47例阑尾肿瘤临床资料的回顾性分析
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摘要
目的探讨阑尾肿瘤的诊断及治疗的要点。方法回顾性分析中日友好医院2006年1月至2016年6月收治的47例病理诊断为阑尾肿瘤患者的临床资料。结果 47例病理诊断为阑尾肿瘤的患者中,黏液性囊腺瘤21例,交界性黏液性囊腺瘤11例,阑尾黏液囊肿13例,神经内分泌肿瘤2例。2例合并腹膜假黏液瘤,1例合并(左卵巢)交界性黏液性囊腺瘤伴多灶性上皮内癌变。手术切除45例,其中17例行单纯阑尾切除,14例行回盲部切除术,3例行扩大切除术(单纯阑尾+部分盲肠壁切除术),11例行右半结肠切除术。2例患者未手术切除阑尾,其中1例行结肠镜下阑尾开口息肉电切术,1例行腹腔镜探查取活检。33例患者获得随访。结论阑尾肿瘤发病率低,且临床症状缺乏特异性,术前确诊困难,误诊率极高。可疑阑尾肿瘤的患者应行扩大切除术,一期手术完整切除肿瘤组织,尽可能做到切缘阴性,以避免再次手术。
Objective Discussion on appendix cancer diagnosis and treatments. Method Retrospective analysis of the clinical datas of the 47 cases of patients with appendix tumors in China-Japanese Friendship Hospital in Beijing from January 2006 to June 2016. Result 21 cases of mucinous cystadenoma, 11 cases of borderline mucinous cystadenoma,13 cases of appendiceal mucoceles, 2 cases of neuroendocrine tumors. In 2 patients with peritoneal mucinous tumor, 1 merge(left ovary) borderline mucinous cystadenoma with multifocal epithelial carcinogenesis. Surgery in 45 cases, 17 patients were treated with appendectomy,14 cases of patients with ileocecal resection, 3 cases of patients underwent extend appendectomy, 11 cases of right hemicolectomy. 2 patient are not surgical removal of the appendix, of which 1 case of colonic polyp electrosection under appendix opening with endoscopy,1 patient laparoscopic exploration and biopsy. Conclusion The incidence of appendiceal tumor is low, but there is an extremely high rate of misdiagnosis. Appendicitis carcinoma suspected patients should be treated with extended resection to make sure the complete resection of tumor tissue and negative margin as possible. It can effectively avoid the risk of reoperation to help patients recover, increasing the postoperative survival rate and improving quality of life.
Objective Discussion on appendix cancer diagnosis and treatments. Method Retrospective analysis of the clinical datas of the 47 cases of patients with appendix tumors in China-Japanese Friendship Hospital in Beijing from January 2006 to June 2016. Result 21 cases of mucinous cystadenoma, 11 cases of borderline mucinous cystadenoma,13 cases of appendiceal mucoceles, 2 cases of neuroendocrine tumors. In 2 patients with peritoneal mucinous tumor, 1 merge(left ovary) borderline mucinous cystadenoma with multifocal epithelial carcinogenesis. Surgery in 45 cases, 17 patients were treated with appendectomy,14 cases of patients with ileocecal resection, 3 cases of patients underwent extend appendectomy, 11 cases of right hemicolectomy. 2 patient are not surgical removal of the appendix, of which 1 case of colonic polyp electrosection under appendix opening with endoscopy,1 patient laparoscopic exploration and biopsy. Conclusion The incidence of appendiceal tumor is low, but there is an extremely high rate of misdiagnosis. Appendicitis carcinoma suspected patients should be treated with extended resection to make sure the complete resection of tumor tissue and negative margin as possible. It can effectively avoid the risk of reoperation to help patients recover, increasing the postoperative survival rate and improving quality of life.
引文
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[8]李方,齐长海,卢一艳,等.高级别阑尾黏液性肿瘤伴腹膜假黏液瘤9例临床病理分析[J].诊断病理学杂志,2017,24(6):406-410,422.
[9]张娣,王红霞,张培功,等.阑尾黏液性肿瘤影像学表现及病理相关性研究[J].实用放射学杂志,2017,33(1):69-71,102.
[2]华积德.现代普通外科学[M].北京:人民军医出版社,1999:686-687.
[3]梁思渊,牟永华,聂寒秋,等.阑尾肿瘤16例诊治分析[J].临床医学,2007,27(9):6-7.
[4]Landen S,Bertrand C,Maddern GJ,et a1.Appendiceal mucoceles and pseudomyxoma peritoneal[J].Surg Gynecol Obstet,1992,175(5):401.
[5]朱雄伟,王强,胡志前,等.阑尾黏液囊肿的临床分析[J].中国医师杂志,2005,7(8):1021-1023.
[6]Boudreaux JP,Klimstra DS,Hassan MM,et al.The NANETSconsensus guideline for the diagnosis and management of neuroendocrine tumors:well-differentiated neuroendocrine tumors of the jejunum,appendix,and cecum[J].Pancreas,2010,39(6):753-766.
[7]陈瑞云,张琳,孙国锋,等.腹腔镜手术治疗阑尾黏液性肿瘤的临床体会(附11例报告)[J].腹腔镜外科杂志,2017,22(8):612-614.
[8]李方,齐长海,卢一艳,等.高级别阑尾黏液性肿瘤伴腹膜假黏液瘤9例临床病理分析[J].诊断病理学杂志,2017,24(6):406-410,422.
[9]张娣,王红霞,张培功,等.阑尾黏液性肿瘤影像学表现及病理相关性研究[J].实用放射学杂志,2017,33(1):69-71,102.