阑尾类癌21例诊治分析

目的：探讨阑尾炎癌的生物学特性，诊断和外科治疗经验，方法：回顾性总结自1967－1997年收治的21例阑尾类癌患者的临床和病理资料。结果：本组21例患者中有12例（57％）的症状和体征提示为急性阑尾炎，9例患者（43％）为偶然发现，肿瘤直径大于1cm有16例，1－2cm3例，大于2cm 2例，15例肿瘤浸润深度限于粘膜下或肌层，4例侵及浆膜，有2例患者显示肿瘤浸润至阑尾系膜，1例患者肿瘤大于2cm伴局部淋巴结转移，除1例肿瘤直径大于2cm且伴阑尾系膜淋巴结阳性者再次行右半结肠切除术外，其余20例均仅行阑尾切除术，获随访的19例患者中，所有患者均无复发和远处转移。结论：阑尾类癌少见且多无症状，小于1cm的阑尾类癌仅作单纯性阑尾切除术即可。肿瘤大于2cm的患者应行右半结肠切除术。

Carcinoid tumors of the appendix:a report of 21 cases

Objective To summarize the diagnosis and treatment experience for patients with appendiceal carcinoid tumors.Methods 21 patients with appendix carcinoid tumors were admitted and received surgery from 1967 to 1997 in our hospital.Results 12 patients (57%) presented with signs and symptoms suggestive of acute appendicitis.In 9 patients(43%) tumors were discovered incidentally.The tumors were at the tip in 17 patients,at the middle third in 3,and at the base of the appendix in one.The tumor was less than 1 cm in diameter in 16 patients,between 1 and 2 cm in 3 patients,and larger than 2 cm in 2 patients.Tumor invasion was confined to the submucosa or muscle layers in 15 patients,serosa involved in 4 patients,and into the meso appendicular fat in the remaining 2 patients.Twenty patients underwent appendectomy alone.One patient with a tumor size larger than 2 cm and positive lymph nodes in the mesoappendix underwent secondary right hemicolectomy.Complete follow up was achieved in 19 patients,and all patients remained free of tumor recurrence and metastasis.Conclusion Appendiceal carcinoids of less than 1 cm could be adequately managed by appendectomy alone.The appropriate treatment for tumors of 1 to 2 cm are still controversial.Right hemicolectomy is recommended for tumors larger than 2 cm .