Deans G T, Spence R A
Department of Surgery, Belfast City Hospital, UK.
Br J Surg. 1995 Mar;82(3):299-306. doi: 10.1002/bjs.1800820306.
Neoplasms occur in 0.5 per cent of appendices. Ultrasonography or computed tomography is beneficial, but preoperative detection is rare. At operation, the diagnosis is considered in under half of cases. Mucocele, localized pseudomyxoma peritonei, benign tumours and most appendiceal carcinoids are cured by appendicectomy alone. Right hemicolectomy is indicated for: (1) invasive adenocarcinoma; (2) tumours close to the caecum; (3) lesions larger than 2 cm; (4) mucin production; (5) invasion of the lymphatics, serosa or mesoappendix; and (6) cellular pleomorphism with a high mitotic rate. Tumours of 1-2 cm, small mucinous carcinoids, adenocarcinoma confined to the mucosa, and tumours in children may be treated by appendicectomy alone at the surgeon's discretion. The 5-year survival rate associated with classical carcinoid is more than 90 per cent. The prognosis of mucinous carcinoid is intermediate between that of classical carcinoid and well differentiated adenocarcinoma. The prognosis of adenocarcinoma is determined by Dukes' stage and is similar, stage for stage, to that of colorectal carcinoma.
肿瘤在0.5%的阑尾中出现。超声检查或计算机断层扫描是有益的，但术前检测很少见。在手术中，不到一半的病例会考虑到该诊断。黏液囊肿、局限性腹膜假黏液瘤、良性肿瘤和大多数阑尾类癌仅通过阑尾切除术即可治愈。右半结肠切除术适用于：（1）浸润性腺癌；（2）靠近盲肠的肿瘤；（3）大于2厘米的病变；（4）黏液产生；（5）淋巴管、浆膜或阑尾系膜受侵；以及（6）细胞多形性伴高有丝分裂率。1 - 2厘米的肿瘤、小黏液性类癌、局限于黏膜的腺癌以及儿童肿瘤，可由外科医生酌情单独行阑尾切除术治疗。经典类癌的5年生存率超过90%。黏液性类癌的预后介于经典类癌和高分化腺癌之间。腺癌的预后由Dukes分期决定，且在分期上与结直肠癌相似。
