原发性小肠恶性肿瘤误诊原因分析

Analysis of misdiagnosis of small intestine malignant tumors

目的探讨原发性小肠恶性肿瘤的临床特点及误诊原因。方法回顾性分析1998年以来我院外科诊治的26例原发性小肠恶性肿瘤患者的临床特点及诊断、治疗。结果肿瘤位于十二指肠3例（11．5％），空肠9例（34．6％），回肠14例（53．9％）；病类型腺癌3例，印戎细胞癌2例，平滑肌肉瘤18例，恶性淋巴瘤3例。常见症状为：腹痛、腹部肿块、不明原因肠梗阻和消化道出血。术前误诊或不能明确诊断18例（69．2％）。26例均手术治疗，术后死亡3例。结论原发性小肠恶性肿瘤少见，缺乏特异性症状和体征，误诊率高，对诊断不明确的患者应综合各项检查，必要时尽早行剖腹探查术。治疗应以手术切除为主。

Objective To discuss the causes of misdiagnosis and clinical characteristics of primary malignant tumors of small intestine. Methods The clinical data of 26 cases of primary malignant tumors of small intestine at Anzhen hospital since 1998 were reviewed. Results In this study, 3 cases （ 11.5% ） had tumor location at duodenum, 9 cases （ 34.6% ） at jejunum and 14 cases （ 53.9% ） at ileum. Pathology type includes adenocarcinoma （ 3 cases ）, signetring cell carcinoma （ 3 cases ）, leiomyosarcoma （ 18 cases ）, and malignant lymphoma （3 cases）. The common clinical features were abdominal pain, abdomen mass, intestinal obstruction and gastrointestinal hemorrhage. Preoperative misdiagnosis occurred in 18 cases （69. 2% ）. 26 cases （100%） underwent operation, among which 3 cases （ 11.5% ） died after operation. Conclusion Primary malignant tumors of the small intestine is uncommon. The preoperative misdiagnosis rate is high due to absence of typical clinical features. For patients with uncertain diagnosis, comprehensive examinations should be done, including exploratory laparotomy when necessary. Meanwhile the main therapy is still surgery.