~Teachingcenter的醫學筆記~

有關Mucocele of Appendix，下列敘何者有誤？

A. 在組織學上可分良性及惡性兩種

B. Mucocele rupture會形成pseudomyxoma peritonei

C. 施行Appendectomy手術治療是不夠的，應再加上大網膜等之切除

D. 在施行Appendectomy時，應小心不要弄破Mucocele

E. 可能有卵巢Mucinous tumors同時發生

Ans: C.

C. 錯誤，若為未破裂的黏液囊腫，只需要切除appendix和mesoappendix即可

闌尾黏液囊腫(Mucocele of Appendix)

多半是急性闌尾炎切除後，病理檢查發現的，主要的惡性過程有四個階段：黏液堆積於囊腫(retention cysts)、黏膜層增生(mucosal hyperplasia)、良性囊腺瘤(cystadenomas)、惡性囊腺瘤(cystadenocarcinomas)，至於良性惡性，無法從外觀或影像學分辨。不過，只要是未破裂的囊腫，一般只要完整不破裂地連帶藍偉和闌尾網膜切除，未來無明顯風險。

相反的，若是破裂，就需要完整的腹部探查！

Schwartzs Principles of Surgery 10^th ed. P.1258

原文：A mucocele of the appendix is an obstructive dilatation by intraluminal accumulation of mucoid material. Mucoceles may be caused by one of four processes: retention cysts, mucosal hyperplasia, cystadenomas, and cystadenocarcinomas. The clinical presentation of a mucocele is nonspecific, and often it is an incidental finding at operation for acute appendicitis. An intact mucocele presents no future risk for the patient; however, the opposite is true if the mucocele has ruptured and epithelial cells have escaped into the peritoneal cavity. As a result, when a mucocele is visualized at the time of laparoscopic examination, conversion to open laparotomy is recommended. Conversion from a laparoscopic approach to a laparotomy ensures that a benign process will not be converted to a malignant one through mucocele rupture. In addition, laparotomy allows for thorough abdominal exploration to rule out the presence of mucoid fluid accumulations. The presence of a mucocele of the appendix does not mandate performance of a right hemicolectomy. The principles of surgery include resection of the appendix, wide resection of the mesoappendix to include all the appendiceal lymph nodes, collection and cytologic examination of all intraperitoneal mucus, and careful inspection of the base of the appendix. Right hemicolectomy or, preferably, ileocecectomy is reserved for patients with a positive margin at the base of the appendix or positive periappendiceal lymph nodes. Recently, a more aggressive approach to ruptured appendiceal neoplasms has been advocated. This approach includes a thorough but minimally aggressive approach at initial laparotomy, as described earlier, with subsequent referral to a specialized center for consideration of re-exploration and hyperthermic intraperitoneal chemotherapy.

(圖為示意，一般症狀腹痛不一定明顯)