结肠镜检查在阑尾肿瘤诊治中的临床意义

Clinical significance of colonoscopy in the diagnosis and treatment of appendiceal neoplasms

目的:探讨结肠镜检查在阑尾肿瘤诊治中的临床意义。方法:回顾性分析中日友好医院消化内科与外科重症医学科2012年1月~2017年3月收治的共45例不同病理类型阑尾肿瘤患者的临床、结肠镜表现与病理资料。结肠镜检查发现的纳入结肠镜发现组,通过腹盆CT及化验检查等诊断的纳入非结肠镜发现组。结果:45例中,阑尾低级别黏液性肿瘤(LAMN)13例,阑尾黏液腺癌32例。LAMN中,结肠镜诊断占46.2%、腹盆CT诊断占53.8%,均行手术切除。阑尾黏液腺癌中,结肠镜发现共11例(局限性病变8例、区域性病变2例、远处转移1例),非结肠镜检查组共21例(局限性病变6例、区域性病变5例、远处转移10例),2组间局限性病变的发现率差异有统计学意义(P<0.05)。2组可以行R0(手术切缘未见癌细胞)切除的分别为10例(90.9%)和5例(23.8%),差异有统计学意义(P<0.01)。LAMN的结肠镜表现为阑尾开口处半球形隆起、黏膜光滑;黏液腺癌表现为阑尾开口处黏膜粗糙、僵硬、糜烂及易出血。结论:结肠镜检查对于阑尾肿瘤的早期诊治具有重要意义。

Objective:To summarize the significance of colonoscopy in the diagnosis and treatment of appendiceal neoplasms.Methods:The clinical,colonoscopic and pathological data of 45 patients with appendiceal neoplasms in Department of Gastroenterology and Department of Surgery Intensive Care Unit of China-Japan Friendship Hospital from January 2012 to March 2017 were analyzed retrospectively.Those diagnosed by colonoscopy were grouped into colonosocpy group and those diagnosed by lab and abdominopelvic CT scan were into non-colonoscopy group.Results:All these 45 cases were with complete data,including 13 cases of low grade appendiceal mucinous neoplasm(LAMN)and 32 cases of appendiceal mucinous adenocarcinoma.Among the 13 cases of LAMN,6 cases(46.2%)were diagnosed by colonoscopy and 7 cases(53.8%)by abdominopelvic CT scan,and all of which underwent surgical resection.Among the 32 cases of mucinous adenocarcinoma of appendix,11 cases were found in colonoscopy group,including 8 cases with localized lesions,2 cases with regional lesions and 1 case with distant metastasis;21 cases in non-colonoscopy group,6 cases with localized lesions,5 cases with regional lesions and 10 cases with distant metastasis,respectively.The difference of localized lesion numbers between the two groups was statistically significant(P<0.05).R0 resection was performed in 10 cases(90.9%)and 5 cases(23.8%)in the two groups,respectively(P<0.01).There were 17 cases with complete colonoscopy data.The colonoscopic manifestations of LAMN were hemispherical protuberances at the opening of the appendix with smooth mucosa,while appendiceal mucinous adenocarcinoma was characterized by rough,stiff,erosive and bleeding mucosa at the opening of the appendix.Conclusion:Colonoscopy plays an important role in the early diagnosis and treatment of appendiceal tumors.