低级别阑尾黏液性肿瘤35例临床病理特点分析

Low-grade appendiceal mucinousneoplasms:A clinicopathological analysis of 35 cases

目的探讨低级别阑尾黏液性肿瘤(LAMN)病人的临床病理特点,为临床诊治提供参考。方法回顾性分析2013年3月至2019年3月期间于郑州大学第一附属医院就诊的35例LAMN病人的临床病理资料。结果35例LAMN病人中,男13例,女22例,年龄(57.7±12.4)岁。腹痛14例,发现腹部包块12例,腹胀6例,下肢水肿1例,消化道出血1例,体检发现1例。行术前超声检查18例,行术前下腹部增强CT检查26例。癌胚抗原(CEA)升高18例,CA19-9升高6例。LAMN病人与LAMN合并腹膜假黏液瘤(LAMN+PMP)病人CA19-9及CEA阳性率差异无统计学意义。7例行传统开放手术,28例行腹腔镜及腹腔镜辅助手术。其中10例行右半结肠切除,且淋巴结活检均未见转移。5例术中发现阑尾穿孔。随访期间肿瘤进展或复发5例,均为LAMN+PMP。结论肿瘤标记物联合影像学检查对LAMN的诊断及治疗有一定提示意义。阑尾穿孔或合并卵巢黏液肿瘤多见于LAMN+PMP,且LAMN预后优于LAMN+PMP。

Objective To explore the clinicopathological characteristics of low-grade appendiceal mucinousneoplasms(LAMN),and to provide reference for clinical diagnosis and treatment.Methods The clinicopathological data of 35 LAMN patients admitted in the First Affiliated Hospital of Zhengzhou University between March 2013 to March 2019 were analyzed retrospectively.Results Among the 35 patients with LAMN,13 were male and 22 were female,aged(57.7±12.4)years.There were 14 cases of celialgia,12 cases of abdominal masses,6 cases of abdominal distension,1 case of lower extremity edema,1 case of gastrointestinal bleeding,and 1 case of physical examination.Eighteen cases were performed preoperative ultrasound and 26 cases performed enhanced CT of the lower abdomen before operation.CEA increased in 18 cases and CA19-9 increased in 6 cases.There was no significant difference in the positive rates of CA19-9 and CEA between LAMN patients and LAMN patients with pseudomyxoma peritonei(LAMN+PMP).Seven cases underwent traditional open surgery,28 cases had laparoscopic or laparoscopic assisted operations,and 5 cases were found to have perforated appendix during operation.Among them,10 cases underwent right hemicolectomy and no lymph node biopsy showed metastasis.During the median follow-up period,there were 5 cases of tumor progression or recurrence,all of them were LAMN+PMP.Conclusion The combination of tumor markers and imaging examination has certain prompt significance for the diagnosis and treatment of LAMN.Appendiceal perforation or ovarian mucinous tumors are more common in LAMN+PMP,and the prognosis of LAMN is better than LAMN+PMP.