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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]. 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]. 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.

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