影响阑尾腺癌预后的因素

Adenocarcinoma of the Appendix-clinical Review of 110 cases

作者收集国内110例阑尾腺癌,72.5%有急性、慢性阑尾炎及其周围脓肿,其中急性者占全组52%。由于缺少特异性临床表现,术前正确诊断率仅为2.9%。影响阑尾腺癌预后的因素:(1)老年人死亡率(35%)高于青年人(28.3%);女性(34.5%)高于男性(27.3%),但女性术后存活时间比男性长4倍;(2)穿孔、腹水和右下腹包块占全组59.8%,死亡率分别为75%、50%、31.3%,高于无并发症者21.6%;(3)粘液和分化性腺癌共占92.5%,其死亡率分别为28%、36.1%;(4)临床分期Ⅰ～Ⅳ期分别为5.6%、13.9%、31.9%、48.6%。中晚期占80.6%,死亡率随临床分期增加而增多;(5)剖腹探查未切除阑尾者死亡率100%,高于单纯阑尾切除48.1%。2次手术和Ⅰ期右半结肠切除者21.4%。考虑到本病两次手术机率高,适于单纯阑尾切除者少,作者认为除晚期失去手术机会者外,第一次手术时尽可能行右半结肠切除,这既可使患者免受两次手术之苦,又可减少肿瘤扩散转移的危险,从而提高疗效,改善预后。

110 cases of appendical adenocarcinoma were col- lected from chinese literature,and factors influencing prognosis were analysed.Mortality was closely associ- ated with complications,it was 75% in perforated cas- es,50% in aseities.31% in cases with abdominal mass- es compared with 21.6% in cases without complica- tions.80.6% of all cases were at middle or late stage. Mortality was also cloesely correlated with surgery, with 100% in only laporotomy,48.1% in simple ap- pendectomy and 21.4% in primary or secondary right- sided colectomy.The authors came to the conclusion that right-side colectomy was the treatment of choice when it was feasible.