阑尾类癌6例分析

Analysis of 6 cases with appendicel carcinoid

目的探讨阑尾类癌的临床特征,以提高手术治愈率。方法对本院普外科1990年1月-2008年6月共收治的阑尾类癌6例的临床资料进行回顾性分析。结果6例中无1例术前诊断,均为术中偶然发现或术后病理诊断确诊。肿块发生在阑尾头部5例,阑尾根部1例。肿瘤直径<1 cm 1例,1-2 cm 3例,>2 cm 2例。类癌浸润深度限于粘膜下或肌层4例,侵及浆膜1例,浸润至阑尾系膜及局部淋巴组织1例。病理组织学分型,腺样型5例,实性团块型1例。5例急诊行阑尾切除术,1例行右半结肠切除+淋巴结清扫术,无再次手术病例。6例患者均随访6个月-5年,除1例合并结肠癌转移于术后1年死亡,余均存活。结论阑尾类癌临床表现不典型,术前诊断极困难,主要由术中或术后病理学检查得以诊断。瘤体大小是选择手术方案和判断预后的主要依据。

Objective To summarize the clinical features of appendiceal carcinoid to elevate the cure rate of the operation. Methods The clinical data of 6 cases wth appendiceal carcinoid who had been treated in our hospital from January 1990 to june 2008 were retrospectively analyzed. Results None of 6 cases had been diagnosis as appendiceal carcinoid before operations. All cases were accidentally discovered during operation and confirmedly diagnosed through pathological diagnosis after operation. The diagnosis was established pathologically after operation or casual discovery in the operation. The tumors of 5 cases located at the head of appendix, and one did at the root of appendix. The tumor diameter was less than 1 cm in 1 case, between 1 and 2 cm in 3 cases, and larger than 2 cm in 2 cases. Tumor invasion in 4 cases was confined to the submucosa or muscle layers, and tumor in 1 ease invaded to serosa, and tumor in the remaining 1 case invaded into mesoappendix and local lymph nodes. According to the pathological type, 5 cases were adenoid, and 1 case was solid lump. Single emergency appendectomy was performed on 5 cases, and right-side coloncctomy and local lymph nodes sweeping were carried out in 1 case. No second operation was performed in all cases. All patients who had been followed-up from 6 month to 5 years still survived except 1 case died of the metastasis of colon carcinoma in 1 year after the operation. Conclusion Appendiceal carcinoid don＇t have the typical clinical manifestation and It is difficult to diagnoseappendiceal carcinoid preoperatively for operation and pathological examination. tumor. its untypical clinical manifestations. The scheme of the operation and the The confirmed diagnosis was only made by prognosis mainly depend on the size of the tumor.