阑尾类癌13例报告

回顾并结合文献分析13例阑尾类癌患者的临床病理特征、治疗和预后。13例阑尾类癌患者,6例肿瘤直径<1cm,局限于浆膜内无转移,单纯阑尾切除术后无瘤生存10年者5例,非肿瘤性死亡1例。3例肿瘤直径1~2cm,局限于浆膜内无淋巴结转移,回盲部切除术后生存5年者3例,生存10年者1例。4例肿瘤直径>2cm,1例侵犯浆膜外无淋巴结转移者,回盲部切除术后生存满5年;2例侵犯浆膜外并淋巴结转移,回盲部切除术+术后化疗,生存5年者1例;合并肝脏转移者1例,右半结肠切除术+术后化疗,2年内死亡。初步研究结果提示,阑尾切除术中应常规纵形切开阑尾标本检查有无微小肿瘤;肿瘤直径<1cm者可单行阑尾切除术;直径1~2cm者回盲部切除,术后辅以化疗;肿瘤直径≥2cm可有浆膜受侵和淋巴结转移,宜行右半结肠切除术,术后辅以化疗。

Thirteen cases of carcinoid tumor of appendix

We have studied the clinical pathological features, therapeutics and prognosis of carcinoid of appendix, by reviewing the clinical data of 13 patients and documents. Six patients with tumor less than 1 cm in diameter lived out 10 years without further treatment after appendectomy, except one patient died of other disease. Of the 3 cases with tumors from 1-2 cm in diameter confined within the serous membrane without metastasis, all 3 cases survived 5 years and 1 caseeven lived out 10 years after resection of ileocecal junction. Of the 4 cases with tumor larger than 2 cm in diameter with the serous membrane tumor invasion, 1 case who had no metastases lived out 5 years after resection of ileocecal junction, 2 cases had lymph node metastases and of which, only 1 case lived out 5 years after resection of ileocecal junction plus chemotherapy, and 1 case with hepatic metastases that was treated by right hemicolectomy plus chemotherapy died of within 2 years. The results suggest that longitudinal incision of the appendix should be performed routinely after appendectomy to see if there is a micro tumor in the wall. Appendectomy is a suitable treatment when tumor diameter is less than 1 cm. Resection of ileocecal junction plus postoperative chemotherapy are needed when the tumor diameter is from 1-2 cm. Whereas, right hemicolectomy followed a systemic chemotherapy is strongly prompted when the tumor diameter is more than 2 cm with lymph node metastasis or serous membrane tumor invasion.