阑尾粘液囊肿:未解决的问题。

IF 1.6 Q4 ONCOLOGY International Journal of Surgical Oncology Pub Date : 2015-01-01 Epub Date: 2015-03-23 DOI:10.1155/2015/139461
Mohammad Ezzedien Rabie, Mubarak Al Shraim, Mohammad Saad Al Skaini, Saad Alqahtani, Ismail El Hakeem, Abdulla Saad Al Qahtani, Tarek Malatani, Abduelah Hummadi
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引用次数: 28

摘要

背景:阑尾粘液囊肿是一种罕见的疾病,其病理分类和治疗策略尚未规范。目的:报告我们对阑尾黏液囊肿的处理,强调其陷阱和可能的避免方法。材料与方法:回顾我院2008年7月至2013年5月收治的阑尾黏液囊肿病例。结果:9例,男3例,女1例,中位年龄62岁。腹部超声(US)和计算机轴位断层扫描(CT)各有1例怀疑诊断。2例粘液囊腺瘤行开放性阑尾切除术,其中1例边缘呈阳性,但未行进一步手术。腹腔镜阑尾切除术3例,1例为粘液囊腺瘤,无需进一步手术,1例为粘液囊腺癌合并腹膜假性粘液瘤,3例为低级别粘液瘤,均需行右半结肠切除术。探查性剖腹探查3例,其中1例粘液囊腺瘤/?恶性潜能不确定的粘液瘤;在另外2例中,仅因粘液性增生伴阑尾类癌1例和粘液性囊腺瘤/?有不确定恶性潜能的粘液瘤。第9例为腹腔镜胆囊切除术时发现;当发现由阑尾黏液囊肿引起的腹膜假性粘液瘤时,则行腹腔镜阑尾切除术并腹膜活检。两例粘液囊腺瘤的组织病理学诊断不确定,其中粘液瘤的恶性潜能不确定是另一种可能性。围手术期结肠镜检查仅1例,随访计划有缺陷,最长随访时间为180天。结论:右下腹部囊性病变的鉴别诊断应考虑阑尾粘液囊肿。由于它的罕见性,它继续引起外科医生、放射科医生和病理学家的兴趣。对于粘液囊腺癌,通常需要右半结肠切除术,而对于增生和囊腺瘤,如果切除边缘自由,阑尾切除术通常就足够了。对于恶性潜能不确定的黏液性肿瘤和低级别黏液性肿瘤以及腹膜假性黏液瘤,判断就不那么简单了。至于腹腔镜手术,没有可靠的证据支持或反对其安全性。虽然尚未标准化,围手术期结肠镜检查和定期随访,以发现早期复发可能应该是管理计划的一部分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Mucus containing cystic lesions "mucocele" of the appendix: the unresolved issues.

Background: Mucocele of the appendix is a rare condition, the pathological classification and management strategy of which have not been standardized yet.

Aim: To report on our management of appendiceal mucocele, highlighting the pitfalls and possible means for avoiding them.

Materials and methods: Our registries were reviewed to retrieve cases of appendiceal mucocele, encountered in the period from July 2008 to May 2013.

Results: We had 9 cases, three males and sex females, with a median age of 62 years. Abdominal ultrasound (US) and computerized axial tomography scan (CT) suspected the diagnosis in only one case each. Open appendectomy was done in two cases of mucinous cystadenoma with no further surgery performed, despite the positive margin in one. Laparoscopic appendectomy was done in three cases: mucinous cystadenoma in one case which needed no further surgery, mucinous cystadenocarcinoma with pseudomyxoma peritonei in another, and low grade mucinous tumour in a third case, and all needed subsequent right hemicolectomy. Exploratory laparotomy was done in three cases: of these, synchronous right hemicolectomy was done in one case of mucinous cystadenoma/?mucinous tumour of uncertain malignant potential; in the other two cases, appendectomy only was done for mucinous hyperplasia with carcinoid tumour of the appendix in one case and mucinous cystadenoma/?mucinous tumour of uncertain malignant potential in another. The 9th case was discovered upon laparoscopy for cholecystectomy; when pseudomyxoma peritonei arising from an appendiceal mucocele was found, laparoscopic appendectomy with peritoneal biopsy was then performed instead. Histopathologic diagnostic uncertainty was present in two cases of mucinous cystadenoma where mucinous tumour of uncertain malignant potential was an alternative possibility. Perioperative colonoscopy was performed in only one case and our follow-up programme was defective, with the longest period being 180 days.

Conclusion: Mucocele of the appendix should be considered in the differential diagnosis of cystic lesions in the right lower abdomen. Owing to its rarity, it continues to intrigue the surgeon as well as the radiologist and pathologist alike. For mucinous cystadenocarcinoma, right hemicolectomy is usually needed, whereas for hyperplasia and cystadenoma, appendectomy usually suffices if the resection margins are free. For mucinous tumours of uncertain malignant potential and low grade mucinous tumours as well as pseudomyxoma peritonei, the decision is not as simple. As for laparoscopic surgery, no solid proof exists with or against its safety. Although not yet standardized, perioperative colonoscopy and regular follow-up to detect early recurrences should probably be part of the management plan.

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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
5
审稿时长
20 weeks
期刊介绍: International Journal of Surgical Oncology is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies in all areas of surgical oncology.
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