原发性十二指肠恶性肿瘤81例诊治分析

Diagnosis and treatment of primary duodenal malignant tumor:analysis of 81 cases

目的探讨原发性十二指肠恶性肿瘤的诊断和治疗选择。方法回顾性分析我院1996～2004年收治的81例原发性十二指肠恶性肿瘤的临床资料。结果本组常见临床表现有上腹隐痛不适、黄疸及上消化道出血等。各种检查方法的诊断正确率分别为：纤维十二指肠镜84．6％（11／13）、上消化道气钡造影80％（16／20）、CT35．1％（13／37）、MRCP46．7％（14／30）。行手术治疗75例，胰十二指肠切除术63例，局部根治性十二指肠肠段切除3例，十二指肠球部及胃窦部切除术1例，肿瘤局部切除1例，胆肠内引流或／和胃空肠吻合5例，胆总管外引流2例，6例放弃手术自动出院。56例病人得到随访，行胰十二指肠切除术后1年、3年和5年生存率分别为78．7％、34．1％和26．8％。行节段性肠切除术2例1年内复发死亡，1例存活2年5个月。局部切除1例术后复发转移1年6个月死亡。内引流、外引流患者均于术后1年内死亡。结论原发性十二指肠恶性肿瘤的临床表现多样，早期诊断困难，纤维十二指肠镜和十二指肠低张造影是主要的检查方法。根治性胰十二指肠切除术是改善预后的关键。

Aim To investigate the diagnosis and treatment of primary malignant tumor of the duodenum （PMTD）. Metheds The most common clinical manifestations were abdominal pain, jaundice and gastrointestinal haemorrhage, etc. The clinical data of 81 cases with PMTD from 1996 -2004 were analyzed retrospectively. Result The correct diagnostic rate of auxiliary examination were：Duodenoscopy of 84.6% （ 11/13 ） , air barium double radiography of 80% （ 16/20 ） , CT of 35.1% （ 13/37 ） , MRCP of 46.7% （ 14/30 ）. 75 cases were operated, 63 cases underwent pancreastoduodenectomy, 3 cases received segmental duodenectomy, 1 case underwent local resection for duodenal carcinoma, 5 cases were subjected to cholecystojejunostomy and/or gastroenterostomy, 6 cases refused operation. 56 cases were followed up. The survival rate of 1-year, 3-year and 5-year after pancreastoduodenectomy were 78.7%, 34.1% and 26.8% respectively. 2 cases with segmental duodenectomy recurred and died in 1 year, and in the meantime, 1 case survived for 2 years and 5 months. 1 case with local resection for duodenal carcinoma recurred and died after 1 and half years, all patients with cholecystojejunostomy and/or gastroenterostomy died in l year. Conclusion The clinical manifestations of duodenal neoplasms vary,so it is difficult to diagnose in the early. Duodenoscopy and hypotonic duodenography are good diagnostic approaches. Pancreaticoduodenectom is crux to improve prognosis.