CAJ | 학술논문

目的探讨阑尾源性腹膜假黏液瘤的治疗效果.方法回顾性分析1970年至2010年卫生部北京医院收治的51例阑尾源性腹膜假黏液瘤患者的临床资料,对患者手术及复发再手术情况,辅助治疗及随访情况进行分析.术后是否接受腹腔化疗的患者复发再手术间隔时间的比较采用双尾t检验.结果51例患者中48例接受手术治疗,手术时间(135±72) min.34例患者肿瘤复发,其中16例接受再减瘤手术,再手术次数33次.45例患者中位随访时间49.7个月(3～ 132个月),25例带瘤生存,16例无瘤生存,4例死亡.术后病理检查良性型-弥漫性腹膜腺黏液病19例,中间型6例,恶性型-腹膜黏液癌病26例.3、5、10年生存率分别为75％(38/51)、55％(28/51)和22％(11/51).术后接受化疗患者的生存时间和再手术间隔时间分别为(21±4)个月和(10±6)个月,较未接受化疗患者的(19±7)个月和(7±4)个月有所延长,但差异无统计学意义(t=1.027,0.361,P＞0.05).良性型-弥漫性腹膜腺黏液病、中间型及恶性型-腹膜黏液癌病患者中位生存时间分别为96、63、23个月.良性型-弥漫性腹膜腺黏液病患者与恶性型-腹膜黏液癌病患者肿瘤复发间隔时间分别为(15±5)个月和(7±4)个月,两者比较,差异有统计学意义(=2.193,P＜0.05).结论应该以积极态度实施阑尾源性腹膜假黏液瘤减瘤手术,复发患者合理适时选择二次或多次的减瘤手术,可以延长复发时间,改善患者的预后.
목적 탐토란미원성복막가점액류적치료효과.방법 회고성분석1970년지2010년위생부북경의원수치적51례란미원성복막가점액류환자적림상자료,대환자수술급복발재수술정황,보조치료급수방정황진행분석.술후시부접수복강화료적환자복발재수술간격시간적비교채용쌍미t검험.결과51례환자중48례접수수술치료,수술시간(135±72) min.34례환자종류복발,기중16례접수재감류수술,재수술차수33차.45례환자중위수방시간49.7개월(3～ 132개월),25례대류생존,16례무류생존,4례사망.술후병리검사량성형-미만성복막선점액병19례,중간형6례,악성형-복막점액암병26례.3、5、10년생존솔분별위75％(38/51)、55％(28/51)화22％(11/51).술후접수화료환자적생존시간화재수술간격시간분별위(21±4)개월화(10±6)개월,교미접수화료환자적(19±7)개월화(7±4)개월유소연장,단차이무통계학의의(t=1.027,0.361,P＞0.05).량성형-미만성복막선점액병、중간형급악성형-복막점액암병환자중위생존시간분별위96、63、23개월.량성형-미만성복막선점액병환자여악성형-복막점액암병환자종류복발간격시간분별위(15±5)개월화(7±4)개월,량자비교,차이유통계학의의(=2.193,P＜0.05).결론 응해이적겁태도실시란미원성복막가점액류감류수술,복발환자합리괄시선택이차혹다차적감류수술,가이연장복발시간,개선환자적예후.
Objective To investigate the management of pseudomyxoma peritonei originated in the appendix.Methods The clinical data of 51 patients with pseudomyxoma peritonei originated in the appendix who were admitted to the Beijing Hospital from 1970 to 2010 were retrospectively analyzed.The results of operation,reoperation,adjuvant treatment and follow-up were analyzed.The time from pseudomyxoma peritonei recurrence to the reoperation between patients who did or did not receive chemotherapy was compared by two tailed t test.Results Of the 51 patients,48 received operation,and the operation time was (135 ± 72 )minutes.Tumor recurrence was observed in 34 patients,and 16 of them received cytoreduction procedure,and 33 cytoreduction procedures were performed in total.The median time of follow-up was 49.7 months (range,3-132 months).The disease-specific survival was observed in 25 patients and disease-free survival in 16 patients.Four patients died of tumor recurrence or progression.The results of postoperative pathological examination confirmed that 19 patients were with benign disseminated peritoneal adenomucinosis (DPAM),26 were with malignant peritoneal mucinous carcinomatosis (PMCA) and 6 were with intermediate subtype (PMCA-1).The 3-,5- and 10-year survival rates were 75％ (38/51),55％ (28/51) and 22％ ( 11/51 ),respectively.The survival time and reoperation time interval for patients who received postoperative chemotherapy were ( 21 ± 4) months and ( 10 ± 6 ) months,which were longer than (19 ±7 )months and (7 ±4)months of those who did not receive postoperative chemotherapy (t =1.027,0.361,P ＞ 0.05).The median survival time of patients with benign DPAM,PMCA-1 and malignant PMCA were 96,63,23 months,respectively.The tumor recurrence interval for patients with benign DPAM and those with malignant PMCA were ( 15 ± 5 ) months and (7 ± 4) months,with significant difference ( t =2.193,P ＜ 0.05 ).Conclusions An active cytoreduction surgery is feasible for patients with pseudomyxoma peritonei originated in the appendix in improving survival.Repeated cytoreduction is a treatment of strategy to prolong the recurrence time and improve the prognosis of selected patients.