易误诊为妇科肿瘤的阑尾黏液肿瘤25例临床研究

Appendiceal mucocele mimicking right adnexal mass：a report of 25 cases

目的 探讨女性右下腹部包块的鉴别诊断及处理.方法 回顾性分析北京协和医院2000至2010年收治的25例女性阑尾黏液性囊腺瘤、阑尾黏液性囊腺癌和单纯阑尾黏液囊肿病例资料,患者平均年龄58.2岁,总结其临床表现、辅助检查及治疗方法.结果 10年来因右下腹包块进行手术的女性阑尾黏液肿瘤患者占同期女性阑尾切除标本的2.16%.其临床表现不特异,术前40%误诊为右卵巢肿物而行妇科手术.术前妇科检查包块的触诊阳性比例8/10,外科腹部检查触诊阳性率为66.7%;超声检查诊断肿物来源于阑尾的正确率为54.2%,CT检查诊断正确率为60%;癌胚抗原（CEA）阳性比例8/14,糖抗原19-9（CA199）阳性比例2/11.但差异均无统计学意义.结论 中老年女性右下腹包块应考虑到阑尾来源肿物这一罕见疾病的可能,术前诊断的重要意义在于避免医源性破裂.超声和CT等影像学检查以及血清学CEA检查对于明确肿物来源有一定的参考意义.

Objective To explore the differential diagnosis and pertinent treatment of women with right lower quadrant abdominal mass.Methods The clinical data of 25 women patients with appendiceal mucocele at our hospital from 2000 to June 2010 were recorded.And their clinical presentations, auxiliary examinations and treatment were analyzed retrospectively with the SPSS17.0 software.Results Among 1157 women undergoing appdicelectomy at our hospital, 25 （2.16 %） had appendiceal mucocele.Their mean age was 58.2 years old.Their presenting symptoms and signs were non-specific.Ten cases （40%） were misdiagnosed as adnexal mass.The mass could be palpable by pelvic examination in 80% cases while 66.7% by abdominal examination.For preoperative auxiliary examination, the correct rate of ultrasonogram was 54.2% and CT 60%.The positive rate of carcinoembryonic antigen （CEA） was 57.1% while that of carbohydrate antigen 19-9 （CA199） 18.2%.Neither had statistical significance.There were three pathological entities： mucinous cystadenoma, malignant mucinous cystadenocarcinoma and simple retention mucoceles.Because of incidental discovery, the treatment remained variable.The approaches included appendectomy, cecectomy, right hemicolectomy and debulking according to the frozen pathological examination.Conclusion As a rare condition, appendiceal mucocele is usually misdiagnosed as right adnexal lesion.Because of its anatomic position, it should be considered in the differential diagnosis of adnexal masses.Auxiliary examinations such as ultrasonogram, computed tomography and serum CEA may be helpful for its diagnosis.Its optimal management is achieved through an accurate preoperative identification and subsequently careful resection.