阑尾类癌21例临床分析

A Clinical Analysis of 21 Cases with Appendiceal Carcinoid

目的 探讨阑尾类癌的生物学特性、临床诊断和手术治疗经验，提高首次手术治愈率。方法 对1985-2004年我们收治的21例阑尾类癌患者的临床及病理资料进行回顾性分析。结果 21例中无1例术前诊断．均为术中偶然发现或术后病理确诊。采用单纯性阑尾切除术16例。回盲部切除术2例。右半结肠切除2例，姑息性手术1例。肿瘤直径〈1cm 15例，1-2cm 3例。〉2cm 3例。14例肿瘤浸润深度限于黏膜下或肌层，3例侵及浆膜，4例浸润至阑尾系膜，其中3例患者肿瘢〉2cm伴局部淋巴结转移。获随访的16例患者中，15例无复发和远处转移．1例死亡。结论 阑尾类癌少见。多袭现为阑尾炎症状，难以做出术前诊断。应根据肿瘤大小、部位及浸润深度决定术式及切除范围。

Objective To summarize the experiences of diagnosis and treatment in appendiceal carcinoid. Methods The clinical data of 21 cases wth appendiceal carcinoid from 1985 to 2004 were retrospectively analyzed. Methods The clinical data of 21 cases wth appendix eareinoid boors from 1985 to 2004 were chspectively analyzed. Results The diagnosis was established pathologically after operation. Single appendectomy was performed on 16 cases, ileocecoectomy on two cases, right-side colonectomy on two cases and palliative operation on one case. The tumor diameter was less than 1 cm in 15 cases, between 1 and 2 cm in three cases, and larger than 2 cm in three cases. Tumor invasion was confined to the submueosa or muscle layers in 14 cases, to serosa in three cases, and into mesoappendix fat in the remaining four cases （ three of whom had local lymph node metastasis）. Among the 16 cases whose follow-up was complete, 15 ones remained free of tumor recurrence and metastasis, and one died. Conclusion Appendiceal carcinoid is rare and difficult to make a diagnosis preoperatively, and most of the patients manifest the sign and symptom of appendicitis. The operative principles and methods depend on the size, location and depth of the tumor.