腹腔镜手术治疗阑尾粘液性肿瘤的临床体会(附11例报告)

摘要

Objective:To investigate the advantages and effects of laparoscopic surgery in the treatment of the appendiceal mucinous tumor.Methods:Retrospective analysis was carried out in 11 patients of appendiceal mucinous tumor from May 2010 to Oct.2016.Results:Eleven patients with preoperative suspected acute appendicitis underwent laparoscopic surgery.All patients were diagnosed during operation,and diagnostic rate was 100％.8 patients underwent laparoscopic appendectomy.2 patients underwent laparoscopic right hemicolectomy.Perfusion tube was placed in 1 patient for thermal cycle after laparoscopic exploration.3 cycles of lobaplatin and raltitrexed treatment were used for hot perfusion chemotherapy after operation.All patients had no serious complications,and all were cured or improved.Operating time was 30-120 min,and the average duration was (48.18±31.64) min.The blood loss was 20-100 ml,and the median was 35 ml.The average anal exhaust time was (2.09±1.04) d.The average hospital stay was (4.27±1.90) d (range,3-8 d).There was no conversion to laparotomy or perioperative death.Conclusions:Appendiceal mucinous tumor is a rare disease with no clinical specificity,which leads to high rate of misdiagnosis.Laparoscopy in the treatment can provide exact exploration with few trauma,rapid recovery,and short hospital stay.It is a kind of safe and effective surgical treatment.%目的:探讨腹腔镜手术治疗阑尾粘液性肿瘤的优势及作用.方法:回顾分析2010年5月至2016年10月收治的11例阑尾粘液性肿瘤患者的临床资料.结果:11例患者术前均拟诊为急性阑尾炎行腹腔镜手术治疗,经腹腔镜探查后术中均明确诊断,确诊率100％,8例行腹腔镜阑尾切除术,2例行腹腔镜右半结肠切除术,1例经腹腔镜探查后放置区域热循环治疗灌注管,术后应用洛铂及雷替曲塞等化疗药物行腹腔区域循环热灌注化疗3个疗程.术后均未出现严重并发症,11例均痊愈或好转出院.手术时间30～120 min,平均(48.18±31.64) min;出血量20～100 ml,中位数35 ml;肛门排气时间平均(2.09±1.04) d;住院3～8 d,平均(4.27±1.90) d,无中转开腹及围手术期死亡病例.结论:阑尾粘液性肿瘤罕见,无临床特异性,临床误诊率较高.腹腔镜手术治疗阑尾粘液性肿瘤探查确切,患者创伤小,术后康复快,住院时间短,是安全、有效的治疗手段.