十二指肠间质瘤的临床病理特点与外科治疗的研究

Clinical features and surgical management of duodenal stromal tumors

目的探讨十二指肠间质瘤的临床病理学特点和外科治疗方法。方法回顾性分析1995年1月至2004年12月收治的23例十二指肠间质瘤的临床资料。结果黑便和腹痛是本组患者的主要临床症状。行胰十二指肠切除术13例,其中4例合并右半结肠切除术,1例合并右肝转移灶切除,2例合并右肝脓肿引流术;行保留幽门的胰十二指肠切除术3例;行肿瘤局部切除术7例。肿块大小平均(6．6±4．8)cm:小于5 cm者10例,为潜在恶性的交界性肿瘤;5-10 cm者7例,大于10 cm者6例,均为恶性间质瘤。除1例术后1年死于肝转移外,其余病例已健康存活2个月-9年。结论十二指肠间质瘤是一种低度恶性肿瘤。首选积极的手术切除治疗,肿瘤完全切除者预后良好。

Objective To investigate clinicopathological features ,diagnosis and surgical treatment of duodenal stromal tumors. Methods A retrospective clinical analysis was made in 23 cases of duodenal stromal tumors admitted from 1995 to 2004. Results Melena and abdominal pain was the most common presenting symptom. Complete resection was achieved in all cases, including pancreatoduodenectomy in 13 cases, by pylorus-preserving pancreatoduodenectomy in 3 cases, and tumor enucleation in 7 cases. The mean size of the tumor was 6.6cm （2 -21 cm）, among them 〈Scm diameter in 10 cases, 5-10cm in 7 and 〉 10 cm in 6. Pathologically tumors less than 5 cm were all of potential malignancy, whereas those larger than 5 cm were malignant. Follow-up of 2 months to 9 years found all cases alive and healthy except for one who died of liver metastasis one year postoperatively. Conclusion Duodenal stromal tumors were low malignancy tumors. Aggressive surgery is the choice of treatment. Favorable prognosis is expected after complete surgical excision.