阑尾类癌32例诊治分析

目的　探讨阑尾类癌的临床及生物学特性、诊断和手术治疗经验。方法　回顾性分析自 1978～ 1998年收治的 3 2例阑尾类癌患者临床资料。结果　本组 3 2例患者中 2 6例 ( 81 2 5 %)的症状和体征提示为阑尾炎。 6例患者 ( 18 75 %)为偶然发现。肿瘤直径 <1 0cm 2 5例 ,1 0～ 2 0cm 4例 ,>2 0cm 3例。 2 9例局限于阑尾壁内 ,2例侵犯兰尾系膜 ,1例伴局部淋巴结转移。 3例肿瘤直径 >2 0cm侵犯阑尾系膜及局部淋巴结转移 ,再次行右半结肠切除术 ,2例行盲肠切除术 ,2 7例行阑尾切除术。 2 8例患者获得随访 ,均无复发和远处转移。结论　阑尾类癌少见 ,多表现为阑尾炎的症状。阑尾根部类癌行盲肠切除术 ,<1 0cm的阑尾类癌仅作单纯阑尾切除术即可 ,1 0～ 2 0cm的阑尾类癌可行阑尾及其系膜切除术 ,>2 0cm的阑尾类癌应行右半结肠切除术

An Analysis on the Diagnosis and Treatment of 32 Cases of Appendiceal Carcinoid

Objective To explore the diagnosis and surgical management experience of appendiceal carcinoid. Methods The clinical data of 32 patients with appendiceal carcinoid from 1978 to 1998 were retrospectively analyzed. Results 26 patients (26/32, 81 25%) manifested the sign and symptom of appendicitis, and 6 patients (6/32, 18 75%) with carcinoid were incidentally discovered. The tumors were less than 1cm in diameter in 25 patients, between 1 and 2 cm in 4 patients, and larger than 2 cm in 3 patients. Tumor invasion was confined to the appendix in 29 patients, involved in the mesoappendix in 2 patients, and one patient had local lymphonodus metastasis. Three carcinoid patients with tumor lymph-nodes metastasis in the mesoappendix underwent secondary right hemicolectomy, 2 patients underwent appendicocecostomy, and 27 patients underwent appendectomy. The follow-up was performed in 28 patients, and all patients remained free of tumor recurrence and metastasis. Conclusion Appendiceal carcinoid was rare, and most of the patients manifested the sign and symptom of appendicitis. Appendiceal carcinoid of less than 1 cm diameter could be adequately managed by appendectomy alone. Appendiceal carcinoid in basis of the appendix could be adequately managed by appendicocecostomy. The treatment approach for tumors of 1 to 2 cm in diameter was still controversial. The right hemicolectomy should be performed in the patients with larger than 2 cm in diameter tumors.