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某區域醫院小腸原發性惡性腫瘤十一年之經驗

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(1)

95017 303 1

2%

84 4 95 3

15 80

61.8

( Leiomyosarcoma ) ( Leiomyoma )

( Stromal tumor ) ( Carcinoid tumor )

7 5 % 9 0 %

2%

1-3

( ) (

) ( )

( )

4-7

152

( ) 159 ( )

(2)

( 1 )

( Stromal tumor )

( )

( 2 )

22 94

6 1 . 8 6 5

53

59.3 62.7

( 52 ) ( ) ( 3 )

( 86.7% ) ( 53.3% )

( )

( 25% )

( )

( American Joint Committee on Cancer guidelines )

8

5 2 6 1 22

*

, 28, 50

^

, 63, 67, 78, 80

*

55.4

3 2 4 1 40, 69

^

, 70

*

, 77

*

, 94 70

2 0 1 1 33

^

, 71 52

1 0 0 1 85

^

85

11 4 11 4 927 61.8

( ) ( 65 ) ( 53 ) (62.7) (59.3)

6 4 2 1 13 (86.7%)

2 1 3 (20.0%)

1 1 1 1 4 (26.7%)

1 4 1 6 (40.0%)

2 1 2 5 (33.3%)

5 2 1 8 (53.3%)

1 1 ( 6.7%)

4 2 2 1 9 (60.0%)

1 1 ( 6.7%)

0 3 0 1 4 (26.67%)

4 1 2 0 7 (46.67%)

3 1 0 0 4 (26.67%)

7 (46.67%) 5 (33.33%) 2 (13.33%) 1 ( 6.67%) 15 (100%)

(3)

( 3 ) ( 2 ) ( 2 )

1 4 5 6 6

( 13.3% ) ( )

( 52.7/68 )

( 384.7/251.3 ) ( )

( )

( )

( 11 509 ) 13.57

( 19,307 ) 20.72

( 91,202 ) 12.06

1.7:1

( )

( )

1 III 3556

2 I 2837

3 IV 288

4 IV 519

5 IV 477

6 I 158

7 IV

8 III 14

9 ? 566

10 ? 174

11 ?

12 II 466

13 II

14 II

15 III 35

4 5 6 7

1954-1977 1960-1989 1969-1981 1995-2002 1994-2006

6 30 7 13 5

4 26 8 12 7

25 42 20 5 2

0 3 0 2 1

22 65 24 18 11

13 36 11 14 4

35.5 47.5 37.2 58.4 61.8

15% 23% 7.4% ? 13.3%

(4)

( )

9

( )

(

)

4,9,13

6

( )

4-7

13.3% 15%

23% 7.4%

( )

3,10,11

9 - 1 3

14

95%

9

2000 ( leiomy-

oma ) ( leiomyosarcoma )

( Stromal tumor )

9 , 1 5

( interstitial cells of Cajal ) ( mesynchymal neoplasms ) 95%

CD117 ( KIT )

5 0 % C D 3 4 ( smooth muscle actin )

( subtype ) ( spindle cell ) ( epithelioid ) ( mixed )

5 ( 50 )

5 4 %

9 , 1 5

(5)

1.Zollinger RM, Sternfeld WC, Schreiber H. Primary neoplasms of the small intestine. Am J Surg 1986; 151: 654-8.

2.Ashley SW, Wells SA Jr. Tumors of the small intestine. Semin Oncol 1988; 15: 116-28.

3.Frost DB, Mercado PD, Tyrell JS. Small bowel cancer: a 30-year review. Ann Surg Oncol 1994; 1: 290-5.

4.Huang TJ, Sheen MC, Chen CY. Primary malignant tumors of the small intestine. J S A ROC 1979; 12: 95-105.

5.Lee WJ, Chang KJ, Wang SM, Chen KM, How SW. Primary malignant tumor of the small intestine. J Formosan Med Assoc 1991; 90: 776-81.

6 .

1982; 81: 1056-61 7.

2003;

20: 118

FL, Page DL, Fleming ID, et al eds. AJCC Cancer Staging Manual. 6th ed. New York: Springer-verlag Co. 2002; 107-12.

9.Zeh III HJ. Cancer of the small intestine. In: Delvita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: principles & practice of oncology. 7th ed. Philadelphia: Lippincott Williams &

Wilkins Co. 2005; 1035-49.

10.North JH, Pack MS. Malignant tumors of the small intestine: a review of 144 cases. Am Surg 2000; 66: 46-51.

11.Talamonti MS, Goetz LH, Rao S, Joehl RJ. Primary cancers of the small bowel: analysis of prognostic factors and results of sur- gical management. Arch Surg 2002; 137: 564-70.

12.Minardi AJ Jr, Zibari GB, Aultman DF, McMillan RW, McDonald JC. Small-bowel tumors. J Am Coll Surg 1998; 186:

664-8.

13.Rustgi AK. Small intestinal neoplasms. In: Feldman M, Friedman LS, Sleisenger MH, eds. Gastrointestinal and Liver Disease: pathophysiology/diagnosis/management. 7th ed.

Philadelphia: Saunders Co. 2002; 2169-74.

14.

2006; 21: 18-24

15.Trent JC, Benjamin RS. New developments in gastrointestinal

stromal tumor. Curr Opin Oncol 2006; 18: 386-95.

(6)

11-year Experience

in A Regional Hospital in Taitung

Chin-Hsien Li, Ming-Jong Bair, Wen-Hsiung Chang, Shee-Chan Lin, Chih-Jen Chen, and Wen-Shen Liao

Primary malignant tumors of the small intestine represent less than 2% of all gastrointestinal malignancies.

In Taiwan, published investigations of these tumors have been limited to hospitals on the west coast. We retro- spectively evaluated cases of small bowel malignancies seen at our hospital in Taitung on the east coast of Taiwan from April 1995 to March 2006. The most common diagnoses among the 15 cases we found were stromal tumor, followed by adenocarcinoma, lymphoma and carcinoid tumor. For unknown reasons, lymphoma appeared to be less common in our series than in those before 1991 from western Taiwan. The incidence of these tumors was higher in the aboriginal as compared with the non-aboriginal population of Taitung, although a larger series is probably needed to confirm the discrepancy. The leiomyoma and leiomyosarcoma have been more recently clas- sified as gastrointestinal stromal tumors. In our series, more men than women had small bowel malignancies.

The average age at diagnosis was 61.8, and the commonest symptom was abdomen pain. Not surprisingly, sur- vival was better among patients with tumors discovered in the early stage. Greater awareness of the possibility of these rare cancers might enhance early diagnosis. ( J Intern Med Taiwan 2007; 18: 29-34 )

Gastroenterology Division, Department of Internal Medicine,

Mackay Memorial Hospital, Taitung Branch, Taiwan

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