阑尾类癌13例报告

Thirteen cases of carcinoid tumor of appendix

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＜1 cm,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1～2 cm,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＞2 cm,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＜1 cm者可单行阑尾切除术;直径1～2 cm者回盲部切除,术后辅以化疗;肿瘤直径≥2 cm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.

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 easeeven 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.