阑尾肿瘤误诊为急诊阑尾炎行急诊阑尾切除术36例原因分析  

Analysis of causes of 36 cases of emergency appendectomy for emergency appendicitis

作　　者：孟松峰 朱运海[1] Meng Songfeng;Zhu Yunhai(Department of gastrointestinal surgery,The First People’s Hospital of Shangqiu,Shangqiu Henan,476000,China)

机构地区：[1]商丘市第一人民医院胃肠肝胆外科,商丘476000

出　　处：《河南外科学杂志》2021年第1期36-38,共3页Henan Journal of Surgery

摘　　要：目的分析阑尾肿瘤误诊为急诊阑尾炎行急诊阑尾切除术的原因,总结以急性阑尾炎为主要临床表现的阑尾肿瘤的诊治体会。方法 2015-07—2020-06间商丘市第一人民医院胃肠肝胆外科共行急诊阑尾切除术2 031例,其中36例(1.77%)术中冰冻切片或术后常规病理学检查诊断为阑尾肿瘤。回顾性分析36例患者的临床及病理资料。结果 36例患者中,男14例,女22例;平均年龄64.9(39~84)岁。发病至就诊时间9 h~2 a。急性阑尾炎表现12例,慢性腹痛反复急性发作21例,腹泻2例,腹胀1例,发热19例。白细胞计数>15×10~9/L 14例。所有患者术前均行阑尾超声检查,23例阑尾直径>13 mm。病理结果:阑尾黏液腺瘤21例,黏液腺癌8例,纤维母细胞瘤2例,胃癌伴阑尾系膜转移1例,神经内分泌肿瘤4例。6例行术中冰冻切片检查,5例(83.33%)与术后常规病理符合。1例(17%)术中冰冻切片检查诊断为黏液腺瘤,术后常规病理报告为黏液腺癌。术中见阑尾坏疽、穿孔12例,阑尾周围脓肿形成15例,单纯阑尾炎9例。阑尾与周围组织粘连严重者28例。右半结肠切除术17例,单纯阑尾切除术9例,阑尾部分切除活检2例,回盲部切除3例,5例术后二次手术行右半结肠切除术。结论年龄>64岁,阑尾直径>13 mm时,阑尾肿瘤发生概率明显升高。如术中诊断不清,可行术中冰冻切片检查,以防误诊和误治。Objective To analyze the causes of misdiagnosis of appendicitis as emergency appendicitis and summarize the experience of diagnosis and treatment of appendicitis with acute appendicitis as the main clinical manifestation.Methods Emergency appendectomy for gastrointestinal hepatobiliary surgery in Shangqiu the First People’s Hospital from 2015-07 to 2020-06 Of the 2031 cases,36(1.77%)were diagnosed as appendiceal tumors by intraoperative frozen sections or postoperative routine pathology.Clinical and pathological data of 36 patients were analyzed retrospectively.Results Of the 36 patients,14 were male,22 females;Average age was 64.9(39~84)years.Time of onset 9 h~2 years.Acute appendicitis,12 cases,Chronic abdominal pain recurrent acute attack 21 cases,Diarrhea in 2 cases,Abdominal distension 1 case,fever in 19 cases.White blood cell count>15×10~9/L 14 cases.All patients underwent appendiceal ultrasound before surgery,The diameter of appendix>13 mm.Pathological results:21 cases of appendiceal mucinous adenoma,mucinous adenocarcinoma 8 cases,Fibroblastoma,2 cases,Gastric cancer with mesenteric metastasis:1 case,neuroendocrine tumors in 4 cases.6 cases underwent intraoperative frozen section examination,In 5 cases(83.33%),One patient(17%)was diagnosed with mucinous adenoma by intraoperative frozen section examination,Postoperative routine pathology was reported as mucinous adenocarcinoma.There were 12 cases of appendiceal gangrene and perforation,An abscess around the appendix formed in 15 cases,pure appendicitis in 9 cases.There were 28 cases of severe adhesion between appendix and surrounding tissue.Right hemicolon resection,17 cases,Complete appendectomy in 9 cases,Partial appendectomy,biopsy,2 cases,Three cases of ileocecal resection,Right hemicolon resection for 5 patients after secondary operation.Conclusion When the age>64 and the diameter of appendix>13 mm,the probability of appendiceal tumor increased significantly.If the intraoperative diagnosis is not clear,intraoperative frozen section examination can

关 键 词：急诊阑尾切除术 阑尾肿瘤 术中冰冻 阑尾直径 

分 类 号：R735.3[医药卫生—肿瘤]