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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 481 -490. doi: 10.3877/cma.j.issn.2095-3224.2025.06.001

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腹膜假黏液瘤肿瘤细胞减灭手术策略
林卓涛1,2, 杨科力1,2, 王辉1,2,†()   
  1. 1510000　广州，中山大学附属第六医院结直肠外科
    2510000　广州，广州市黄埔区中六生物医学创新研究院
  • 收稿日期:2025-05-01 出版日期:2025-12-25
  • 通信作者: 王辉
  • 基金资助:
    中山大学附属第六医院"1010"计划资助项目(No. 1010CG（2022）-08)

Surgical strategies for cytoreductive surgery of pseudomyxoma peritonei

Zhuotao Lin1,2, Keli Yang1,2, Hui Wang1,2,†()   

  1. 1Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
    2Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510000, China
  • Received:2025-05-01 Published:2025-12-25
  • Corresponding author: Hui Wang
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林卓涛, 杨科力, 王辉. 腹膜假黏液瘤肿瘤细胞减灭手术策略[J/OL]. 中华结直肠疾病电子杂志, 2025, 14(06): 481-490.

Zhuotao Lin, Keli Yang, Hui Wang. Surgical strategies for cytoreductive surgery of pseudomyxoma peritonei[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2025, 14(06): 481-490.

腹膜假黏液瘤（PMP）是一种罕见且具有高度异质性的临床病理综合征，其核心病理特征表现为腹腔内黏液分泌性肿瘤细胞的播散种植和黏液性腹腔积液进行性蓄积。该疾病多继发于阑尾黏液性肿瘤，临床早期常呈隐匿性进展，以腹胀、腹痛为首发症状。肿瘤细胞减灭术（CRS）联合腹腔热灌注化疗（HIPEC）是治疗PMP的首选方法，但该策略存在手术创伤大和并发症发生率高等问题。在追求肿瘤细胞减灭疗效的同时，如何最大限度地降低手术并发症的发生风险，是目前PMP治疗面临的关键挑战。

关键词: 腹膜假黏液瘤, 阑尾黏液性肿瘤, 肿瘤细胞减灭术, 手术并发症

Pseudomyxoma peritonei (PMP) is a rare and highly heterogeneous clinicopathological syndrome, characterized primarily by the dissemination and implantation of mucin-secreting tumor cells within the abdominal cavity, along with the progressive accumulation of mucinous ascites. It most commonly arises as a complication of appendiceal mucinous tumors. In its early stages, the disease often progresses insidiously, typically presenting with abdominal distension and pain as initial clinical manifestations. Currently, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for PMP. However, this therapeutic approach is associated with considerable surgical trauma and a high risk of postoperative complications. In the treatment of PMP, the central challenge lies in attaining effective CRS while simultaneously minimizing the risk of surgical complications.

Key words: Pseudomyxoma peritonei, Appendiceal mucinous neoplasm, Cytoreductive surgery, Surgical complications
表1 PMP的病理分型比较（Ronnett对比PSOGI）[4,29,30]
分类系统 类型 描述 特点
Ronnett DPAM 腹膜病变由丰富的细胞外黏液组成，含有少量的单纯性到局灶性增殖性黏液上皮，细胞异型性或有丝分裂活性很少，伴或不伴阑尾黏液腺瘤 最早且广泛认可的工具之一，强调PMP的组织学分级及其对预后的影响
PMCA 更丰富的黏液上皮组成，具有癌的结构和细胞学特征，伴有或不伴有原发性黏液腺癌
PMCA I/D 中间型，介于DPAM和PMCA之间，具有更高的淋巴结和腹腔外器官转移潜力
PSOGI LG-PMP 黏液中见低级别组织学特征的黏液性上皮，肿瘤细胞呈单层排列，胞质丰富，核位于基底，轻度异型，核分裂象少见 排除无细胞型黏液病变，更注重组织学分级与临床行为的关联
HG-PMP 黏液中见高级别组织学特征的黏液性上皮，肿瘤组织结构复杂，呈条索状、簇状及腺样排列，瘤细胞复层，核深染，异型性显著，核分裂象易见
SC-PMP 黏液池中可见漂浮的大量印戒细胞，轮廓呈圆形，胞质中大量黏液聚积，核位于一侧呈印戒样
图1 腹膜癌指数PCI评分标准[36]。注：LS为病灶大小评分
表2 肿瘤细胞减灭程度评分（CC评分）标准[32]
CC评分 CRS术后腹膜残余肿瘤大小
CC-0 无腹膜转移癌
CC-1 腹膜残余瘤直径<0.25 cm
CC-2 腹膜残余瘤直径为0.25 cm~2.50 cm
CC-3 腹膜残余瘤直径>2.50 cm，或存在无法切除病灶
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