64例成人阑尾类癌的诊断与外科治疗

Diagnosis and surgical treatment of carcinoid tumors of the appendix in 64 patients

目的总结阑尾类癌（CTA）的诊断和外科治疗经验。方法回顾性分析1972年至2006年收治的64例CTA患者的临床资料。结果64例患者术前仅有6例（9．4％）确诊，58例（90．6％）为术中发现或术后病理确诊，术前误诊率高达90．6％。CTA主要采取手术治疗，术式的选择取决于手术者对CTA良、恶性的判断，以及类癌病灶大小、部位、侵袭深度、周围淋巴结转移情况和年龄等因素。64例患者中，采用单纯阑尾切除术54例，回盲部切除术4例，右半结肠切除术2例，右半结肠切除并清除区域淋巴结4例。随访58例，其中57例存活13年，1例术后13年因肝脏转移死亡。结论CTA少见，术前误诊率高，手术切除是CTA惟一有效的治疗方法，合理的术式选择是手术成功和提高患者生存率的关键。

Objective To summarize the experience in the diagnosis and surgical treatment of carcinoid tumors of the appendix. Methods From 1972 to 2006, 64 patients with carcinoid tumors of the appendix received surgical treatment in our hospitals. The clinical data of those patients were retrospectively analyzed. Results Of the 64 cases, only 6 cases （9.4%）were correctly diagnosed preoperatively, while 58 （90.6%） not confirmed, with a misdiagnosis rate of 90.6%. All patients underwent surgical treatment, including appendectomy in 54, ileocecectomy in 4, right hemicolectomy in 2 and right hemicolectomy with regional lymph node dissection in 4 cases. The operation modes were determined according to the doctor＇s judgments based on the age of the patients, the nature, size, location, infiltration depth and lymph node metastasis of the tumors. Of the 64 patients, 58 were followed up with a longest follow-up period of 13 years, while 6 lost follow-up. Fifty-seven of those were still surviving, only one died of liver metastasis at 13 years after operation. Conclusion Carcinoid tumor of the appendix is rare with a high rate of misdiagnosis before operation. Surgical resection is the only effective treatment for this disease and proper operation mode is the key to achieve good survival.