作者：李璇1，陈钰榕1，陈志强2，邹瞭南3,4

单位：1.广州中医药大学第二临床医学院研究生，广东 广州 510120；2.广东省中医院泌尿外科，广东 广州 510120；3.广东省中医院肛肠外科，广东 广州 510120；4. 广州中医药大学第二临床医学院，广东 广州 510120

Authors: Li Xuan1，Chen Yurong1，Chen Zhiqiang2，Zou Liaonan3,4

Unit:  1. Postgraduate of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong, China；2. Department of Urology Surgery, Guangdong Hospital of Traditional Chinese Medicine,  Guangzhou 510120, Guangdong, China；3. Department of Anorectal Surgery, Guangdong Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong, China；4. The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510120, Guangdong, China

摘要：

目的  本文探讨异时性结肠造口处肿瘤的临床特点及诊治过程，为特殊部位的异时性结直肠癌的诊治提供临床经验。方法  回顾性描述1 例低位直肠癌经腹会阴联合切除术后10年，出现造口处肿瘤的临床病例，并进行相关文献复习。结果  结合患者病史、症状、体征及辅助检查，考虑患者造口处肿瘤是由于造口护理不当、肠道分泌物及粪便反复污染刺激所致。患者的自身免疫系统疾病也是潜在病因。我们采取造口肿瘤及周围皮肤的根治性切除术，术后至2023年8月9日未见疾病进展征象。结论  对于特殊部位的异时性结直肠癌，其诊疗方式更趋向于个体化，尚未能形成规范的治疗方案，定期规律监测随访是早发现早诊治的有效途径，是减少全身转移风险、提高R0切除机会的可靠方法。

关键词： 造口肿瘤；直肠癌根治术；异时性肿瘤；病例报道

Abstract：

Objective   This paper discusses the clinical characteristics and diagnostic and treatment process of tumours at metachronous colostomies to provide clinical experience for metachronous colorectal cancer at special sites. Method  A clinical case of a patient presenting with tumour at the stoma 10 years after combined transabdominal perineal resection for low rectal cancer was retrospectively described, and relevant literature review was performed. Result  Combining the patient's medical history, symptoms, signs and auxiliary examinations, it was considered that the tumours at the patient's stoma were due to improper stoma care and stimulation by repeated contamination with intestinal secretions and faeces. The patient's autoimmune system disease was also identified as a potential cause. Following the radical resection of the stoma tumours and surrounding skin, no signs of disease progression have been observed from post-operation to August 9, 2023. Conclusion  The diagnosis and treatment of metachronous colorectal cancer at special sites tends to be more individualised, and no standardised treatment plan has been formed yet. Regular monitoring and follow-up are effective ways for early detection and diagnosis and treatment, which is a reliable method to reduce the risk of systemic metastasis and improve the chance of R0 resection.

Key Words:  Stoma tumour；Radical resection of rectal cancer；Metachronous cancer；Case report

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