阑尾的应用解剖学探讨

目的 为临床应用提供更多的形态学资料。方法 在106具福尔马林固定的汉族成人尸体上对阑尾及其系膜进行了观测。结果 观察了阑尾的位置、形态、长度、开口形状,动脉分支及阑尾系膜的形态等指数。结论 阑尾位置以回肠前位最多,阑尾的形态以“S”形和扭曲形最多,阑尾开口呈漏斗形者最多,阑尾长度平均为(66.3±0.3)mm,阑尾系膜以三角形最多。     

Necrotizing arteritis of the vermiform appendix. A clinicopathologic study of 12 cases

Necrotizing arteritis of the vermiform appendix (NAVA) is an uncommon condition. There are conflicting reports in the literature about its relationship to systemic polyarteritis nodosa (PAN). In this study, 12 cases of NAVA are described, constituting 0.28% of histologically examined appendixes. Nine of the patients were followed up for a mean of 6.8 years. Systemic necrotizing arteritis was found in three cases, all of which were complicated by secondary ulceration or infarction of the colon. The results strengthen the association between NAVA and systemic PAN. However, it is more meaningful to relate NAVA to the broader group of necrotizing vasculitides rather than exclusively to classic PAN.     

Granulomatous disease in the vermiform appendix.

In a twenty-year period 19 appendicectomy specimens were diagnosed as primary Crohn's disease. This represents 4.9% of the total number of both resection specimens and mucosal biopsies diagnosed as Crohn's disease during that time. This is a review of the main histopathological features found in these appendices and their subsequent clinical outcome. The predominant feature is transmural inflammation characterised by fibrosis and giant cell epithelioid granulomata. An accompanying spectrum of acute imflammatory changes is also seen. One patient progressed to more widespread ileal and caecal disease 17 months later. One patient developed perianal fistulae and chronic non-specific proctitis 24 months later. This represents a proven recurrence of one case in a study population of 19. The conclusion is that primary Crohn's disease of the appendix is usually an isolated phenomenon but rarely it may forewarn of more widespread bowel disease in the future. A discussion regarding the differential diagnosis of granulomatous appendiceal lesions is included.     

Adenocarcinoid of the vermiform appendix

Summary Four cases of adenocarcinoid of the appendix were studied. Two tumours were found among 28 cases primarily diagnosed as appendiceal carcinoids. They showed characteristic histological structures with features of both a conventional carcinoid tumour and a mucinproducing adenocarcinoma with goblet cells. All tumours were small and ill-defined; three were associated with fibrous obliteration of the appendiceal lumen. All were diagnosed incidentally by the pathologist in appendices removed en passant or because of acute appendicitis. Three of the tumours appeared well differentiated with a low degree of malignancy similar to that of the conventional carcinoid tumour. In one case however, the tumour was less differentiated with atypical foci and a high mitotic count and had metastasised to peritoneum and both ovaries.     

The vermiform appendix: A review

New research on the vermiform appendix has shed light on its function. In further understanding the function of the appendix, this information should not negatively impact the clinical judgment in the event of appendicitis. Although the appendix and its pathology have been noted for centuries, it still presents a challenge in the operating room. The most common emergency surgical procedure performed is an appendectomy. Its highly variable position within the abdomen can cause confusion for clinicians. However, improved imaging modalities have heightened the physician's ability to diagnose disease of this organ. This article reviews germane literature regarding the human vermiform appendix. Clin. Anat. 26:833–842, 2013. © 2013 Wiley Periodicals, Inc.     

Mucin producing carcinoid tumours of the vermiform appendix.

Six cases of an unusual mucoid variant of carcinoid tumour of the appendix are reported. These lesions are small, detected incidentally, and carry a good prognosis. Their histological features are distinctive and differ from those of ordinary carcinoid tumours and adenocarcinoma. They have been confused with adenocarcinoma, sometimes resulting in radical surgery. Surgery beyond appendicectomy is probably unwarranted in these cases. The mucin secreted by goblet cells of the normal mucosal epithelium and by the cells of these carcinoid tumours have certain histochemical similarities.     

In vivo location of the human vermiform appendix

The anatomic position of the appendiceal tip is cited in many surgical and anatomical texts as being fixed in the retrocecal position in as many as two-thirds of cases studied. The reference most often quoted to support this observation is Wakeley (1933), but this frequency did not correspond to the clinical experience of the surgical staff at the authors' institution. Accordingly, a prospective survey of the in vivo location of the vermiform appendix was undertaken over a 6-month period. The results demonstrated that the retrocecal position was indeed the most common location, but occurred in only 33% of instances. This observation may encourage greater utilization of laparoscopic appendectomy, since it suggests that retroperitoneal dissection will not be necessary to locate the appendiceal tip in the majority of cases. © 1994 Wiley-Liss, Inc.     

Cadaveric topography and morphometry of the vermiform appendix

Our study justified by the frequency of acute appendicitis and the possibility of anatomic variations of the caecoappendicular area attempt to index the topographic variations of the vermiform appendix (v.a.). On 80 fresh native cadavers (62 men and 18 women) without surgical antecedent whose mean age was 36 years (range between 16 and 78 years) we note the morphotype and the height. More over we study the intraperitoneal projection of the Mac Burney point, topography and shape of the cecum and the situation, shape and dimensions of the v.a. We note also the level of implantation of this latter on the cecum, appearance of the mesoappendix and the distance separating the base of the appendix to the ileo-caecal junction. Mac Burney's point permitted to localize appendix in 66%; the cecum has more often than not the form of a bulb (98.7%) and sited in right fossa iliaca. We noted 7 types of topographic disposition; front varieties were more frequent (68.7%) notably the pelvic direction (51.2%) with a medial (72.5%) or a posteromedial (27.5%) establishment on the cecum. The v.a. was more often in the form of worm with a long mesoappendix; his mean length was 106.4 mm (between 65 and 160 mm) and the mean diameter 6.77 mm (range between 4 and 10 mm). The distance which separated the base of the appendix to the ileo-cecal junction varied between 15 to 40 mm with a mean distance of 24.2 mm. Thus in this study, dimensions of the v.a. were very variables. Located in right fossa iliaca he adopted a front topography with pelvic direction and medial establishment on bulbar cecum. In spite of scarcity of ectopic situation of the appendix for which laparoscopic approach is salutary, a similar topographic study during surgical treatment of acute appendicitis will be interesting.     

The position of the vermiform appendix at laparoscopy

Background The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy. Methods Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively. The positions of the appendix and the caecum were determined after insertion of the laparoscope, prior to any other procedure and the relative frequencies calculated. Results A total of 303 (102 males and 201 females) patients with a median age of 52 years (range 18–93 years) were studied. An emergency appendicectomy was performed in 67 patients, 49 had a diagnostic laparoscopy, 179 underwent a laparoscopic cholecystectomy and eight had other procedures. The caecum was at McBurney’s point in 245 (80.9%) patients, pelvic in 45 (14.9%) and high lying in 13 (4.3%). The appendix was pelvic in 155 (51.2%) patients, pre-ileal in 9 (3.0%), para-caecal in 11 (3.6%), post-ileal in 67 (22.1%) and retrocaecal in 61 (20.1%) patients. Conclusion Contrary to the common belief the appendix is more often found in the pelvic rather than the retrocaecal position. There is also considerable variation in the position of the caecum.     

Development of the vermiform appendix during the fetal period

This study aimed to determine the location and development of the vermiform appendix (VA) in terms of morphometry. It was carried out on 80 human fetuses that exhibited neither external pathology nor anomaly and whose gestational ages were between 10 and 40 weeks. The location of the VA and cecum was established. Total VA diameter, lumen diameter, wall thickness, serosa, muscularis and mucosa thickness were measured on microscope slides. The VA was almost always observed in the subcecal region during the fetal period. The length of the VA and the attachment length of the meso-appendix to the VA increased with the gestational age. Lymphocyte aggregation was first seen at the 17th week of the fetal period. Positive and meaningful correlation was found between gestational age and morphometric parameters of the VA. A significant difference was found between the genders in the thickness of mucosa, which was larger in girls (p<0.05). When the proximal, median and distal parts were compared, the thickness of serosa between the proximal and distal parts was also significantly different (p<0.05). The present study has revealed that the VA matures in the second trimester during the fetal period. Furthermore, the morphologic development of the VA is almost uniform from the proximal to distal part.This study was presented as an oral presentation at the Meeting of the Anatomical Society of Turkey, 25–30 October 1999, Antalya, Turkey     

Goblet cell carcinoids and related tumors of the vermiform appendix

Appendiceal carcinoids with glandular differentiation pose difficulties in classification and prediction of clinical behavior. Sixty-four such cases were divided into three histologic groups on the basis of routine and immunohistochemical stains: (1) Tubular carcinoids were small and confined to the appendix, had small amounts of intraluminal mucin with few or no goblet cells, were nonargentaffin, lacked serotonin, and were diffusely positive for glucagon. All ten with follow-up (mean, 17 months) were without metastasis. (2) Goblet cell carcinoids were confined to the appendix and mesoappendix, circumferentially surrounded the appendiceal lumen, and were often not suspected grossly. Histologically, they were often mixed with small crypt-like glands and were serotonin positive. All 22 with follow-up (mean, 19 months) were without metastasis whether or not right hemicolectomy was performed. (3) Mixed carcinoid-adenocarcinomas showed spread into the cecum or adjacent viscera at the time of diagnosis and had a large carcinomatous pattern with areas of mucinous, signet-ring, or single-file structure, in addition to goblet cell or insular carcinoid. All patients had right hemicolectomies, and all but two with follow-up died of the disease (mean, 16 months). Although a histologic spectrum exists among carcinoid tumors and certain adenocarcinomas of the appendix, it is possible to delineate three biologically distinct groups. Surgical margins should be taken of all appendices because these tumors often do not form discrete masses.     

Diverticulosis of the vermiform appendix in patients with cystic fibrosis

This paper presents a study of diverticulosis of the vermiform appendix in patients with cystic fibrosis. The records of two hospitals were reviewed. A total of 39 autopsy specimens and 18 surgical specimens were obtained. Diverticulosis of the appendix was found in 14 per cent (eight of 57) of all appendices. Two of these cases also showed diverticulitis. These results stand in contrast to the incidence of diverticulosis of the appendix in the general population, which has been measured at 1 to 2 per cent in various reviews.