十二指肠腺癌89例临床分析

Clinical analysis of primary duodenal adenocarcinoma of 89 cases

目的探讨原发性十二指肠腺癌的诊断和根治术术式选择。方法对1985--2009年经手术切除、病理证实的89例十二指肠腺癌患者的临床资料进行回顾性分析。结果十二指肠腺癌发病率低，临床表现缺乏特异性，术前内镜确诊率为93％，胃肠X线气钡造影为90％，磁共振胰胆管造影为82％，B超为42％，MRI／CT为70％。肿瘤位于十二指肠第2段占65％。48例行胰十二指肠切除，19例行十二指肠节段切除，切除术后患者5年生存率分别为47％和50％。结论内镜和X线气钡双重造影是诊断十二指肠腺癌的主要检查方法。早期诊断和根治手术是提高切除率和疗效的主要途径。

Objective To evaluate the preoperative diagnosis and treatment of primary duodenal adenocarcinoma （PDA）. Methods Clinical data of 89 PDA cases undergoing laparotomy from 1985 to 2009 in three hospital in Beijing and Zhengzhou were analyzed retrospectively. Results The prevalence rate of PDA is comparatively low and its clinical manifestations are not specific. The correct diagnostic rate of auxiliary examination were 93% by endoscopy,90% by gastrointestinal X-ray air barium double radiography, 82% by MRCP,42% by BUS,70% by CT/MRI. The most common location of the adenocarcinoma（65% ） was at the second portion of the duodenum. Among 67 PDA cases 48 cases underwent pancreatoduodenectomy, 19 cases received segmental deodenectomy. The 5 year＇s survival rate was 47% and 50% respectively. Conclusions Endoscope and X-ray radiography are mainstays for the diagnosis of PDA. Early diagnosis and radical operation are the key to improve the resection rate and the long term survival.