頁籤選單縮合
| 題 名 | 大腸直腸平滑肌肉瘤 |
|---|---|
| 作 者 | 林華卿; | 書刊名 | 中華民國外科醫學會雜誌 |
| 卷 期 | 25:5 民81.09-10 |
| 頁 次 | 頁1349-1355 |
| 分類號 | 416.245 |
| 關鍵詞 | 大腸直腸平滑肌肉瘤; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 大腸直腸肉瘤(sarcoma)是少見的惡性腫瘤，其發生率遠不及於腺癌。腸道的平滑肌肉瘤(leiomyosarcoma)雖佔小腸所有惡性腫瘤的百分之二十，卻僅佔大腸直腸惡性腫瘤不及百分之一。從1981年至1990年，三軍總醫院共有七例大腸直腸平滑肌肉瘤，其中兩例發生於大腸，五例發生於直腸；兩例為女性，五例為男性；平均年齡是52歲。在十年來三軍總醫院所有大腸及直腸惡性腫瘤中，它的發生率分別是0.4%及1.2%。可觸摸到的腹部腫塊是大腸平滑肌肉瘤的主要臨床表徵，而主腸平滑肌肉瘤主要症狀是排使習慣改變。腫瘤的預後依文獻及我們的經驗主要決定於腫瘤大小、病理分化程度及腫瘤有無侵犯鄰近器官或穿孔至腹腔。腫瘤的轉移主要是經由血路至肺臟及肝臟，在我們的病例中，有一例發生了淋巴結轉移，另一例發生了脊椎及右側股骨頭的轉移。由於放射及化學治療對於大腸直腸平滑肌肉瘤成效不大，七例腫瘤都只接受了手術治療。在本文中，將就本院的經驗及回顧文獻採討大腸直腸平滑肌肉瘤的臨床表徵、病理變化、治療及預後。 |
| 英文摘要 | The sarcoma of the large bowel is rarely seen as comparing to the carcinoma of the large bowel which occurs commonly. The leiomyosarcoma of the intestine is measured about 20% of all small bowel malignancies but less than 0.1% of all malignancies of the colon and rectum. Seven patients who presented at Tri-Service General Hospital between 1981 to 1990 with leiomyosarcoma of the colon and rectum have been reviewed in this study. The incidence of these tumors was 0.4% in al1 malignancies of the colon and 1.2% in the rectum. There was male predominance of our cases, and average age was 52 years. In our study, five tumors arose from the rectum with four limited in the lower rectum and two arose from the colon. Palpable abdominal mass was the major clinical finding in patients with colonic leiomyosarcoma, whereas the rectal leiomyosarcoma usually occurred with change of bowel habit. Rare presentation of rectovaginal fistula, which needed repeated biopsy, and perforation were noted in two of rectal leiomyosarcomas. Because it was histological1y difficult to distinguish between leiomyoma and leiomyosarcoma, the histologic criteria used for differentiation included mitosis, size, cellularity, pleomorphism, necrosis, myxoid change, hyalinization and calcification, and ulceration. The metastases of these tumors were principally by local and hematogenous routes, usual1y to the lung and liver, however there were one lymph-node and one bony metastasis in our cases. Since chemotherapy and radiotherapy were not effective in leiomyosarcoma, all our cases received operation only. One case of the leiomyosarcoma of colon received right hemicolectomy, and another received the segmental resection of the transverse colon. Abdominoperineal resection was our procedure choice for good-risk patient with leiomyosarcoma of the rectum. In poor risk patient with a small diameter (< 2 cm) and low grade malignancy, local excision was of choice. In our experience, the clinicopathologic features that correlated with a poor prognosis included large tumor size, the presence of tumor invasion into a adjacent organ or structure, perforation into the peritoneal cavity, or high grade. |
本系統中英文摘要資訊取自各篇刊載內容。