- 期刊
Mucocele of the Appendix: With Special Emphasis on Image Studies
闌尾黏液囊腫：特別關注影像學檢查
摘要
自1984年元月至1989年四月，在1268闌尾切除例中，病理診斷為闌尾黏液囊腫者十例，占0.78%，僅一例有正確的術前診斷。本文回顧分析這些病例，特別關注影像學檢查，期能提昇往後的術前診斷率。 十例中，除一例為胃癌手術中偶然發現者外，其餘皆以右下腹痛或腫塊表現。一例於腹部X光片可見右下腹弧線狀鈣化。七例於術前接受腹部超音波檢查：一例未見到病灶，二例呈現低或無回音條狀病灶，另二例為併有內底部不同程度回音的囊腫，而以腸套疊或闌尾周邊膿瘍等併發症表現者各一例。四例大腸鋇劑攝影闌尾不顯影，且在盲腸有充填缺損。另一例於闌尾黏液囊腫診斷前十年及五年各接受一次大腸鋇劑攝影，兩次皆顯現充有鋇劑但狹窄的闌尾；慢性發炎造成狹窄阻塞可能是此病例的重要原因。四例接受大腸纖維內視鏡檢，皆可看到黏液囊腫底部自闌尾開口向盲腸內部突擠出，一例更造成慢性腸套疊影像。電腦斷層攝影能顯現較佳的解剖方位，可見一長條含液病灶自盲腸突出，注射對比劑後，其壁可有良好的顯影。治療一般以闌尾切除即可，對於其中四例已破裂的病灶，手術中儘可能清除外散的黏液亦有相當良好的預後。 闌尾黏液囊腫雖是罕見的疾病，但如能熟知其影像學檢查的圖相，並列入右下腹痛鑑別診斷，正確的術前診斷是可期的。
並列摘要
In a review of 1,268 appendectomies from January 1984 to April 1989, ten cases were diagnosed as ”mucocele” by pathology. All these cases presented with a right lower quadrant (RLQ) mass or pain of variable duration except one whose mucocele was found incidentally during an operation for gastric cancer. One case revealed curvilinear and mottled calcification outlining a large mucocele on plain film of the abdomen. Abdominal ultrasonography in 7 patients showed negative finding in one case, a hypoechoic or anechoic tubular lesion with good transmission in two, an ovoid cystic lesion with variable internal echoes in dependent portion in two, intussusception in one and a periappendiceal abscess in one. Barium enema of 4 patients showed nonvisualization of the appendix but either filling defects with round smooth shape or external compression to the cecum were found. Fibercolonoscopy was performed in 4 cases, all were disclosed intrusions of mucocele from the appendiceal orifice. In one of them, the mucocele invaginated deeply and caused chronic appendico-cecal intussusception. Computed tomography was performed in one case, the mucocele showed a near-water-density tubular lesion with good enhancement of the wall after contrast injection. Though appendiceal mucocele is a rare clinical entity, it should be in the list of differential diagnosis of RLQ pain. With the disease in mind and advanced imaging modalities available, preoperative diagnosis is probable.
延伸閱讀
- 賴永智、陳振寬、吳啟華、李嘉龍、詹順雄、詹益裕、侯書文（1984）。闌尾粘液囊腫─一例報告。中華民國消化系醫學會雜誌，1(2)，62-66。https://doi.org/10.6557/GJTa.198404_1(2).0003
- Tsai, T. C., Liu, C. T., Kuo, Y. C., Chang, P. C., & Teng, C. L. (1997). 闌尾膀胱癭管－病例報告及文獻回顧. 中華民國泌尿科醫學會雜誌, 8(4), 210-213. https://doi.org/10.7024/JUAROC.199712.0210
- Huang, K. J., Liang, W. Y., Wang, L. C., Jiang, J. K., Lin, H. H., Lin, C. C., Lan, Y. T., Chang, S. C., Yang, S. H., Chen, W. S., Lin, T. C., Lin, J. K., Huang, S. C., Cheng, H. H., & Wang, H. S. (2020). 闌尾之杯狀細胞腺癌－個案報告以及文獻回顧. 中華民國大腸直腸外科醫學會雜誌, 31(4), 286-292. https://doi.org/10.6312/SCRSTW.202012_31(4).10916
- Chang, R. S., Lin, I. L., Chen, P. C., & Wu, J. D. (2010). 闌尾切除後併腹腔內異位性骨化擬腹內睪丸腫瘤：病例報告及文獻回顧. 中華放射線醫學雜誌, 35(1), 67-70. https://www.airitilibrary.com/Article/Detail?DocID=10188940-201003-201006250021-201006250021-67-70
- Wang, K. C., Chen, C. H., Chen, C. Z., Huang, H. Y., You, J. J., Lin, T. C., Chen, H. C., & Huang, T. M. (2012). 闌尾低度惡性黏液瘤—罕見之急性腹痛原因. 中華民國大腸直腸外科醫學會雜誌, 23(4), 183-189. https://doi.org/10.6312/SCRSTW.2012.23(4).10029