56例原发性十二指肠肿瘤术式选择与分析

Surgical options for primary duodenal tumors:clinical analysis of 56 cases

目的探讨原发性十二指肠肿瘤的手术方式及术式,改进以提高治疗水平。方法 7例原发性十二指肠良性肿瘤中3例行肿瘤局部切除术,2例行标准胰十二指肠切除术,2例行十二指肠节段切除术;49例原发性十二指肠恶性肿瘤中29例行标准胰十二指肠切除术,2例行保留幽门的胰十二指肠切除术;4例行十二指肠节段切除术,3例行局部肿瘤切除术;11例行旁路手术。结果本组患者无手术死亡病例,49例恶性肿瘤中术后并发症5例,并发症发生率10.2%。术后随访时间2～78个月,中位随访时间36个月。7例原发性十二指肠良性肿瘤患者术后5年生存率100%;49例原发性十二指肠恶性肿瘤患者,29例行标准胰十二指肠切除术后患者1、3、5年生存率分别为82.8%(24/29)、58.6%(17/29)、34.5%(10/29);9例行肿瘤局部切除术及十二指肠节段切除术后患者1、3、5年生存率分别为55.6%(5/9)、33.3%(3/9)、11.1%(1/9);11例旁路手术后患者1年生存率为9.1%(1/11),生存时间6～19个月,中位生存时间仅11个月。结论胰十二指肠切除术是原发性十二指肠恶性肿瘤首选术式,良性肿瘤可行肿瘤局部切除术或十二指肠节段切除术,对晚期患者可采用旁路手术以改善预后。

Objective To determine surgical options for primary duodenal tumor （PDT） and to improve the prognosis after PDT. Methodsin 7 patients with primary benign duodenal tumor （PBDT）, 3 underwent simple resection, 2 underwent standard pancreaticoduodenectomy, and 2 received segmental duo- denectomy. Among 49 patients with primary malignant duodenal tumor （PMDT）, 29 were subjected to standard pancreaticoduodenectomy, 2 to pylorus preserving pancreaticoduodenectomy, 4 to segmental duodenectomy, 3 to simple resection, and 11 to bypass operation. Results There was no operative death in the two groups. In the 49 PMDT patients, 5 （ 10.2% ） had postoperative complications. After operation all patients were followed up for 2 -78 months. The 5-year survival rate of the PBDT patients was 100%. The 1-, 3-, 5-year survival rates of the 29 of the 49 PMDT patients, who underwent standard pancreaticoduodenectomy, were 82.8% （24/29）, 58.6% （ 17/29 ） and 34.5% （ 10/29 ） respectively. The 1-, 3-, 5-year survival rates of the 9 patients who underwent simple resection and segmental duodenectomy were 55.6% （5/9）, 33.3% （3/9）and 11.1% （1/9） respectively. The one-year survival rate of the 11 patients who underwent bypass operation was 9.1% （1/11）, with a survival of 6 to 19 months and a median survival of 11 months. Conclusions Pancreaticoduodenectomy is the first-line therapy for PMDT. Simple resection and segmental duodenectomy are suitable for PBTD, and bypass operation is suitable for late-stage patients to improve the prognosis .