十二指肠肿瘤58例外科诊断与治疗

Surgery diagnosis and therapy of 58 cases of duodenal tumor

目的:提高十二指肠肿瘤的诊治水平。方法:对58例十二指肠肿瘤外科诊治的临床资料进行回顾性分析。结果:(1)十二指肠肿瘤位于乳头上方4例,乳头周围50例,乳头下方4例;(2)临床表现随部位不同而不同,乳头上方肿瘤临床表现上腹部疼痛和呕吐,呕吐物胃内容,不含胆汁;乳头周围肿瘤临床表现为梗阻性黄疸,肤目黄染伴不同程度上腹不适和不规则发热,可扪及肿大胆囊;乳头下方肿瘤临床表现上腹疼痛伴呕吐,呕吐物为胃内容含胆汁,或呕血,黑便,可扪及肿块;(3)消化道气钡造影诊断正确率57.14%,B超35.9%,CT70.59%;纤维十二指肠镜为90.48%;(4)病理组织学诊断恶性肿瘤54例,其中十二指肠腺癌51例,包括十二指肠溃疡伴溃疡边缘癌变1例,乳头状腺瘤伴癌和局限性癌变各1例和十二指肠平滑肌肉瘤3例;乳头腺瘤2例;乳头壶腹部溃疡1例和乳头黏膜下腺癌样增生1例;(5)外科手术,胰十二指肠切除术50例,根治性胃十二指肠切除术4例,根治性十二指肠节段性切除术3例,经十二指肠乳头开口处肿瘤局部切除,胰胆管引流术1例;(6)治疗结果:全组均治愈或好转出院,无手术死亡率;随访结果,获随访21例,1年生存率66.67%,3年生存率42.86%,5年生存率33.33%。结论:纤维十二指肠镜检查和活检是诊断十二指肠肿瘤的主要方法;肿瘤部位不同,治疗方法亦异,乳头上方肿瘤以胃十二指肠切除为主,乳头下方肿瘤以十二指肠节段性切除为主,乳头周围肿瘤根据肿瘤生物学特性选择胰十二指肠切除或经十二指肠肿瘤局部切除(TDE)或ESE。

Objective:To improve the diagnosis and therapy of duodenal tumor.Methods:The retrospective analysis was made on the clinical information about the surgical therapy of 58 cases of duodenal tumor.Results:(1) Among them,there were 4 cases with the tumor located above the papilla,50 around the papilla and 4 below the papilla;(2) The clinical syn-dromes differed due to the different locations.The tumors above the papilla had such syndromes as upper abdominal pains and vomiting,but without bile;those around the papilla had the syndromes of obstructive jaundice from skin and eyes accom-panied by the upper abdominal ailment and irregular fever while the enlarged gallbladder was palpable;and those below the papilla had the syndromes of upper abdominal pains and vomiting with bile or blood,and had palpable lumps and black stools;(3) The correctness of diagnosis by way of gastro-intestinal pneumatic barium contrast examination was 57.14%;that of B-mode ultrasonic scope 35.9%;that of CT 70.59%;and that of the fibroptic duodenoscope 90.48%;(4) Diagnosed with patho-histology were 54 cases of malignant tumor(51 cases of the duodenal adenocarcinoma(AC),including 1 case of the duodenal ulcer with cancerous lesions around,1 case of mastoid adeno-tumor with carcinoma,1 case of mastoid adeno-tumor with local cancerous lesions and 3 cases of the duodenal leiomyoscrcoma),2 cases of papillary adenocarcinoma(PAC),1 case of papillary ampullary ulcer and 1 case of papilla submucose AC-like hyperplasia;(5) The surgical operations included 50 cases of the pancreatoduodenectomy,4 cases of the radical gastroduodenotectomy,3 cases of the radical duodenal segmental excision and 1 case of local tumor excision from the opening of duodenal papilla accompanied by pancreas-biliary tract drainage;(6) As for the result of treatment and the recent curing effect,the patients in all groups left the hospital either being cured or better up,with no occurrence of death.As a result of follow-up for 21 cases in total,the rate of survival for 1 year was 6.67%;that for 3 years 42.86%;and that for 5 years 33.3%.Conclusion:The duodenoscopy and the biopsy are the prin-ciple methods for the diagnosis of the duodenal tumor;the therapy varies as the location of the tumor differs in such a way that the gastroduodenotectomy is advisable mainly for the tumor above the papilla,the duodenal segmental excision is for the tumor below the papilla,and either the pancreatoduodenectomy or the local excision of the duodenal tumor is to be the choice for the papilla periphery tumor according to the biological property of the tumor itself.