族性肠腺瘤性息肉病及慢性结肠直肠炎这些癌前病变.小儿结肠癌十分罕见,仅为百万分之一.小儿结肠癌最常见的临床症状是腹痛、肠道出血、排便习惯改变、体重减轻、恶心和呕吐.最常见的发病部位是直肠和横结肠.与成人相比粘液腺癌和印戒细胞癌的组织类型较多,分化差,临床分期级别高,预后较差.结论小儿结肠癌发病率很低,症状不典型,常伴有癌前状态,往往得不到早期诊断和治疗,导致预后不良.应该重视对小儿结肠癌及其癌前状态的诊治.
목적 통과대1례소인장신경원성발육이상증합병결장암병례적보도,결합복습상관문헌,탐토량충질병지간적관련,이제고대소인결장직장암적인식화중시대소인만성편비적진치.방법 묘술1례장신경원성발육이상증소인합병결장암병례적림상표현、병리특정화진치상황,사열근60다년래적의학문헌중적소인결장직장암병례,병진행토론.결과 1례장신경원성발육이상증환인인반복복통화구토3개월여입원,체검시복부종괴이진행수술절제.술후병리결과위횡결장침윤성인계세포암,장신경원성발육이상증.열사근60다년적의학문헌,전세계10세급10세지내적소인결장직장암부위11례,대다유가족성장선류성식육병급만성결장직장염저사암전병변.소인결장암십분한견,부위백만분지일.소인결장암최상견적림상증상시복통、장도출혈、배편습관개변、체중감경、악심화구토.최상견적발병부위시직장화횡결장.여성인상비점액선암화인계세포암적조직류형교다,분화차,림상분기급별고,예후교차.결론 소인결장암발병솔흔저,증상불전형,상반유암전상태,왕왕득불도조기진단화치료,도치예후불량.응해중시대소인결장암급기암전상태적진치.
Objective To explore the correlations between colorectal carcinoma and intestinal neuronal dysplasia (IND) and reviewed the relevant literatures so as to pay great attention to chronic constipation and improve the recognition of colorectal cancer in childhood.Methods The clinicopathological features,diagnosis and treatment of colorectal carcinoma complicated with IND were described.And the relevant literature of colorectal cancinoma in children over the last 60 years was reviewed.Results This IND child complained of abdominal pain and vomiting for 3 months.On examinations,an abdominal mass was identified and then excised.The pathologic report was infiltrative signet-ring cell carcinoma of transverse colon and IND of colon.Colorectal cancer is extremely rare in children with an incidence of one child per one million.There were only 11 cases of colorectal cancinomas in children aged under 10 years over the last 60 years in the literature.Most of them had familial adenomatous polyposis or chronic colorectitis precancerous conditions.The most common presenting symptoms were abdominal pain,gastrointestinal bleeding,altered bowel habits,weight loss,nausea and vomiting.The most common sites of involvement were rectum and transverse colon.Children had more unfavorable histotypes (i.e.,mucinous adenocarcinoma ＆ signet ring cell carcinoma) when compared with adults.Poorly differentiated tumors and advanced stage were more common in children with a worse prognosis.Conclusions Colorectal cancer is exceedingly rare in children.And its clinical features are often atypical.Many patients have precancerous conditions and delayed diagnosis and treatment lead to a poor prognosis.Clinicians should pay great attention to colorectal cancer and its predisposing conditions in children.