原发性十二指肠癌病理观察与临床相关问题的探讨

Pathology of Primary Duodenal Cancer and Its Related Clinical Problems

目的 :了解原发性十二指肠癌的病理学特征及其与临床相关问题的关系。方法 :选取 1983～ 1997年间 39例经内窥镜活检 ,手术探查和手术后病理证实的原发性十二指肠癌进行病理观察 ,研究和分析病理学特征与临床表现 ,诊断及手术方法的关系。结果 :原发性十二指肠癌发生部位 :乳头上部 15 .4% (6 /39) ,乳头下部 12 .8% (5 /39) ,乳头周部 71.8% (2 8/39)。病理类型 :息肉菜花型 71.8% (2 8/39) ,溃疡浸润型 2 5 .6 % (10 /39) ,缩窄型 2 .6 % (1/39)。组织学 :乳头管状腺癌 76 .9% (30 /39) ,低分化腺癌 12 .8% (5 /39) ,粘液腺癌 5 .1% (2 /39) ,类癌 5 .1% (2 /39)。转移情况 :胰头直接浸润 37.8% (14/37) ,肝转移 18.9% (7/37) ,胰头十二指肠周围淋巴结和肠系膜腹主动脉旁淋巴结转移分别是 2 4.3% (9/37)和 18.9% (7/37) ,总转移率 5 6 .5 %。结论 :原发性十二指肠癌好发于乳头周部且以息肉菜花型多见 ,组织学主要是乳头管状腺癌。癌肿的转移部位与病理类型、组织学类型、癌肿发生的部位无关。临床表现与癌肿部位和病理类型密切相关。治疗方法以胰十二指肠切除术为主 ,其它术式在不同情况下也可酌情应用。

Purpose: To study the relationship between the pathological features of primary duodenal cancer and its associated clinical problems. Methods: The pathologic features of 39 primary duodenal cancers confirmed by endoscopic biopsy [KG(7”:*9]and postoperative histological examination, and its associated clinical manifestations, diagnosis and surgical procedures were studied. Results: According to the site of cancer, tumors above, around and below the duodenal papilla accounted for 15 4%, 71 8%and 12 8%respectively The pathological types of the tumor were polypoid (71 8%), ulcerative or invasive (25 6%) and stenotic (2 6%). The histological types were papillo-glandular 76 9%, mucoid 5 1%, poorly differentiated 12 8%and carcinoid 5 1%. Metastasis was noted in head of pancreas in 37 8%, liver in 18 9%, lymph nodes around pancreatico-duodenum in 24 3%, mesentery and abdominal aorta in 18 9%with an overall metastatic rate of 56 5%. Conclusion: The primary duodenal cancers mainly occur around duodenal papilla and most of the cancers are polypoid or cauliflower types. Histologically it is usually papillary glandular adenocarcinoma. The metastasis and the site of metastasis is not related with the pathological, histological types and the site of tumor. The clinical picture is closely related with the site and gross types of the tumor. The primary duodenal cancer is mainly treated by radical pancreaticoduodenectomy.