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本文报道一组172例根治术后两个月内出现腹腔转移5例(并发率约3%),作者认为,年龄“较轻”,已侵浆膜及肠系膜淋巴结、有慢性肝肾疾病是急性转移的主要诱因,临床表现以恶性腹腔积液及不全肠梗阻,尤以腹胀为突出,5例中有3例进行了手术探查,术中见肠系膜淋巴结肿大,肠系膜高度水肿,肠壁松弛,内充气体,无明显机械梗阻,经病理证实肠系膜淋巴转移癌,或可见到粟粒状转移病灶,3例手术治疗不能解决“梗阻”,均于短期内死亡;2例经腹水找痼细胞及CEA证实诊断后,采取综合治疗:支持疗法、蛋白制剂应用、卡铂的应用、胃肠减压、肛管排气、腹腔穿刺、皮肠穿刺排气、中药治疗等,2例均能渡过“危象”,1例出院后慢性腹泻,3个月后死亡;1例腹水消失出院后能骑自行车外出,至今已超过10个月。作者认为,直(结)肠癌手术后近期腹膜转移,病变广泛,肠系膜淋巴结浸润和淋巴管反应、系膜广泛水肿、肠壁肌层蠕动失调有广泛性和功能性,医生必须了解病理变化,明确诊断,决不可贸然手术,加速病人死亡。
This article reports a group of 172 cases of radical peritoneal metastasis within 5 months after radical surgery (concurrency rate of about 3%), the authors believe that age is “lighter”, has invaded serosa and mesenteric lymph nodes, chronic liver and kidney disease is acute The main causes of metastasis were clinical manifestations of malignant ascites and incomplete intestinal obstruction, especially bloating. Three out of five patients underwent surgical exploration. The mesenteric lymph nodes were enlarged, the mesentery was highly edema, and the intestinal wall was loose. Inflated body, no mechanical obstruction, pathologically confirmed mesenteric lymph node metastasis, or visible miliary metastatic lesions, 3 cases of surgical treatment can not solve the “obstruction”, all died in the short term; 2 cases of ascites find cells and CEA After the diagnosis was confirmed, comprehensive treatment was taken: supportive therapy, application of protein preparations, application of carboplatin, gastrointestinal decompression, anal canal exhaust, abdominal puncture, skin puncture and exhaust, and Chinese medicine treatment, and both cases were able to survive. “Crisis”, 1 case of chronic diarrhea after discharge, died after 3 months; 1 case of ascites disappeared and was able to go out on a bicycle after leaving the hospital, so far it has been more than 10 months. The authors believe that the immediate (coastal) colon cancer surgery peritoneal metastasis, extensive lesions, mesenteric lymph node infiltration and lymphatic response, extensive mesangial edema, extensive and functional peristalsis of intestinal muscle wall, the doctor must understand the pathological changes, A clear diagnosis must not be rushed to surgery to speed up patient death.