十二指肠乳头癌的诊断与外科治疗

Diagnosis and surgical treatment of duodenal papilla carcinoma

目的探讨十二指肠乳头癌的早期诊断及治疗。方法回顾性分析1 0年间收治的7 1例经手术及病理证实的十二指肠乳头癌患者的临床资料。结果十二指肠乳头癌主要以进行性无痛性黄疸(5 7例)、上腹部隐痛(1 0例)及上消化道出血(4例)为首发临床表现。术前纤维十二指肠镜确诊率为9 6.8%,逆行性胆胰管造影(ERCP)阳性率为1 0 0.0%,磁共振胰胆管显像(MRCP)为83.3%,B超为8 5.9%,CT为7 2.3%。4 6例行胰十二指肠切除术(Whipple术),2 2例行十二指肠乳头癌局部切除术,3例行姑息性胆肠吻合术。Whipple术及局部切除术术后的3年生存率分别为4 3.9%和4 4.4%;5年生存率分别为3 1.7%和3 3.3%。结论纤维十二指肠镜检查和ERCP,MRCP是诊断十二指肠乳头癌的有效方法,早期诊断、早期选择合理的根治性切除手术是治疗的关键。

Objeclive To investigate the early diagnosis and treatment of duodenal papilla carcinoma. Methods The clinical data of 71 patients with duodenal papilla carcinoma were analyzed retrospectively. Results Painless jaundice （57 cases ） , discomfort of upper abdomen （ 10 cases ） and hemorrhage of upper digestive tract （4 cases ） were the initial main clinical symptoms. The correct diagnostic rate for preoperative examinations were： ERCP in 100% , duodenoendoscopy in 96.8% , MRCP in 83.3% , BUS in 85.9% and CT in 72. 3 % of cases. Forty-six cases underwent pancreatoduodenectomy, 22 cases received local resection, and the remaining 3 cases were treated by palliative surgery. The 3-year survival rate of Whipple operation and local resection was 43.9% and 44.4% respectively, and the 5-year survival rate was 31.7% and 33. 3% respectively. Conclusions Duodenoendoscopy, ERCP and MRCP are the major effective diagnostic methods for duodenal papilla carcinoma. Early diagnosis and early selection of rational radical operation are essential for successul treatment of this condition.