原发性十二指肠恶性肿瘤的诊断和外科治疗

Diagnosis and Surgical Treatment of Primary Duodenal Malignant Tumors

目的:探讨原发性十二指肠恶性肿瘤的诊断及治疗方法。方法:回顾分析79例原发性十二指肠恶性肿瘤患者的资料,通过内镜及影像学检查获得诊断,行根治切除手术60例,旁路手术19例。结果:各种检查方法的准确率:十二指肠镜93.0%,上消化道造影88.0%,CT59.5%。根治手术组和姑息手术组的中位生存期分别为2.32年、0.57年,根治术后辅助化疗组中位生存期为3.35年。统计学分析显示单纯根治组与根治化疗组生存期存在显著差异。结论:十二指肠肿瘤缺乏临床特异性,联合内镜及影像学检查可以提高术前诊断率。治疗以胰十二指肠切除和局部根治性十二指肠段切除术为主,姑息的捷径手术可改善生活质量,辅助化疗可能延长术后生存期。

Objective To evaluate the diagnostic and therapeutic methods of primary malignant tumor of the duodenum （PMTD）. Methods Clinical data of 79 patients with primary duodenal tumor hospitalized were analyzed retrospectively. Endoscopy and imaging study were used for preoperative diagnosis. Sixty patients received pancreaticoduodenectomy, while 19 patients received variant bypass procedures. Results The preoperative diagnosis accuracy of variant investigations were： duodenal endoscopy 93.3%, upper alimentary tract radiography 88.0%, and CT 59.5%. Median survival periods were 2.32 years and 0.57 year respectively for radical operation group and palliative operation group, 3.1 years achieved in groups with adjuvant therapy after radical resection. There were no significant differences of the survival periods between groups with adjuvant therapy after radical resection and radical resection. Conclusions Patients with PMTD are usually lack of specific symptoms and signs, proper adoption of endoscopic and radiological studies are favorable for preoperative diagnosis. Curative methods such as pancreaticoduodenectomy or radical segmental duodenal resection remain the principal treatment, and palliative operation may improve the quality of life. Meanwhile, chemotherapy may extend the survival periods postoperatively.