阑尾腺癌5例临床诊疗分析

Diagnosis and treatment of appendiceal adenocarcinoma: a report of 5 cases

目的 探讨阑尾腺癌的临床特点及诊治原则。方法 回顾性分析2010年1月至2020年12月华中科技大学同济医学院附属协和医院收治的5例阑尾腺癌病人的临床资料。结果 5例病人中有3例初诊为急性阑尾炎,一期行阑尾切除术,二期行右半结肠根治术;2例术前诊断为回盲部占位性病变,肠镜取活检确诊为阑尾腺癌,一期行右半结肠根治术。5例病人中结肠型腺癌2例(中分化),黏液腺癌2例(中分化),杯状细胞腺癌1例(中分化)。结论 阑尾腺癌在临床上极为少见,缺乏特异性症状,术前诊断困难,术前CT和肠镜检查有助于确诊,右半结肠根治术是常规手术方式,对侵犯浆膜的肿瘤术中、术后可行腹腔热灌注化疗,术后应根据分期辅以化疗。

Objective To explore the clinical features,diagnoses and treatments of appendiceal adenocarcinoma(AA).Methods The relevant clinical data were retrospectively reviewed for 5 hospitalized AA patients.Results Among them,3 cases were diagnosed as acute appendicitis at the first time,one-stage appendectomy was performed,second-stage right hemicolectomy was performed,2 cases were diagnosed as ileocecal space-occupying lesions before operation,enteroscopic biopsy was performed for diagnosing appendiceal adenocarcinoma,and first-stage right hemicolectomy was performed.Among the 5 patients,colonic adenocarcinoma(moderately differentiated,n=2),mucinous adenocarcinoma(moderately differentiated,n=2)and goblet cell adenocarcinoma(moderately differentiated,n=1).Conclusion In clinical practices,AA is extremely rare.Due to a lack of specific symptoms,a preoperative diagnosis is rather difficult.Preoperative CT and colonoscopy may aid a definite diagnosis.Radical operation of right colon is routinely performed.Intraoperative and postoperative intraperitoneal hyperthermic perfusion chemotherapy is feasible for tumors invading serosa.And postoperative chemotherapy should be supplemented according to clinical stages.