阑尾黏液瘤的诊断和治疗

doi:10.16139/j.1007-9610.2021.01.005

摘要/Abstract

中图分类号:

R735.36

杨萍, 熊斌. 阑尾黏液瘤的诊断和治疗[J]. 外科理论与实践, 2021, 26(01): 21-27.

YANG Ping, XIONG Bin. Diagnosis and treatment of appendiceal mucinous neoplasm[J]. Journal of Surgery Concepts & Practice, 2021, 26(01): 21-27.

图/表 5

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参考文献 53

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术语	分级	组织学特征
腺瘤	低/高度发育异常	局限于黏膜,黏膜肌层完整
锯齿状息肉	低/高度或无发育异常肿瘤	锯齿状特征,局限于黏膜,黏膜肌层完整
LAMN	低级别	具有低级别细胞学的黏液性肿瘤和以下特征中的任何一种：固有层和黏膜肌层缺失黏膜下层纤维化呈“推挤性”模式进入阑尾壁,膨胀性或憩室样生长方式无细胞的黏液切割入阑尾壁内黏液和(或)肿瘤性黏液上皮位于阑尾壁外
HAMN	高级别	伴高级别细胞学（至少局灶存在）的黏液性肿瘤且无浸润性生长
黏液性腺癌	高/中/低分化	黏液瘤,包含>50%的细胞外黏蛋白,呈浸润性生长
印戒细胞低分化（黏液性）腺癌	低分化	≤50%的印戒细胞成分
（黏液性）印戒细胞癌	低分化	>50%的印戒细胞成分
腺癌	/	/

分化程度	组织学标准
高分化G₁	低级别细胞学
中分化G₂	高级别细胞学,无印戒细胞,常伴有浸润
低分化G₃	高级别细胞学,伴印戒细胞和浸润

分期	T	N	M	G
0期	Tis	N₀	M₀
0期	Tis(LAMN)	N₀	M₀
Ⅰ期	T₁	N₀	M₀
Ⅰ期	T₂	N₀	M₀
ⅡA期	T₃	N₀	M₀
ⅡB期	T_4a	N₀	M₀
ⅡC期	T_4b	N₀	M₀
ⅢA期	T₁	N₁	M₀
ⅢA期	T₂	N₁	M₀
ⅢB期	T₃	N₁	M₀
ⅢB期	T₄	N₁	M₀
ⅢC期	任何T	N₂	M₀
ⅣA期	任何T	N₀	M_1a
ⅣA期	任何T	任何N	M_1b	G₁
ⅣB期	任何T	任何N	M_1b	G₂、G₃、G_x
ⅣC期	任何T	任何N	M_1c	任何G

分期		描述
原发肿瘤（T）
T_x		原发肿瘤无法评价
T₀		无原发肿瘤的证据
Tis		原位癌(黏膜内癌;侵入固有层;侵犯黏膜肌,但未穿透黏膜肌层)
Tis(LAMN)		LAMN,局限于固有肌层的。黏液或黏液上皮可侵入固有肌层。注：T₁和T₂不适用于LAMN,黏液或黏液上皮进入浆膜下层或浆膜层时应分到T₃或T_4a
T₁		肿瘤侵及黏膜下层（穿透黏膜肌层,未达到固有肌层）
T₂		肿瘤侵及固有肌层
T₃		肿瘤穿透固有肌层,侵及浆膜下或阑尾系膜
T₄	T_4a	肿瘤侵犯腹膜脏层,包括黏液或黏液上皮侵入阑尾浆膜或阑尾系膜
	T_4b	肿瘤侵犯邻近组织及器官
区域淋巴结（N）
N_x		淋巴结不能评价
N₀		无淋巴结转移
N₁	N_1a	1枚淋巴结转移
	N_1b	2~3枚淋巴结转移
	N_1c	无淋巴结阳性,但浆膜下或肠系膜处可见癌细胞
N₂		≥4枚淋巴结转移
远处转移（M）
M₀		无远处转移
M₁		有远处转移
	M_1a	腹膜内的无细胞黏液,在腹膜播散性的黏液中未见明确肿瘤细胞
	M_1b	仅腹膜内转移,包括腹膜黏液中见肿瘤细胞
	M_1c	腹膜外转移
分化程度（G）
G_x		无法评估分化程度
G₁		高分化
G₂		中分化
G₃		低分化,未分化

阑尾黏液瘤的诊断和治疗

Diagnosis and treatment of appendiceal mucinous neoplasm

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