十二指肠良性肿瘤的诊治体会(附26例报告)

Experience in diagnosis and treatment of benign tumor of duodenum:Report of 26 cases

目的 探讨十二指肠良性肿瘤的临床表现、病理学特征、诊断和治疗方法。方法 对我 院收治的经病理证实的26例十二指肠良性肿瘤病人的临床资料进行回顾分析并进行随访。结果 本组病例息肉样腺瘤9例,间质瘤5例,管状腺瘤5例,管状绒毛状腺瘤2例,异位胰腺、胰岛细胞瘤、 神经鞘瘤、胃泌素瘤、血管瘤各1例。内镜检查发现17例,上消化道钡气双重对比X线造影检查发现 4例,数字减影血管造影(DSA)检查发现3例,因腹部包块行剖腹探查发现2例。9例病人在内镜下 行肿瘤切除术,7例行肿瘤局部切除术,5例行肿瘤局部切除加括约肌成形术,4例行胰十二指肠切除 术,1例行肿瘤切除加胃大部切除术。随访6个月～10年,除1例局部肿瘤切除术后复发并癌变、2 例死于非相关恶性肿瘤、2例失访外,其余病人生活质量良好。结论 十二指肠良性肿瘤临床症状不 典型,术前确诊困难。反复腹痛和黑便是十二指肠良性肿瘤最常见的症状,内镜检查和X线造影是 主要的诊断手段,内镜下切除或手术治疗是十二指肠良性肿瘤的首选治疗方法。十二指肠良性肿瘤 预后良好。

Objective To investigate the clinical manifestations, histopathological patterns and effective diagnostic methods of benign duodenal tumor.Methods The data of 26 patients with benign of duodenal tumor confirmed pathologically in our unite were analyzed retrospectively, and their prognosis was followed up. Of the 26 patients, there were 9 cases of Brunner's gland adenoma, 5 leiomyoma, 5 tubular adenoma, 2 tubulovillous adenoma, 1 gastrinoma, 1 hemangioma, 1 neurilemmoma, 1 ectopic pancreas, 1 islet cell tumor. Seventeen patients were diagnosed by gastroduodenoscopy, 4 by upper gastrointestinal tract barium X ray examination, 3 by digital subtraction angiography and 2 by abdominal exploration. Nine patients were subjected to tumor resection by gastroduodenoscopy, 7 to underwent tumor resection, 5 to tumors resection and sphincteroplasty, 4 to pancreaticoduodenoctomy, 1 to Billrith I gastrectomy. During a follow-up of 6 mouths to 10 years, all patients had a rather better living quality except one patients had tumor canceration 8 months after operation, 2 patients died from other irrelative malignant tumors and 2 patients failed to follow-up.Conclusion The clinical symptoms of the patients with benign duodenal tumors were nonspecific and the preoperative diagnosis was difficult. Abdominal pain and melena are the main symptoms of the patients with benign duodenal tumor. Gastroduodenoscopy and upper gastrointestinal tract X ray examination are major methods for diagnosis of this disease. The best treatment of benign duodenal tumors is to resect the tumor, and these patients usually have a satisfactory prognosis.