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[阑尾黏液囊肿。病例报告]

[Appendiceal mucoceles. A case report].

作者信息

Emmi S, Galasso M G, Ursino V, Scala R, Guastella T

机构信息

Istituto I Clinica Chirurgica Generale e Terapia Chirurgica, Catania.

出版信息

Minerva Chir. 1998 Oct;53(10):807-10.

PMID:9882971
Abstract

A case of benign mucocele presenting as a subocclusive syndrome is reported; the surgical treatment consisted in a right colectomy. Appendiceal mucoceles are rare lesions of the appendix, characterized by a gross enlargement of the appendix from accumulation of mucoid substance within the lumen. It is a rare condition, encountered in only 0.1-0.4% of all appendectomies with a female predominance and an average age at the time of diagnosis over 50 years. Following careful review of the literature, the difficulties in differential diagnosis are underlined, especially between benign and malignant forms and the possibility of a pre-operative diagnosis is examined. Abdominal ultrasound and CT scan of the abdomen or colonoscopy may suggest the diagnosis. However, often the diagnosis is an incidental event. The pathogenesis, histologic aspect of the lesion and the different surgical strategies are discussed. A frozen section examination should be performed in all patients, while the abdomen is open, because it may be impossible to predict the underlying pathology merely by inspecting the serosal surface of a dilated appendix. If a simple retentional cyst is uncovered, without atypia, appendectomy should be curative; if cystadenoma or cystadenocarcinoma of the appendix are found, more extended resection was necessary. However if the operation is done as an emergency, a frozen section examination is not always available: in those patients a more extended resection is suggested.

摘要

报告了一例表现为亚闭塞综合征的良性黏液囊肿病例;手术治疗为右半结肠切除术。阑尾黏液囊肿是阑尾的罕见病变,其特征是阑尾因管腔内黏液物质积聚而明显肿大。这是一种罕见疾病,在所有阑尾切除术中仅占0.1 - 0.4%,女性居多,诊断时的平均年龄超过50岁。在仔细查阅文献后,强调了鉴别诊断的困难,尤其是良性和恶性形式之间的鉴别,并探讨了术前诊断的可能性。腹部超声、腹部CT扫描或结肠镜检查可能提示诊断。然而,诊断往往是偶然发现。文中讨论了病变的发病机制、组织学特征以及不同的手术策略。所有患者在腹部开放时均应进行冰冻切片检查,因为仅通过检查扩张阑尾的浆膜表面可能无法预测潜在的病理情况。如果发现的是单纯潴留性囊肿,无异型性,阑尾切除术应可治愈;如果发现阑尾黏液腺瘤或黏液腺癌,则需要更广泛的切除。然而,如果手术是作为急诊进行,冰冻切片检查并不总是可行:对于这些患者,建议进行更广泛的切除。

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