Garwood Robert A, Sawyer Mark D, Ledesma E J, Foley Eugene, Claridge Jeffrey A
Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Am Surg. 2005 Feb;71(2):110-6.
Gastrointestinal tract perforation (GITP) secondary to metastatic lung cancer is extremely rare. We present a case of small bowel perforation secondary to metastatic lung cancer. The objective of this study was to review the current literature and further characterize the incidence, histology, and risk of GITP secondary to lung cancer metastasis. A Medline search was done to identify all the cases of GITP attributed to metastatic lung cancer reported in the literature. Data was collected and analyzed from a collection of cases in the medical literature since 1960. We identified 98 cases of perforated lung cancer metastasis to the small intestine. Four gastric perforations, three colonic perforations, and one appendiceal perforation were also identified but not analyzed. The mean age was 64.5 years. There was a male predominance of 89 per cent versus 11 per cent female. Perforations occurred most often in the jejunum (53%) followed by ileum (28%). Combined jejunum-ileum lesions accounted for 4 per cent of perforations. No duodenal perforations were reported, though a specific site was not determined in 13 per cent of cases. Small bowel perforations were most often caused by adenocarcinoma (23.7%), squamous cell carcinoma (22.7%), large cell carcinoma (20.6%), and small cell carcinoma (19.6%). The prevalence of small bowel perforation secondary to a given primary lung cancer histology varied by region. The mean survival was 66 days with 50 per cent of patients not surviving past 30 days. Despite a high incidence of lung cancer, small bowel perforation secondary to lung cancer metastasis remains relatively rare. Perforated metastases occur more often in men and are found more commonly in the jejunum. Small bowel perforations are caused most often by adenocarcinoma; however, squamous cell and large cell carcinoma metastases are more likely to result in perforation. Small bowel perforation in this setting has a significant impact on mortality, decreasing 1-year survival to less than 3 per cent.
转移性肺癌继发胃肠道穿孔（GITP）极为罕见。我们报告一例转移性肺癌继发小肠穿孔的病例。本研究的目的是回顾当前文献，并进一步描述肺癌转移继发GITP的发病率、组织学特征及风险。通过检索医学文献数据库（Medline）来识别文献中报道的所有转移性肺癌继发GITP的病例。收集并分析了自1960年以来医学文献中的一系列病例数据。我们共识别出98例肺癌转移至小肠并穿孔的病例。还识别出4例胃穿孔、3例结肠穿孔和1例阑尾穿孔，但未对其进行分析。平均年龄为64.5岁。男性占比89%，女性占比11%。穿孔最常发生于空肠（53%），其次是回肠（28%）。空肠-回肠联合病变占穿孔病例的4%。虽有13%的病例未确定具体穿孔部位，但未报道十二指肠穿孔病例。小肠穿孔最常见的病因是腺癌（23.7%）、鳞状细胞癌（22.7%）、大细胞癌（20.6%）和小细胞癌（19.6%）。特定原发性肺癌组织学类型继发小肠穿孔的患病率因地区而异。平均生存期为66天，50%的患者生存期未超过30天。尽管肺癌发病率较高，但肺癌转移继发小肠穿孔仍然相对罕见。穿孔性转移在男性中更常见，且在空肠中更为多见。小肠穿孔最常见的病因是腺癌；然而，鳞状细胞癌和大细胞癌转移更易导致穿孔。这种情况下的小肠穿孔对死亡率有显著影响，使1年生存率降至不足3%。
