十二指肠乳头癌的诊断与外科治疗:附48例报告

Diagnosis and surgical treatment of carcinoma of duodenal papilla :a report of 48 cases

目的 探讨十二指肠乳头癌的诊断及治疗效果。方法 回顾分析收治的 48例十二指肠乳头癌患者的临床资料。黄疸 43例 ,上腹疼痛 2 3例 ,皮肤瘙痒 12例 ,其他症状 7例。B超、CT及ERCP检查确诊率分别为 3 9.6% ,5 0 .0 %和 93 .3 %。 3 9例行胰十二指肠切除术 (其中 1例为保留幽门术式 ) ,5例行胆肠和 /或胃肠吻合术 ,1例行肿瘤局部切除 ,3例确诊后自动出院。结果 随诊 3 6例。胰十二指肠切除术后生存期超过 1a者占 66.7% ( 2 4/3 6) ,超过 3a者 3 0 .6% ( 11/3 6)。胰十二指肠切除术 8例中有 2例术后 7年至今仍存活。 3例放弃手术治疗者无 1例生存期超过 1a。行胆肠和 /或胃肠吻合术中仅有 1例生存期超过 1a。结论 ERCP加活检是该病的主要诊断手段 。

Objective To study the results of diagnosis and treatment of duodenal papilla carcinoma. Methods The clinical data of 48 cases of duodenal papilla carcinoma admitted and treated in our hospital during a 7-year period were analyzed retrospectively. The main clinical symptoms included jaundice(43 cases), upper abdominal pain(23 cases), pruritus of skin(12 cases) and other symploms (7cases). The diagnosis accuracy rate of B ultrasound, CT, and ERCP examination were 39.6%, 50.0% and 93.3% respectively. Pancreaticoduodenectomy was performed in 39 cases. (of these, 1 case underwent pylorus-preserving procedure), 5 cases underwent cholecystojejunostomy and/or gastroenterostomy, and 3 were willfully discharged after diagnosis.Results Thirty-six patients were followed up.Survival beyond 1 year and beyond 2 years afer pancreaticoduodeneoctomy were 66.7% and 30.6% (respectively), and 2 cases among 8 cases of 7-year survivors are alive now. But the 3 discharged patients who refused operations lived less than 1 year; and only 1 patient among those who underwent cholecystojejunostomy and/or (gastroenterostomy) lived more than 1 year. Conclusions ERCP plus biopsy are the primary means of diagnosis, and radical resection is the main treatment modality for duodenal papilla carcinoma.