阑尾低级别黏液性肿瘤临床、CT特征及伴发腹膜假性黏液瘤风险性研究

Clinical and CT Features of Low-grade Mucinous Tumors of the Appendix and the Risk of Associated with Pseudomyxoma Peritonei

目的:探讨阑尾低级别黏液性肿瘤(low grade appendi ceal mucinous neoplasms,LAMNs)临床及多层螺旋CT(MSCT)的特征性表现,并探讨其伴发腹膜假性黏液瘤(pseudomyxoma peritonei,PMP)的相关因素。方法:回顾性分析我院经手术及病理证实的29例LAMNS患者的临床表现及MSCT影像学特点。根据是否伴发PMP分为观察组(伴发PMP)及对照组,并对两组患者间相关临床及CT征象进行比较,探讨其差异性。结果:LAMNs好发中老年女性,平均年龄为(59±13)岁;96.55%患者表现为腹痛不适,58.62%伴发白细胞计数增高;62.07%患者前临床误诊为阑尾炎。CT图像LAMNs形态及大小差异大;65.52%患者表现囊壁增厚,68.97%病灶伴发感染而边缘模糊渗出改变;17.24%患者囊壁见斑点钙化灶;LAMN囊腔内黏液密度较高,15例(51.72%)≥20HU;9例LAMNs合并PMP,表现肝脏周围呈“扇贝样”压迹。LAMNs伴发PMP组患者病灶较大,其长径及短径均约为单纯LAMNs组的2倍,另病灶囊壁厚度、囊壁不光整的比例均高于后者。结论:LAMNs的临床及MSCT上具有一定的特征性,并且病灶大小、囊壁厚度情况或许能作为判断PMP发生的危险因素。

Objective:To investigate the clinical and multislice spiral CT(MSCT)characteristics of low grade appendi ceal mucinous neoplasm(LAMN)and the factors associated with pseudomyxoma peritonei(PMP).Methods:The clinical manifestations and MSCT imaging characteristics of 29 LAMN patients confirmed by surgery and pathology in our hospital were retrospectively analyzed.All patients were divided into observation group(with PMP)and control group according to the presence or absence of PMP,and relevant clinical and CT signs were compared between the two groups to explore the differences.Results:LAMNs were more common in middle-aged and elderly women,with an average age of(59±13)years.Abdominal pain and discomfort were observed in 96.55% of the patients,and leukocyte count was increased in 58.62%.62.07% of the patients were misdiagnosed as appendicitis;the morphology and size of LAMNs varied greatly,65.52% of the patients showed cystic wall thickening,and 68.97% of the lesions were associated with infection,but the edges were blurred and exuded.17.24% of the patients had spotted calcification lesions in the cyst wall.The density of mucus in LAMN lumen was higher than 20HU in 15 cases(51.72%).LAMN combined with PMP showed“scallop-like”pressure traces around the liver in 9 patients;patients in the PMP group accompanied by LAMNs had larger lesions,and their long diameter and short diameter were about twice as large as those in the simple LAMN group.In addition,the thickness of lesion cyst wall and the proportion of cyst wall insufficiency were both higher than the latter.Conclusion:LAMNs have certain clinical and MSCT characteristics,and size and wall thickness of the lesion might be used as risk factors to determine the occrrence of PMP.