原发性小肠恶性肿瘤的诊治

Diagnosis and Treatment of Primary Small Intestinal Tumor

目的 探讨原发性小肠恶性肿瘤的诊断与治疗。方法 对我院 1990年 1月至 2 0 0 3年 1月收治的88例原发性小肠恶性肿瘤的临床资料进行回顾性分析。结果 术前确诊 36例 ,误诊 5 2例 ,误诊率为 5 9.1%。主要临床表现为腹痛 6 6例 (75 .0 % )、肠梗阻 5 6例 (6 3.6 % )、腹部肿块 5 1例 (5 8.0 % )及大便隐血或便血 4 8例(5 4 .5 % )。病理类型 :腺癌 4 9例 (5 5 .7% ) ,平滑肌肉瘤 2 2例 (2 5 .0 % ) ,淋巴瘤 12例 (13.6 % ) ,脂肪肉瘤 5例 (5 .7% )。病变部位依次为 :空肠 36例 (40 .9% ) ,回肠 34例 (38.6 % ) ,十二指肠 18例 (2 0 .5 % )。结论 原发性小肠恶性肿瘤术前诊断困难 ,误诊率高。为减少误诊 ,提高治愈率 :①要提高对原发性小肠恶性肿瘤的高度警惕性 ,全面掌握和分析临床资料 ;②对 4 0岁以上有不明原因的腹痛、消瘦、贫血、消化吸收功能紊乱、腹部肿块等的患者 ,进行有针对性的辅助检查 ,如胃肠道气钡双重造影、纤维内窥镜、B超、CT和肠系膜上动脉造影等 ,可提高原发性小肠恶性肿瘤的检出率 ;③不能排除小肠恶性肿瘤时 ,应及时剖腹探查 ,以免延误诊断治疗 ;④治疗以手术切除为主 ,术后辅助化疗 ,可改善预后。

Objective To investigate the diagnosis and treatment of primary small intestinal tumor (PSIT). Methods Eighty-eight cases of PSIT were analyzed in our hospital retrospectively. Results Thirty-six cases were diagnosed before operation, 52 cases were misdiagnosed and the percentage amounted to 59.1%. The major clinical manifestations of PSIT were abdominal pain (66 cases, 75.0%), obstruction (56 cases, 63.6%), abdominal mass (51 cases, 58.0%) and stool with blood (48 cases, 54.5%).The major pathological types of PSIT were adenocarcinoma (55.7%), sarcoma of smooth muscle (25.0%), lymphoma (13.6%), fatty sarcoma (5.7%). The tumors of 36 cases located in jejunum (40.9%), 34 cases in ileum (38.6%) and 18 cases in duodenum (20.5%).Conclusion It is difficult to diagnose PSIT before operation. The following advice could help to get a correct diagnosis: ① Surgeons should be alert when meeting a patient with the above symptoms, and then collect and analyze the clinical data comprehensively. ②Patients over 40 years with complaints of inexplicable abdominal pain, weight loss, anemia, dyspepsia and abdominal mass should be examined appropriately by gastrointestinal X-ray, gastrointestinal endoscopy, ultrasonography, CT and angiography of superior mesenteric artery. ③When the diagnosis can’t be confirmed, an exploratory operation should be performed immediately to avoid the delay of treatment. ④The treatment of PSIT includes radical resection of small intestine and chemotherapy according to the pathological results of tumor.