原发性十二指肠肿瘤77例诊治分析

Diagnosis and Treatment of Primary Duodenal Tumor:A Report of 77 Cases

目的:总结原发性十二指肠肿瘤的病理类型、临床特征及诊治经验。方法:回顾性分析2002年1月至2010年1月间收治的原发性十二指肠肿瘤77例患者的临床病理资料。结果:77例患者中良性肿瘤7例,恶性肿瘤70例,良恶比为1:10。常见的症状为腹痛(80.52%)和体重减轻(55.84%);病理类型包括:腺癌56例(72.73%);恶性胃肠道间质瘤8例(10.38%);腺瘤5例(6.49%)、恶性淋巴瘤3例(3.90%)。肿瘤位于十二指肠球部6例(7.79%)、降部65例(84.42%)、水平部5例(6.49%)、升部1例(1.30%)。术前纤维内镜确诊率为84.62%,上消化道钡餐检出率为92.16%,CT检出率为85.11%,B超检出率50.75%。7例良性肿瘤患者中,6例行手术治疗;70例恶性肿瘤患者中,根治切除率与未手术率均为34.29%,捷径手术占22.86%,姑息手术占8.57%。结论:原发性十二指肠肿瘤以降部最多见,以腺癌为主。临床上无特定症状,全面细致的内镜检查,结合上消化道钡餐、CT和其他检查可提高早期诊断率和术前定位的准确率。

Objective： To summarize the pathological classification, clinical symptom and experience in the diagnosis and treatment of primary duodenal tumor（PDT）. Methods： The clinical data of 77 patients with primary duodenal tumor pathologically confirmed from 2002 to 2010 were analyzed retrospectively. Results： There were 7 benign and 70 malignant duodenal tumors in this series with a ratio of 1： 10. Common clinical manifestations included upper abdominal pain （80. 52% ） and weight loss （55.84%）. The major pathologic types were adenocarcinomas （72. 73% ）, stromal tumor （ 10. 38% ）, adenoma （6. 49% ） and malignant lymphomas （3.90%）. Lesion located in the superior portion of duodenum in 6 cases （ 7. 79% ）, in the descending portion in 65 cases （84.42%）, in the horizontal portion in 5 case （6. 49% ） and in the ascending portion in 1 case （ 1.30% ）. 84. 62% of the cases were correctly diagnosed by endoscopy, 92. 16% by upper gastrointestinal barium meal examination, 85.11% by CT and 50.75 % by BUS. Among the 7 benign PDT cases, 6 cases underwent operation therapy. Among the malignant PTD cases, radical dissection was performed in 34. 29%, gut by-pass operation therapy in 22. 86% , and palliative operation therapy in 8.57%. 34. 29% did not accept surgical treatment. Conclusion： Tumors located in the descending portion of duodenum account for the majority of PDT and mainly are adenocarcinoma. Patients with PTD usually lack specific clinical manifestations, but the combination of endoscopy , upper gastrointestinal barium meal examination, CT and other examinations can improve the early diagnosis rate and preoperative positive diagnosis rate.