原发性阑尾肿瘤22例诊治分析

目的 :探讨提高原发性阑尾肿瘤 (Primary Neoplasm of Appendix,PNA)的诊治水平。方法 :回顾性分析了 16年来 2 2例PNA。结果 :2 2例术前无 1例确诊 ,12例术中确诊 ,10例术后病理确诊。临床表现为急性阑尾炎、肠梗阻和右下腹包块。类癌是最常见肿瘤。 4例黏液囊肿行单纯阑尾切除术 ,6例腺癌中 ,1例非浸润癌行单纯阑尾切除术 ,1例浸润性结肠型腺癌行回盲部切除术 ,3例再次手术行右半结肠根治性切除术 ,2例广泛浸润转移行肿物切除术。11例类癌中 5例单纯阑尾切除术 ,5例回盲部切除术 ,1例右半结肠切除术。 7例阑尾腺癌 ,余予以化疗。随访 :2例腺癌因广泛浸润转移而术后 2个月和 7个月死亡 ,3例腺癌分别存活 13个月、19个月、3年 ,2例超过 5年。 11例类癌 ,6个月死亡 1例 ,30个月死亡 1例 ,其余 9例超过 5年 ,其中6例超过 10年。 4例黏液囊肿均生存至今超过 5年。结论 :PNA无临床特异症状 ,腹部 B超和 CT对术前诊断有重要辅助意义。PNA的手术方式 ,要根据肿瘤类型、有无浸润及深度、淋巴结转移、远隔脏器转移情况及病人全身状态来决定。关腹前标本检查及术后病理学检查有重要意义。腺癌预后较差 ,类癌相对较好。

Diagnosis and Treatment of Primary Neoplasm of Appendix(22 cases)

Objective:To investigate how to improve the diagnosis and treatment of Primary Neoplasm of Appendix(PNA).Methods:22 PNA were analysed retrospectively.Results:There was no case diagnosed accurately before operation, and 12 cases were diagnosed during operation. The common clinical situation were acute appendicitis, intestinal obstruction and right iliac region sack. Carcinoid was the commonest. 4 cases of mucous cyst got appendectomy simply. There were 7 adenocarcinoma, one case got appendectomy, one case got excision of ileocecum because pathological check of cryobiopsy showed infiltrate adenocarcinoma, three cases got a second operation of radical excision of right hemicolon and two cases got indulgent excision of mass because of comprehensive infiltration and metastasis. There were 11 carcinoid, five got appendectomy simply, five got excision of ileocecum and 1 case got radical excision of right hemicolon. Six adenocarcinoma got chemotherapy. All patients were followed-up. Two adenocarcinoma survived 2 and 7 months for comprehensive infiltration and metastasis, three adenocarcinoma survived 13months, 19 months, 3 years, and 2 cases survived more than 5 years. One carcinoid survived 6 months, one carcinoid survived 30 months, nine cases survived more than 5 years and 6 cases than 10 years. Four mucous cyst survived more than 5 years.Conclusion:PNA has no particular clinical symptom. B-ultrasound and CT of abdomen have important assistance for diagnosis before operation. The coverage of operation is based on pathologic tipe, depth of infiltration, metastasis of lymph node or remote viscera and general body state. It is important to dissection appendix before closing abdomen and check pathologically after operation. The prognosi of adenocarcinoma is bad and carcinoid is good.