回盲部癌伴周围脓肿一例报告及文献复习  

Clinical analysis of the ileocecal carcinoma with peripheral abscess: a report of 1 case and literature review

作　　者：罗云 吴定泉[1] 朱长康[1] 吕其君[2] 王崇树[2,3] Luo Yun;Wu Dingquan;Zhu Changkang;Lyu Qijun;Wang Chongshu(The First Department of General Surgery, Beibei Traditional Chinese Medical Hospital, Chongqing 400700,China;The Department of Gastrointestinal Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuang Nanchong 637000, China;The Department of General Surgery, Nanchong Oriental Hospital,Sichuang Nanchong 637000,China)

机构地区：[1]重庆市北碚区中医院外一科,重庆400700 [2]川北医学院附属医院胃肠外科,四川南充637000 [3]南充东方医院普外科,四川南充637000

出　　处：《腹部外科》2019年第4期287-290,共4页Journal of Abdominal Surgery

摘　　要：目的探讨回盲部癌伴周围脓肿(ileocecal carcinoma with peripheral abscess,ICPA)的临床特点及诊治方法。方法报告川北医学院附属医院收治的1例ICPA病历资料,并检索到国内外文献报道的64例ICPA。对65例ICPA的临床特征、诊断及治疗进行分析。结果此例病人行右半结肠切除术+髂窝脓肿病灶清除术+氟尿嘧啶灌洗术+大网膜填塞髂窝脓腔术,术后伤口Ⅰ期甲级愈合,连续6个周期FOLFOX化疗,随访1年,肿瘤未复发。ICPA病人有右下腹疼痛、发热、白细胞升高、右下腹包块等类似阑尾周围脓肿的症状及体征;93.85%的病人被漏诊或误诊,术前初步诊断为阑尾周围脓肿者占87.69%;病理诊断中,腺癌占75.38%,黏液腺癌为23.08%;73.84%的病人行右半结肠切除根治术,21.54%的病人无法切除而行姑息治疗。结论ICPA容易误诊为阑尾周围脓肿,导致耽误病情及治疗时机,右半结肠切除术可达到更好的根治标准,处理特殊的回盲部癌周围的深部脓肿,大网膜填塞是一种可选的较好方法,氟尿嘧啶灌洗也可改善病人的预后。Objective To investigate the clinical features, diagnosis and treatment of ileocecal carcinoma with peripheral abscess (ICPA). Methods A case of ICPA in the Affiliated Hospital of North Sichuan Medical College was reported. The clinical features, diagnosis and treatment of 65 cases of ICPA were analyzed. Results The patient underwent right hemicolectomy + debridement of iliac fossa abscess + fluorouracil lavage + greater omentum plugging of iliac fossa abscess. After operation, the wound healed up to grade A in stage I. After 6 consecutive cycles of FOLFOX chemotherapy, the tumor did not recur after 1 year of follow-up. ICPA patients had symptoms and signs similar to periappendiceal abscess such as right lower quadrant pain, fever, elevated white blood cells, and right lower quadrant mass. 93.85% patients were missed or misdiagnosed. Preoperative diagnosis was periappendiceal abscess in 87.69%. Pathological diagnosis was adenocarcinoma in 75.38%, mucinous adenocarcinoma in 23.08%, right hemicolectomy in 73.84%, and palliative treatment in 21.54%. Conclusion ICPA is easy to misdiagnose as appendicular abscess, leading to delay of the disease and the opportunity of treatment. Right hemicolectomy can achieve a better radical standard. For the treatment of the special deep abscess around ileocecal carcinoma, greater omentum plugging is a good alternative and fluorouracil irrigation can improve the prognosis of patients.

关 键 词：回盲部癌 脓肿 

分 类 号：R735.36[医药卫生—肿瘤]