外科からみた回盲部腫瘤における虫垂腫瘤の実態―腫瘍性病変について

Surgical Aspects of Tumor of the Appendix

要旨　虫垂腫瘤のうちではカルチノイド，粘液囊胞腺腫，粘液囊胞腺癌，腺癌の頻度が高く，その他の腫瘍性病変は極めてまれである．大垣市民病院外科で過去10年間に経験した虫垂腫瘍は14例で，虫垂切除術あるいは結腸右半切除術を施行した4,654例の0.3％にあたった．虫垂腫瘍の内訳は粘液囊胞腺腫5例，粘液囊胞腺癌1例，カルチノイド2例，腺癌5例，悪性リンパ腫1例であり，これらの症例を中心に，虫垂腫瘤の診断，治療，予後について文献的考察も加えて述べた．虫垂腫瘤はUS，CTなどを用いてその存在診断は可能なことが多いが，質的診断は困難である．このため術前に治療方針を決定することは難しいが，良性腫瘍や小さいカルチノイドは虫垂切除術を，悪性腫瘍や1cmを越すカルチノイドは結腸右半切除術を行う方針がよいと思われる．

　Appendiceal tumors are classified into six categories according to the General Rules for Clinical and Pathological Studies on Cancer of Colon, Rectum and Anus. Of these categories carcinoid tumor, mucinous cystadenoma, mucinous cystadenocarcinoma and adenocarcinoma are common while the other very rare.

　For the last 10 years, 14 cases of appendiceal tumor were experienced at Department of Surgery in Ogaki Municipal Hospital accounting for 0.3 percent of 4,654 cases of either appendectomy or right hemicolectomy. These 14 cases were pathologically classified into 5 mucinous cystadenomas, one mucinous cystadenocarcinoma, 2 carcinoid tumors, 5 adenocarcinomas and one malignant lymphoma. Based on these cases and review of literatures, mention was made regarding the diagnosis, treatment and prognosis of appendiceal tumors.

　Appendiceal tumors were visualized on ultrasound, CT and other modalities, but preoperative histologic diagnosis was difficult. The prognosis of benign tumor and small carcionoid tumor of the appendix were excellent, while that for malignant neoplasm poor. In our series a patient with mucinous cystadenocarcinoma, 3 patients with adenocarcinoma and a patient with malignant lymphoma died of recurrence within two years after surgical treatment. Although appendectomy is enough for benign tumors and small carcinoid tumors and considered the treatment of choice, right hemi-colectomy with lymphnode dissection should be per-formed for large carcinoid tumors and malignant neo-plasms.