十二指肠腺癌的诊断与治疗（附38例报告）

Diagnosis and treatment of duodenal adenocarcinoma： a report of 38 cases

目的 探讨十二指肠腺癌的临床诊断和治疗.方法 回顾分析经病理证实的38例十二指肠腺癌的临床表现、诊断、手术及化疗.结果 病理类型为腺癌38例;好发部位为降段（25例）,尤其是乳头区（13例）.诊断手段为纤维胃十二指肠内镜、胃肠钡餐、逆行性胆胰管造影（ERCP）、B超及CT检查.本组行胰十二指肠切除术25例和姑息性手术13例.手术死亡率0.2% （1/38）,术后并发症发生率15.7%（6/38）.胰十二指肠切除术结合术后化疗对Ⅰ～Ⅲ期腺癌治疗效果好,3、5年生存率分别达59.0%和40.9%,姑息性手术无获得长期生存者.结论 十二指肠腺癌,早期临床表现无特异性,主要依据B超、CT和ERCP诊断,对无远处转移的肿瘤应积极争取根治性胰十二指肠切除.晚期肿瘤可行姑息性手术.

Objective To examine the clinical characteristics, diagnosis and treatment of duodenal adenocarcinoma. Methods Clinical data of 38 duodenal adenocarcinoma patients who were admitted to our hospital were analyzed retrospectively. Results All the 38 cases were pathologically confirmed to be adenocarcinomas. The most common site of the tumor was the descending portion（25/38 ）, especially the peripapillary region （13/38）. The most common symptoms and signs were abdominal pain, jaundice, upper gastrointestinal hemorrhage, obstruction, and weight loss. The main adjunct diagnostic tools consisted of gastroduodenoscopy, barium meal, endoscopic retrograde cholangiopancreatography （ERCP） , ultrasound（US） and CT. US or CT together with ERCP was the most useful measure for the diagnosis of peripapilla tumors in the duodenum. Panceraticoduodenectomy and some palliative procedures were performed in 25 and 13 patients respectively. One patient died during the operation. Six patients developed complications after the operation. The 3 - year and 5 - year survival rates in the patients without distant metastasis after the operation were 59.0% and 40.9% respectively. Long term survival failed to be found in the patients who underwent the palliative resections. Conclusion Adenocarcinoma is the most common pathological type of duodenal cancer. No specific symptoms are shown at early stage. US, CT and ERCP are the main diagnostic tests for duodenal adenocarcinoma. Radical pancraticoduodenectomy can prolong survival time and should be adopted for the patients without distant metastasis. Palliative operations may be considered for the patients at advanced stage.