本文選題：小腸癌 + 腹水　； 參考：《蘭州大學》2015年碩士論文

【摘要】：目的：探討小腸癌的臨床特點、病因發(fā)病機制、診斷與治療方法。方法：分析1例小腸腺癌病人的有關臨床資料,并結合文獻進行復習。資料：一中年男性患者,間斷左上腹隱痛20天,門診檢查時發(fā)現(xiàn)腹水腫瘤標志物CEA1500ng/ml。干預措施：進行實驗室、影像學、腹膜穿刺活檢等各項輔助檢查以明確診斷,診斷明確后給予相關化療方案進行化療。結果：患者主要臨床表現(xiàn)為腹痛、腹水,胃鏡結果：反流性食管炎,慢性萎縮性胃炎。結腸鏡結果：所見結腸粘膜未見異常。小腸CT提示：腸系膜及網(wǎng)膜彌漫性結節(jié)樣軟組織分布,致腹腔內(nèi)大、小腸管廣泛粘連,以右中下腹粘連為著,多考慮為惡性結節(jié),轉(zhuǎn)移可能性大；回腸末端可見明顯強化軟組織影,與粘連的回腸及腸間結節(jié)分界不清,建議鏡檢明確有無腫瘤存在。腹膜病變穿刺病檢結果提示傾向低分化腺癌,結合免疫組化結果,支持低分化腺癌,分子表型提示胃腸道來源可能,綜合考慮最后診斷為小腸癌伴腹腔轉(zhuǎn)移。結論：小腸癌的發(fā)病率低,臨床表現(xiàn)亦缺乏特異性,對于腹痛、腹水患者在積極尋找病因的過程中要考慮到小腸惡性腫瘤的可能,再結合實驗室檢查、影像學檢查、內(nèi)鏡檢查以及組織病理學等綜合判斷,這樣可提高小腸癌的早診率。
[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.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R735.32

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