实用老年医学 ›› 2022, Vol. 36 ›› Issue (6): 556-559.doi: 10.3969/j.issn.1003-9198.2022.06.003

• 临床研究 • 上一篇    下一篇

老年阑尾假性黏液瘤的临床诊疗分析

丁辉, 丁永斌   

  1. 223600 江苏省宿迁市,沭阳医院普外科(丁辉);
    211899 江苏省南京市,江苏省人民医院浦口分院普外科(丁永斌)
  • 收稿日期:2021-08-23 出版日期:2022-06-20 发布日期:2022-06-30
  • 通讯作者: 丁永斌,Email:njdyb@njmu.edu.cn
  • 基金资助:
    江苏省干部保健科研课题(BJ16008)

Analysis of clinical diagnosis and treatment of appendix pseudomyxoma peritonei in the elderly

DING Hui, DING Yong-bin   

  1. DING Hui. Department of General Surgery, Shuyang Hospital, Suqian 223600, China;
    DING Yong-bin. Department of General Surgery, Pukou Branch Hospital of Jiangsu Province Hospital, Nanjing 211899, China
  • Received:2021-08-23 Online:2022-06-20 Published:2022-06-30

摘要: 目的 回顾性分析老年阑尾假性黏液瘤的临床和病理学特点以及外科治疗策略对预后的影响。方法 对48例老年阑尾假性黏液瘤病人的一般情况、临床表现、影像学特征、手术治疗策略、病理结果和预后等进行回顾性分析。 结果 入组的48例病人中,38例肿瘤未破裂(肿瘤未破裂组),10例术中见瘤体已破裂(肿瘤破裂组)。肿瘤破裂组与肿瘤未破裂组的年龄、性别、肿瘤标记物、临床表现及肿瘤直径等方面差异均无统计学意义(P>0.05)。肿瘤破裂组术中快速病理提示恶性者5例,肿瘤未破裂组术中快速病理提示恶性者6例,2组比较,差异有统计学意义(P<0.05)。本研究共随访13~101个月(平均34个月),且随访期间均无病人死亡。肿瘤破裂组中,8例病人术后1年内复发,其中5例为初次术中病理诊断恶性并接受顺铂腹腔灌注化疗者,术后3年内10例病人全部复发,均行二次手术治疗,且复发的病人中有3例初次术后病理诊断为良性的病人发生恶变。肿瘤未破裂组病人术后3年内均无复发。肿瘤破裂组的复发和恶变风险均显著高于肿瘤未破裂组,差异有统计学意义(P<0.05)。 结论 完整切除是治疗老年阑尾假性黏液瘤病人的关键,瘤体破裂后更易恶变和复发,且病人从化疗中获益很少。

关键词: 阑尾假性黏液瘤, 腹腔假性黏液瘤, 腹腔灌注化疗, 老年人

Abstract: Objective To analyze the clinicopathological characteristics of appendix pseudomyxoma peritonei in the elderly and the effect of surgical treatment strategy on prognosis. Methods The general data, clinical manifestation, imaging feature, surgical treatment strategies, pathological results and prognosis of 48 elderly patients with appendix pseudomyxoma peritonei were analyzed retrospectively. Results Among the 48 patients, 38 presented with unruptured tumors (unruptured tumor group) and 10 presented with ruptured tumors during the surgery (ruptured tumor group). There were no significant differences in age, gender, tumor markers, clinical manifestation and tumor diameter between the two groups (P>0.05). There were 5 patients with malignant tumor in unruptured tumor group and 6 patients with malignant tumor in ruptured tumor group, and the difference between the two groups was statistically significant (P<0.05). This study was followed up for 13 to 101 months (mean 34 months), and no patient died during the follow-up period. In unruptured tumor group, 8 patients recurred within one year after surgery, including 5 patients who were initially diagnosed as malignant tumor; Within three years after surgery, 10 patients recurred and all of them underwent secondary surgery, and 3 patients who were initially diagnosed as benign transformed to malignant. All the patients in unruptured tumor group had no recurrence within 3 years after surgery. The risk of recurrence and malignant transformation in ruptured tumor group were significantly higher than those in unruptured tumor group (P<0.05). Conclusions Complete resection is key to the treatment of elderly patients with appendiceal pseudomyxoma peritonei. The tumor is more prone to malignant transformation and recurrence after rupture, and the patients rarely benefit from chemotherapy.

Key words: appendix pseudomyxoma peritonei, pseudomyxoma peritonei, intraperitoneal chemotherapy, aged

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