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目的:探讨原发阑尾腺癌侵犯膀胱的特点及诊治方法。方法:回顾性分析2例原发阑尾腺癌侵犯膀胱患者的临床资料。2例中男女各1例,年龄分别为61、45岁。例1为体检发现膀胱肿物,CT示膀胱右侧壁实性肿物,大小约2 cm,不均匀强化,考虑膀胱肿瘤,膀胱镜检查发现右侧壁半球性肿物,活检提示黏膜慢性炎表现。例2表现为尿混浊含絮状物3个月,CT示膀胱右侧壁实性肿物,大小约6 cm,不均匀强化,膀胱镜检查发现右侧壁局部黏膜溃烂,膀胱内含有大量絮状物,活检提示黏膜慢性炎表现。消化道造影提示回盲部受压表现,阑尾未显影。检索Pubmed和CBM数据库相关文献,进行复习。结果:2例均行手术治疗,例1行经尿道肿瘤电切术,术中电切肿物至肌层后发现有絮状物流出,行开放手术,术中见阑尾与膀胱侧壁粘连紧密,考虑阑尾肿瘤侵犯膀胱,行回盲部、阑尾肿瘤切除及膀胱部分切除术,术后病理:阑尾高分化腺癌侵犯膀胱。例2行剖腹探查术,术中见阑尾肿瘤侵犯膀胱,行阑尾肿瘤、右半结肠切除及膀胱部分切除术,术后病理:阑尾黏液腺癌侵犯膀胱。术后随访6、12个月未见肿瘤复发及转移。结论:原发阑尾腺癌临床少见,侵犯膀胱罕见,膀胱继发性肿瘤应考虑阑尾肿瘤侵犯可能,尿中持续有絮状物者应考虑有阑尾膀胱瘘可能。治疗主要以手术为主,行膀胱部分切除或全切,阑尾肿瘤及右半结肠切除,放疗及化疗效果差。
Objective: To investigate the characteristics of primary adenocarcinoma of the appendix and its diagnosis and treatment. Methods: The clinical data of 2 patients with primary adenocarcinoma of the bladder invading the bladder were retrospectively analyzed. 2 cases of male and female in 1 case, the age was 61,45 years old. Case 1 was found for physical examination of the bladder tumor, CT showed the right side of the bladder solid tumors, about 2 cm in size, uneven enhancement, consider the bladder tumor, cystoscopy found that the right side of the hemisphere tumor, biopsy prompted chronic mucosal inflammation which performed. Example 2 showed urine turbidity containing flocs for 3 months, CT showed the right side of the bladder solid tumors, about 6 cm in size, uneven enhancement, cystoscopy found that the right side wall of local mucosal ulceration, the bladder contains a large number of floc Biopsies, biopsies suggest mucosal chronic inflammation. Gastrointestinal imaging showed ileocecal compression performance, appendix did not develop. Retrieve Pubmed and CBM databases for review. Results: Two cases underwent surgical resection. In case 1, transurethral resection of the tumor was performed. After the resection of the tumor to the muscularis propria, flocculent efflux was observed. During the operation, the appendix and the side wall of the bladder were closely adhered, Consider the appendix tumor invasion of the bladder, the line ileocecal, appendectomy and partial resection of the bladder, postoperative pathology: adenocarcinoma of the appendix invading the bladder. Example 2 laparotomy exploration, intraoperative see appendix tumor invasion of the bladder, the line of appendiceal cancer, right partial colon resection and partial resection of the bladder, postoperative pathology: appendix mucinous adenocarcinoma invading the bladder. No tumor recurrence and metastasis were observed 6 and 12 months after operation. Conclusions: The primary adenocarcinoma of the appendix is rare in clinical practice. Bladder invading is rare. Secondary bladder tumor should be considered as an invasion of the appendix. Patients with persistent floc in the urine should consider the possibility of appendix bladder fistula. The main treatment of surgery, partial or partial resection of the bladder line, appendix tumor and right colon resection, radiotherapy and chemotherapy poor results.