小肠癌1例报告并文献复习

发布时间：2018-04-12 08:03

本文选题：小肠癌 + 腹水　；参考：《兰州大学》2015年硕士论文

【摘要】：目的：探讨小肠癌的临床特点、病因发病机制、诊断与治疗方法。方法：分析1例小肠腺癌病人的有关临床资料,并结合文献进行复习。资料：一中年男性患者,间断左上腹隐痛20天,门诊检查时发现腹水肿瘤标志物CEA1500ng/ml。干预措施：进行实验室、影像学、腹膜穿刺活检等各项辅助检查以明确诊断,诊断明确后给予相关化疗方案进行化疗。结果：患者主要临床表现为腹痛、腹水,胃镜结果：反流性食管炎,慢性萎缩性胃炎。结肠镜结果：所见结肠粘膜未见异常。小肠CT提示：肠系膜及网膜弥漫性结节样软组织分布,致腹腔内大、小肠管广泛粘连,以右中下腹粘连为著,多考虑为恶性结节,转移可能性大；回肠末端可见明显强化软组织影,与粘连的回肠及肠间结节分界不清,建议镜检明确有无肿瘤存在。腹膜病变穿刺病检结果提示倾向低分化腺癌,结合免疫组化结果,支持低分化腺癌,分子表型提示胃肠道来源可能,综合考虑最后诊断为小肠癌伴腹腔转移。结论：小肠癌的发病率低,临床表现亦缺乏特异性,对于腹痛、腹水患者在积极寻找病因的过程中要考虑到小肠恶性肿瘤的可能,再结合实验室检查、影像学检查、内镜检查以及组织病理学等综合判断,这样可提高小肠癌的早诊率。
[Abstract]:Objective: to investigate the clinical features, etiology and pathogenesis, diagnosis and treatment of small bowel cancer.Methods: the clinical data of a case of small intestinal adenocarcinoma were analyzed and reviewed.Data: a middle-aged male patient with intermittent left epigastric pain for 20 days found ascites tumor marker CEA 1500 ng / ml during outpatient examination.Intervention measures: laboratory, imaging, peritoneal biopsy and other auxiliary examinations to make sure the diagnosis, after the diagnosis of chemotherapy regimen.Results: the main clinical manifestations were abdominal pain, ascites, gastroscopy: reflux esophagitis, chronic atrophic gastritis.Colonoscopy: the colonic mucosa was not abnormal.Ct findings of small intestine showed that mesentery and omentum diffuse nodular soft tissue distribution, resulting in large abdominal cavity, extensive adhesion of small intestinal duct, right middle and lower abdomen adhesion, mostly considered as malignant nodules, the possibility of metastasis is high;Obviously enhanced soft tissue shadow could be seen at the end of ileum, and the boundary between the ileum and the interintestinal nodule was not clear. It was suggested that the presence of tumor should be confirmed by microscopic examination.The biopsy results of peritoneal lesions showed a tendency towards poorly differentiated adenocarcinoma, combined with immunohistochemical results to support poorly differentiated adenocarcinoma, and molecular phenotype suggested the origin of gastrointestinal tract. Finally, the diagnosis of small bowel cancer with intraperitoneal metastasis was considered.Conclusion: the incidence of small bowel cancer is low, and the clinical manifestation is also lack of specificity. For patients with abdominal pain and ascites, the possibility of small intestinal malignancy should be taken into account in the process of actively searching for the etiology, combined with laboratory examination and imaging examination.Endoscopic examination and histopathology can improve the early diagnosis rate of small bowel cancer.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.32

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