切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (02) : 169 -172. doi: 10.3877/cma.j.issn.2095-3224.2020.02.011

所属专题: 专题评论 文献

论著

阑尾肿瘤急诊手术后追加外科手术的价值评估
卢召1, 张明光1, 程璞1, 关旭1, 赵志勋1, 陈海鹏1, 刘正1, 姜争1, 郑朝旭1,(), 王锡山1,()   
  1. 1. 100021 北京,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科
  • 收稿日期:2019-10-07 出版日期:2020-04-25
  • 通信作者: 郑朝旭, 王锡山
  • 基金资助:
    国家重点研发计划(No.2017YFC0908203); 北京市科技计划(No.D171100002617004); 中国医学科学院医学与健康科技创新工程(No.2016-I2M-1-001,2017-I2M-2-003); 北京市朝阳区科技计划(No.CYSF-1931); 北京金桥种子基金(No.ZZ19055)

The value of supplemental surgery for patients with appendix tumor after emergency surgery

Zhao Lu1, Mingguang Zhang1, Pu Cheng1, Xu Guan1, Zhixun Zhao1, Haipeng Chen1, Zheng Liu1, Zheng Jiang1, Zhaoxu Zheng1,(), Xishan Wang1,()   

  1. 1. Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100021, China
  • Received:2019-10-07 Published:2020-04-25
  • Corresponding author: Zhaoxu Zheng, Xishan Wang
  • About author:
    Corresponding author: Wang Xishan, Email:
    Zheng Zhaoxu, Email:
引用本文:

卢召, 张明光, 程璞, 关旭, 赵志勋, 陈海鹏, 刘正, 姜争, 郑朝旭, 王锡山. 阑尾肿瘤急诊手术后追加外科手术的价值评估[J/OL]. 中华结直肠疾病电子杂志, 2020, 09(02): 169-172.

Zhao Lu, Mingguang Zhang, Pu Cheng, Xu Guan, Zhixun Zhao, Haipeng Chen, Zheng Liu, Zheng Jiang, Zhaoxu Zheng, Xishan Wang. The value of supplemental surgery for patients with appendix tumor after emergency surgery[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(02): 169-172.

目的

探讨以阑尾炎起病的阑尾肿瘤行急诊手术后追加右半结肠切除术的临床意义以及对预后的影响。

方法

收集32例阑尾肿瘤急诊手术后再行补救性右半结肠切除术患者的病例资料,分析其临床病理特征,并对预后进行评价。

结果

32例患者均以阑尾炎起病,其中30例于外院行单纯阑尾切除术,2例行阑尾及回盲部切除术。术后中国医学科学院肿瘤医院病理会诊15例为类癌(类癌组),17例为腺癌、黏液腺癌或者印戒细胞癌(非类癌组),均在本院接受补救性右半结肠切除术。术后类癌组均未发现有癌残留及淋巴结转移,非类癌组有11例(64.7%)发现癌残留或者淋巴结转移。全组患者中位随访时间为60.5(12~156)月,其中类癌组均无复发、转移或死亡;非类癌组有6例出现疾病进展,4例因肿瘤死亡,其5年无病生存率(DFS)及总生存率(OS)分别为67.6%和68.6%。

结论

对于以阑尾炎起病的阑尾肿瘤行急诊手术后病理结果提示类癌者,追加右半结肠根治术后可获得良好的长期预后。而对于腺癌、黏液腺癌或者印戒细胞癌者,有较高的肿瘤残存或淋巴结转移率,应及早追加右半结肠根治术,以决定最终的病理分期,指导后续辅助治疗,进而提高预后。

Objective

To investigate the clinical significance and prognosis of supplemental right hemicolectomy for patients with appendix tumor presented with appendicitis after emergency surgery.

Methods

The clinical pathologic data of 32 patients with appendix tumor underwent rescue right hemicolectomy after emergency surgery were retrospectively collected and analyzed to assess the impact of the rescue surgery on prognosis.

Results

Among all patients presented with appendicitis, thirty patients underwent single appendectomy in other hospitals, and two underwent appendectomy and ileocecoectomy. The pathology consultation of 15 patients was diagnosed as carcinoid (carcinoid group) in our hospital, while 17 patients were diagnosed as adenocarcinoma, mucinous adenocarcinoma and signet cell carcinoma (non-carcinoid group). All 32 patients were received rescue right hemicolectomy. Neither residual cancer nor lymph node metastasis was found in carcinoid group, however, residual cancer or lymph node metastasis was found in 11 (64.7%) patients in non-carcinoid group. After a median follow-up of 60.5 (12~156) months, there was no recurrence or metastasis and death in carcinoid group, while there were six patients with disease progression and four deaths in non-carcinoid group. The 5-year disease-free survival (DFS) and overall survival (OS) rates are 67.6% and 68.6%, respectively.

Conclusions

Patients, with appendix tumor diagnosed as carcinoid after emergency surgery, received rescue right hemicolectomy and could achieve favorable prognosis. However, for patients diagnosed as adenocarcinoma, mucinous adenocarcinoma and signet cell carcinoma, there was a high incidence of residual cancer and lymph node metastasis, and supplemental right hemicolectomy should be carried out early to definite the final pathological stage, guide treatment and improve prognosis.

[1]
Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies [J]. Dis Colon Rectum, 1998, 41(1): 75-80.
[2]
Hesketh KT. The management of primary adenocarcinoma of the vermiform appendix [J]. Gut, 1963, 4: 158-168.
[3]
McCusker ME, Coté TR, Clegg LX, et al. Primary malignant neoplasm's of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973-1998 [J]. Cancer, 2002, 94(12): 3307-3312.
[4]
Benedix F, Reimer A, Gastinger I, et al. Primary appendiceal carcinoma--epidemiology, surgery and survival: results of a German multicenter study [J]. Eur J Surg Oncol, 2010, 36(8): 763-771.
[5]
Ozcelik CK, Turanli S, Bozdogan N, et al. Clinical experience in appendiceal neuroendocrine neoplasms [J]. Contemp Oncol (Pozn), 2015, 19(5): 410-413.
[6]
Teixeira FJR Jr, Couto Netto SDD, Akaishi EH, et al. Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature [J]. World J Emerg Surg, 2017, 12: 12.
[7]
Pasaoglu E, Dursun N, Ozyalvacli G, et al. Comparison of world health organization 2000/2004 and world health organization 2010 classifications for gastrointestinal and pancreatic neuroendocrine tumors [J]. Ann Diagn Pathol, 2015, 19(2): 81-87.
[8]
中国胃肠胰神经内分泌肿瘤病理专家组. 中国胃肠胰神经内分泌肿瘤病理学诊断共识意见 [J]. 中华病理学杂志, 2013, 42(10): 691-694.
[9]
Landry CS, Woodall C, Scoggins CR, et al. Analysis of 900 appendiceal carcinoid tumors for a proposed predictive staging system [J]. Arch Surg, 2008, 143(7): 664-670.
[10]
Rorstad O. Prognostic indicators for carcinoid neuroendocrine tumors of the gastrointestinal tract [J]. J Surg Oncol, 2005, 89(3): 151-160.
[11]
Mullen JT, Savarese DM. Carcinoid tumors of the appendix: a population-based study [J]. J Surg Oncol, 2011, 104(1): 41-44.
[12]
Raoof M, Dumitra S, O'Leary MP, et al. Mesenteric lymphadenectomy in well-differentiated appendiceal neuroendocrine tumors [J]. Dis Colon Rectum, 2017, 60(7): 674-681.
[13]
Mosquera C, Fitzgerald TL, Vora H, et al. Novel nomogram combining depth of invasion and size can accurately predict the risk for regional nodal metastases for appendiceal neuroendocrine tumors (A-NET) [J]. J Surg Oncol, 2017, 116(6): 651-657.
[14]
Boudreaux JP, Klimstra DS, Hassan MM, et al. The NANETS consensus guideline for the diagnosis and management of neuroendocrine tumors: well-differentiated neuroendocrine tumors of the Jejunum, Ileum, Appendix, and Cecum [J]. Pancreas, 2010, 39(6): 753-766.
[15]
Pape UF, Perren A, Niederle B, et al. ENETS Consensus Guidelines for the management of patients with neuroendocrine neoplasms from the jejuno-ileum and the appendix including goblet cell carcinomas [J]. Neuroendocrinology, 2012, 95(2): 135-156.
[16]
Kuiper DH, Gracie WA Jr, Pollard HM. Twenty years of gastrointestinal carcinoids [J]. Cancer, 1970, 25(6): 1424-1230.
[17]
胡美, 杨倩, 崔德军, 等. 原发性阑尾黏液腺癌一例报告并文献复习 [J/CD]. 中华结直肠疾病电子杂志, 2015, 4(6): 664-666.
[18]
尤俊, 许林, 郑耿阳, 等. 原发性阑尾肿瘤患者的诊治与预后 [J]. 中华医学杂志, 2008, 88(27): 1909-1911.
[19]
苏昊, 周海涛, 王锡山, 等. 洛铂用于结直肠癌术中腹腔灌洗化疗的近期疗效分析 [J/CD]. 中华结直肠疾病电子杂志, 2018, 7(2): 125-129.
[20]
Verwaal VJ, van Ruth S, de Bree E, et al. Randomized trial of cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy and palliative surgery in patients with peritoneal carcinomatosis of colorectal cancer [J]. J Clin Oncol, 2003, 21(20): 3737-3743.
[1] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[2] 高杰红, 黎平平, 齐婧, 代引海. ETFA和CD34在乳腺癌中的表达及与临床病理参数和预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 64-67.
[3] 杨建波, 马欢, 黄小梅, 刘华柱. 结肠镜辅助下EMR、CSP和RFA术治疗直径<1cm结直肠息肉的疗效和安全性比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 76-79.
[4] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[5] 梁孟杰, 朱欢欢, 王行舟, 江航, 艾世超, 孙锋, 宋鹏, 王萌, 刘颂, 夏雪峰, 杜峻峰, 傅双, 陆晓峰, 沈晓菲, 管文贤. 联合免疫治疗的胃癌转化治疗患者预后及术后并发症分析[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 619-623.
[6] 张志兆, 王睿, 郜苹苹, 王成方, 王成, 齐晓伟. DNMT3B与乳腺癌预后的关系及其生物学机制[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 624-629.
[7] 陈樽, 王平, 金华, 周美玲, 李青青, 黄永刚. 肌肉减少症预测结直肠癌术后切口疝发生的应用研究[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 639-644.
[8] 关小玲, 周文营, 陈洪平. PTAAR在乙肝相关慢加急性肝衰竭患者短期预后中的预测价值[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 841-845.
[9] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[10] 陈晓鹏, 王佳妮, 练庆海, 杨九妹. 肝细胞癌VOPP1表达及其与预后的关系[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 876-882.
[11] 董晓斌, 张静, 苏莎莎, 莎比亚·沙吾提, 盛好. 溃疡性结肠炎患者相关环状RNA 差异表达谱分析及功能研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 499-509.
[12] 韩加刚, 王振军. 梗阻性左半结肠癌的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 450-458.
[13] 董佳, 王坤, 张莉. 预后营养指数结合免疫球蛋白、血糖及甲胎蛋白对HBV 相关慢加急性肝衰竭患者治疗后预后不良的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 555-559.
[14] 王景明, 王磊, 许小多, 邢文强, 张兆岩, 黄伟敏. 腰椎椎旁肌的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 846-852.
[15] 刘福成, 赵欣, 乔海朋, 刘晓峰, 张翀, 张宗明. 保留左结肠动脉的肠系膜下动脉根部淋巴结清扫对腹腔镜直肠癌根治术的疗效影响[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 647-653.
阅读次数
全文


摘要