原发性阑尾肿瘤患者的诊治与预后

Diagnosis,treatment, and prognosis of primary appendiceal tumors： analysis of 37 cases

目的探讨原发性阑尾肿瘤的诊断、治疗和预后影响因素。方法对1977年1月至2007年2月福建医科大学附属厦门第一医院收治的37例原发性阑尾肿瘤的临床和病理资料进行回顾性分析。结果本组37例临床主要表现为阑尾炎和腹部包块，均经手术和病理确诊，包括阑尾类癌12例，阑尾黏液性肿瘤17例，阑尾腺癌8例，其中术前病理确诊仅4例（10．8％），术中经冰冻切片确诊28例（75．7％），术后病理证实5例（13．5％）。行单纯阑尾切除术17例，回盲部切除术9例，右半结肠切除术8例，其他手术方式3例。随访6～193个月，阑尾类癌、阑尾黏液性肿瘤、阑尾腺癌的1、3、5年生存率分别为100．0％、100，0％、91．7％，100．0％、86．7％、71．5％和75．0％、50，0％、50．0％。结论阑尾肿瘤缺乏特异临床表现，术前诊断困难，术中冰冻切片对诊断及手术方式的选择有重要意义。阑尾类癌者预后良好。

Objective To investigate the pathology, diagnosis,treatment, and prognosis of primary appendiceal tumors. Methods The clinical data of 37 patients with primary tumors of the appendix, 16 males and 21 females, aged 56 ± 13 （35 - 87 ） hospitalized Jan. 1977 to Feb. 2007 were analyzed retrospectively. Results Appendicitis and abdominal mass were the major clinical manifestations. All 37 cases received surgical operation with the diagnosis confirmed by pathology. The pathological types included carcinoid tumor （n = 12）, mucinous tumor （n = 17 ）, and adenocarcinoma （n = 8）. Only 4 cases were diagnosed pathologically by biopsy before operation, 28 cases were diagnosed by intra-operative frozen section, and 5 cases were diagnosed after operation. Single appendectomy were performed in 17 cases, ileocecalectomy in 9 cases , right hemicolectomy in 8 cases, and other operation patterns in 3 cases. The 1, 3, and 5-year survival rates of the primary appendix carcinoid tumor, mucinous tumor, and adenocarcinoma were 100.0% , 100.0% , and 91.7% ,100.0% , 86.7% , and71.5%, and 75.0% , 50.0% , and 50.0% respectively. Conclusion A rare disease, appendiceal tumors lack specific clinical features. Intra-operative exploration and frozen section are very important for diagnosis and operation choice. The prognosis of primary appendix carcinoid tumors is better.