中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (05): 583-587.DOI: 10.19538/j.cjps.issn1005-2208.2024.05.19

• 论著 • 上一篇    下一篇

低级别阑尾黏液性肿瘤58例临床分析

张    琪，汤    东，周家杰，余文豪，王    伟，汪刘华，任    俊，刘    铸，王    杰，孙龙和，朱小冬，王道荣   

  1. 扬州大学附属苏北人民医院胃肠外科，江苏 扬州 225001
  • 出版日期:2024-05-01 发布日期:2024-05-17

  • Online:2024-05-01 Published:2024-05-17

摘要： 目的    探讨低级别阑尾黏液性肿瘤（LAMN）的临床病理及预后特征。方法    回顾性分析2013年7月至2023年4月扬州大学附属苏北人民医院胃肠外科收治的58例LAMN病人的临床病理学资料，按是否合并腹膜假黏液瘤（PMP）分为LAMN组（37例）和LAMN合并PMP组（21例），比较两组病人的临床病理学及预后特征。结果  58例LAMN病人表现腹痛33例，体格检查发现阑尾或盆腔肿物16例，健康检查发现阑尾肿瘤9例。腹部增强CT检查显示回盲部囊实性团块影21例（58.3%），内镜检查显示回盲部或者阑尾开口处黏膜下隆起5例（45.4%）；行单纯阑尾切除12例，阑尾切除联合腹膜活检3例，回盲部切除联合活检或联合器官切除22例，右半结肠切除联合腹膜活检或联合器官切除21例，术后1例病人切缘阳性，回盲部及右半结肠切除病人病理检查未见阳性淋巴结。术后中位随访34（3~119）个月，2例失访，随访期间肿瘤复发5例，其中阳性切缘病人未见复发证据。两组病人3年总生存率均为100.0%，LAMN组3年无进展生存率高于LAMN合并PMP组，差异有统计学意义（100% vs. 76.2%，P＜0.001）。结论    腹痛病人CT或内镜检查提示回盲部肿物对LAMN的诊断有一定提示意义，LAMN手术不常规推荐扩大根治性手术，术后病理标本切缘阳性的病人可密切随访，且LAMN预后优于LAMN合并PMP。

关键词: 低级别阑尾黏液性肿瘤, 腹膜假黏液瘤, 阑尾切除术, 回盲部切除术, 右半结肠切除术

Abstract: Clinical and pathological characteristics and prognostic analysis of low-grade mucinous tumors of the appendix        ZHANG Qi, TANG Dong, ZHOU Jia-jie, et al. Department of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou University, Yangzhou 225000, China
Corresponding author: WANG Dao-rong, E-mail: Wdaorong666@sina.com 
ZHANG Qi and TANG Dong are the first authors who contributed equally to the article
Abstract    Objective    To explore the clinical, pathological, and prognostic characteristics of low-grade mucinous tumors of the appendix (LAMN). Methods    The clinicopathological data of 58 cases of LAMN admitted to the Gastrointestinal Surgery Department of Northern Jiangsu People's Hospital affiliated to Yangzhou University from July 2013 to April 2023 were retrospectively analyzed. The patients were divided into the LAMN group (37 cases) and the LAMN+PMP group (21 cases) based on whether with the presence of peritoneal pseudomyxoma (PMP). The clinical, pathological, and prognostic characteristics of the two groups of patients were compared. Results    Among the 58 LAMN patients, 33 had initial clinical manifestations of abdominal pain, 16 had appendiceal or pelvic masses during physical examination, and 9 were directly diagnosed as appendiceal tumors; 12 patients underwent simple appendectomy, 3 underwent appendectomy+peritoneal biopsy, 22 underwent ileocecal resection+biopsy or combined organ resection, and 21 underwent right hemicolectomy+peritoneal biopsy or combined organ resection. One patient had a positive surgical margin after surgery, and no positive lymph nodes were found in the pathological examination of the ileocecal and right hemicolectomy patients. The median follow-up period after surgery was 34 (3-119) months, with 2 cases lost to follow-up. During the follow-up period, 5 patients were found to have recurrence, and there was no evidence of recurrence in patients with positive margins. The overall 3-year survival rates of both groups of patients were 100.0%. The 3-year progression-free survival rate of the LAMN group was higher than that of the LAMN+PMP group, and the difference was statistically significant (100% vs. 76.2%, P<0.001). Conclusion    CT or endoscopic examination of patients with abdominal pain suggests that a mass in the ileocecal region has certain diagnostic significance for LAMN. Extended radical surgery is not routinely recommended for LAMN surgery, and patients with positive surgical margins can be closely followed up. And the prognosis of LAMN is better than that of LAMN+PMP.

Key words: low -grade appendiceal mucinous neoplasms, peritoneal pseudomyxoma, appendectomy, ileocecal resection, right colectomy