阑尾腺癌五例临床诊治分析  

The diagnosis and treatment of patients with adenocarcinoma of the appendix

作　　者：陈广泉[1] 王鹏[1] 张东[1] 纪大伟[1] 

机构地区：[1]沈阳市第四人民医院普通外科,110031

出　　处：《中华普通外科杂志》2013年第10期767-769,共3页Chinese Journal of General Surgery

摘　　要：目的 探讨阑尾腺癌的临床特点.方法 回顾性分析沈阳市第四人民医院普通外科2005年9月至2010年12月收治的5例阑尾腺癌患者的临床资料.结果 5例患者均为阑尾腺癌,其中2例术中高度怀疑为阑尾恶性肿瘤,送冰冻病理学检查证实为阑尾腺癌,一期行右半结肠切除术；1例行单纯阑尾切除术,术后病理学检查证实为阑尾腺癌,2周后二期行右半结肠切除术；1例术前诊断为阑尾周围脓肿,术中无法单纯切除阑尾,行右半结肠切除术,术后病理学检查证实为阑尾腺癌；1例术前诊断为下腹部占位性病变,腹腔广泛转移,术中证实为阑尾肿瘤,伴腹腔转移,行右半结肠切除、腹腔转移癌切除术.5例术后均辅以化疗.术后随访2～3年,4例无转移,1例术前诊断为下腹部占位性病变、广泛腹腔转移的患者,术后2年再次出现转移.结论 阑尾腺癌误诊率高,术中仔细探查及冰冻病理学检查有助于确诊,确诊后应行右半结肠切除术.Objective To evaluate the clinical features of adenocarcinoma of the appendix.Methods The clinical data of 5 patients with adenocarcinoma of appendix hospitalized at our hospital from Sep 2005 to Dec 2010 were analyzed.Results Intraoperatively two cases were highly suspected of malignant tumor of the appendix,diagnosis of adenocarcinoma was confirmed by frozen pathology,and one stage right hemicolectomy was performed.One patient received simple appendectomy,but postoperative pathology showed adenocarcinoma of appendix and secondary right hemicolectomy was carried out two weeks later.One patient was preoperatively misdiagnosed as periappendiceal abscess and as a result fight hemicolectomy was performed because planned appendectomy was technically impossible.The postoperative pathology revealed adenocarcinoma of the appendix.In the last patient preoperative diagnosis was hypogastric space-occupying lesion with extensive intraabdominal metastasis.During exploration adenocarcinoma of the appendix with extensive metastasis was confirmed.Right hemicolectomy and carcinectomy was performed.Postoperatively all the 5 patients underwent regular chemotherapy.We followed them for 2 to 3 years and only the patient with intraabdominal metastasis at first laparotomy suffered from extensive recurrence 2 years after surgery.Conclusions The adenocarcinoma of appendix can be easily misdiagnosed as other diseases.Radiography,careful exploration during operation and frozen pathology help establish final diagnosis.Right hemicolectomy and postoperative chemotherapy are required in order to reduce tumor recurrence and prolong patients＇ survival.

关 键 词：阑尾肿瘤 腺癌 结肠切除术 化学疗法 肿瘤 局部灌注 

分 类 号：R735.3[医药卫生—肿瘤]