Mosier D M, Bloch R S, Cunningham P L, Dorman S A
Department of General Surgery, Easton Hospital, Pennsylvania 18042.
Am Surg. 1992 Nov;58(11):677-82.
Isolated, small bowel metastases from lung carcinoma are extremely rare; only 34 cases have been previously reported. Rarer still is the presentation of lung carcinoma with a lesion metastatic to the small bowel. These 34 cases and 3 recent ones from Easton Hospital (Easton, PA) were analyzed to clarify the clinical and pathologic features of the disease. The majority of patients had a history of abdominal pain (86%), melena (23%), or nausea and vomiting (26%). Few had weight loss (16%). Twenty-one patients (57%) came to the hospital with perforation and peritonitis, including 9 in whom lung carcinoma was undiagnosed before laparotomy. Thirteen patients (34%) underwent laparotomy because of small bowel obstruction, 2 (6%) for bleeding and 1 (3%) for a mass found during work-up. Squamous cell (49%) and large cell (22%) were the most common cell types, and the jejunum was the most common site of the metastases (79%). Survival time was dismal (mean 51 days) and was unaffected by therapy to the primary site of the cancer or its metastases. The authors conclude that small bowel metastases from lung carcinoma are not uncommon and may be seen more frequently as patients live longer after their diagnosis of cancer. Small bowel metastases must be considered in any patient with both lung carcinoma and abdominal pain, and should be expected in patients with both lung carcinoma and an acute abdomen.
孤立性小肠转移癌极为罕见，此前仅报道过34例。更罕见的是肺癌伴有小肠转移灶。分析了这34例病例以及伊顿医院（宾夕法尼亚州伊斯顿）最近的3例病例，以阐明该病的临床和病理特征。大多数患者有腹痛病史（86%）、黑便（23%）或恶心呕吐（26%）。很少有体重减轻（16%）。21例患者（57%）因穿孔和腹膜炎入院，其中9例在剖腹手术前未诊断出肺癌。13例患者（34%）因小肠梗阻接受剖腹手术，2例（6%）因出血，1例（3%）因检查时发现肿块。鳞状细胞癌（49%）和大细胞癌（22%）是最常见的细胞类型，空肠是转移最常见的部位（79%）。生存时间很短（平均51天），不受针对癌症原发部位或转移灶的治疗影响。作者得出结论，肺癌小肠转移并不罕见，随着癌症患者诊断后存活时间延长，可能会更频繁地出现。任何患有肺癌且伴有腹痛的患者都必须考虑小肠转移，患有肺癌且伴有急腹症的患者也应想到小肠转移。
