26例腹腔假性粘液瘤的诊疗分析

Pseudomyxoma peritonei: a report of 26 cases

关键词:  腹腔假性粘液瘤  腹腔灌注化疗  手术

Key words:  pseudomyxoma peritonei  hyperthermic intraperitoneal chemotherapy  operation

摘要:

目的　探讨26例腹腔假性粘液瘤的诊断治疗经验。方法　对2012年1月至2015年8月解放军第309医院收治的26例腹腔假性粘液瘤患者的临床资料进行回顾性分析。对患者行血常规、肝肾功能等检测，行血液及腹水肿瘤标记物筛查，术前行腹部超声、核磁或CT检查。全部行剖腹探查手术，观察患者的术中情况，手术时间，化疗及生存情况。结果　术前得以明确诊断的有7例（26.9%，7/26）。行剖腹探查术患者均未发生手术死亡。有8例患者经过2次或多次腹部手术，26例患者的平均手术次数为1.3次。共24例行腹腔灌注热化疗，2例口服替吉奥胶囊进行全身化疗。24例患者得到随访，1例于术后6个月死于多器官功能衰竭，3例术后2年死于肿瘤导致的恶液质，余20例患者均目前处于存活状态，存活率为83.3%。结论　腹腔假性粘液瘤的发病率较低，术前诊断较为困难，治疗仍是以手术为主，术毕序贯行腹腔热灌注化疗，对延长复发时间，提高生存率有较好的效果。

Abstract:

Objective 　 To discuss the diagnosis and therapeutic experience of Pseudomyxoma peritonei (PMP).　Methods 　 Retrospective study was made on 26 cases of PMP treated in our department between January, 2012 and September, 2015 and literatures were reviewed. During hospitalization, complete blood count, liver and kidney functions were tested; tumor markers in blood and ascites were also examined. Before operation, the abdominal ultrasonography, nuclear magnetic resonance (MRI) and CT were performed. All patients underwent surgery, and the survival time, mortality, re-operation rate, cause of death and the time for chemotherapy were investigated. 　Results 　 Seven patients (26.9%) had pre-operative diagnosis. The remaining cases were diagnosis during or after surgery. All patients underwent complete cytoreductive surgery (CCS) and no patients died during the surgery. Eight patients received more than two times of CCS and the average number of CCS was 1.3. Following operation, 24 patients underwent hyperthermic intraperitoneal chemotherapy (HIPEC) and 2 patients received Tegafur. The 24 patients were followed up and 4 patients died, one at 6 month after surgery and three at 2 year after surgery by multiple organ failure. Twenty patients (83.3%) survived until now.　Conclusion 　 PMP is a rare condition and difficult to be diagnosed before surgery. CCS plus HIPEC have dramatically changed the prognosis of patients with PMP.