十二指肠乳头占位病变26例临床诊疗分析

Diagnosis and Treatment of 26 Patients with Occupying Lesion in Duodenal Papilla

目的探讨十二指肠乳头癌的临床诊断特点,提高对十二指肠乳头癌的认识及诊断水平,做到早期诊疗.方法回顾性分析26例十二指肠乳头占位疾病者的临床资料,总结诊疗经验.结果十二指肠乳头占位以腺癌最常见,占88.5%(22/26)其次为乳头腺瘤,占11.5%(3/26).首发症状以黄疸最常见,为76.9%(20/26),其次为腹痛,占26.9%(7/26);B超、CT和MRCP检查可发现胆管扩张,有助诊断,ERCP可明确肿瘤的具体位置和形态.腺瘤行乳头切除成形或Whipple术式者远期生存良好,腺癌行Whipple术式者1 a生存率为55.6%,放弃手术者或姑息性胆肠吻合者1 a生存率为0.结论十二指肠占位早期诊断困难,乳头切除成形是治疗腺瘤的首选方式,Whipple术式是腺癌的首选方式;重视胆道疾病影像检查是早期发现十二指肠乳头占位病变的有效方法.

Objective To the explore the clinical characteristics of duodenal papilla cancer,so as to improve the diagnostic levels and make early diagnosis for duodenal papilla cancer.Methods The clinical data of the 26 patients with occupying lesion in duodenal papilla were analyzed retrospectively in order to summarize the clinical characteristics and diagnosis and treatment experiences of occupying lesion in duodenal papilla.Results Adenocarcinoma was the most common tumor in occupying lesion in duodenal papilla,accounting for 88.5%（22/26）,followed by adenoma,accounting for11.5%（3/26）.Obstructive jaundice was the most common symptom,accounting for 76.9%（20/26）,followed by abdominal pain,accounting for 26.9%（7/26）.B ultrasonic diagnostic equipment,CT,MRCP and ERCP can be used to find the occupying lesion,while ERCP was the most sensitive ways.The rate of one years survival rate was 55.6% for patients with adenocarcinoma who were treated with Whioole＇s operation,and the rate was 0 for patients who gived up treatment or treated with choledochojejunostomy,while the rate for patients with adenoma was 100%.Conclusions It is very difficult to early diagnose occupying lesion in duodenal papilla.Papilla tectomy and plasty is first choice for adenoma,and Whiplle＇s operation is the first choice for adenocarcinoma.Imaging examination for biliary tract diseases maybe the most effective way to early find occupying lesion in duodenal papilla.