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同时性多原发结肠癌误诊三例临床分析 被引量:2

The Missed Diagnosis of Synchronous Multiple Primary Colon Cancer: Clinical Analysis of 3 Cases
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摘要 目的探讨同时性多原发结肠癌的临床特点及误诊原因。方法回顾性分析同时性多原发结肠癌误诊3例的临床资料。结果例1因大便带血1个月就诊,经肠镜、下消化道钡剂造影等检查诊断为乙状结肠癌后行手术治疗,1个月后复查癌胚抗原78.5μg/L,行正电子发射型计算机断层扫描(PET/CT)、肠镜及活组织病理检查诊断横结肠癌,再次手术治疗。例2因黏液样便、血便1个月就诊,外院肠镜发现降结肠与回盲部两处病灶,我院复查肠镜未能通过降结肠病灶达盲肠,疑诊升结肠癌,经手术探查及术后病理确诊为同时性多原发结肠癌。例3因大便带血2个月就诊,外院肠镜检查疑诊为乙状结肠单原发结肠癌,我院肠镜检查证实结肠存在3处占位性病灶,经手术及术后病理确诊为同时性多原发结肠癌。3例术后定期门诊复查均未发现肿瘤复发。结论同时性多原发结肠癌临床表现不典型,极易误漏诊。临床医师需加强对同时性多原发结肠癌的认识,对疑诊患者需完善CT、下消化道钡剂造影及PET/CT等检查,必要时再次行肠镜检查,可提高术前诊断率。 Objective To study the clinical manifestations and the cause of missed diagnosis and misdiagnosis of syn- chronous multiple primary colon cancer. Methods Clinical data of three patients with synchronous multiple primary colon cancer who had missed diagnosis and misdiagnosis was retrospectively analyzed. Results One patient was admitted for bloody stool for one month and diagnosed as having sigmoid colon cancer with the eolonoscopy/Barium X-ray, and then underwent surgical treatment. One month later, the review of carcino-embryonic antigen was 78.5 g/L. Via CT scanning colonoscopy pathology, the patient was diagnosed as having transverse colonic carcinoma and underwent the second operation. Another case : the patient was admitted for mueoid stool and bloody stool for one month, the colonoscopy of outer court showed two le- sions in descending colon and cecum, but the colonoscopy of my hospital did not show the lesions in cecum because the colonoscopy could not pass descending colon. The patient was suspected with having ascending colon carcinoma, via operation research and postoperative pathological diagnosis, and the patient was definitely diagnosed as having synchronous multiple pri- mary colon cancer. The last case: the patient was admitted for bloody stool for two months. The colonoscopy of outer court was misdiagnosed as single primary sigmoid colon cancer, but the colonoscopy of our hospital found three lesions in colon. Surgery and postoperative pathology confirmed synchronous multiple primary colon cancer. No recurrence was reported after the 3 patients were discharged after surgery. Conclusion The clinical manifestations of synchronous multiple primary colon cancer lack specificity and may tend to be miss diagnosed and misdiagnosed. The clinicians need to deepen the understanding of synchronous multiple primary colon cancer and improve the CT, Barium X-ray and PET/CT examinations in suspected patients. If necessary, the colonoscopy examination should be made to improve the preoperative diagnostic rate
出处 《临床误诊误治》 2016年第1期21-24,共4页 Clinical Misdiagnosis & Mistherapy
基金 南京市医学科技发展项目(YKK12058)
关键词 肿瘤 多原发性 结肠肿瘤 误诊 漏诊 肿瘤 单原发性 Neoplasm, multiple primary Colonic neoplasm Misdiagnosis Missed diagnosis Neoplasm antibioticresistance, single primary
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