原发性十二指肠肿瘤的诊断和治疗

The diagnosis and treatment of primary duodenal tumor

目的 探讨原发性十二指肠肿瘤（PTD）的诊断和术式选择。方法对北京丰台医院1995—2005年间52例PTD的诊断和手术治疗等临床资料进行回顾性分析。结果术前行十二指肠镜检查42例，发现肿瘤38例（90．5％）；行气钡双重造影40例，发现肿瘤32例（80％）。良性肿瘤6例，均行十二指肠切开、肿瘤局部切除，术后5年生存率为100％；恶性肿瘤46例；28例行胰十二指肠切除，4例行十二指肠阶段性切除，13例行旁路手术，1例活检加T管引流，手术切除率为69．6％，切除后5总年生存率为32．6％。结论十二指肠镜和气钡双重造影是诊断PTD的主要检查方法。恶性肿瘤应首选胰十二指肠切除术。良性肿瘤行十二指肠阶段性切除或局部切除效果满意。

Objective To evaluate the preoperative diagnostic procedures and treatment choice of primary tumor of the duodenum （PTD）. Method The clinical data of 52 cases with PTD in the last 10 years was analyzed retrospectively. Results The correct diagnostic rate of auxiliary examination was ： duodenal endoscopy of 90.5% , air barium double radiography of 80%. Six primary benign tumors of duodenum （PBTD） were resected completely with a 5 year＇s survival of 100%. Among the 46 cases of primary malignant tumors of duodenum （PMTD） , 28 cases underwent panereatoduodeneetomy, 4 eases received segmental duodenectomy, the remaining 13 cases in which the tumors were unresectable were treated by bypass. The resection rate was 69.6% and the 5 years＇ survival rate was 32.6%. Conclusions Duodenal endoscopy and air barium double radiography are mainstays for the diagnosis of PTD. Segmental duodenectomy and simple tumor resection are curable for PBTD; while for PMTD, the therapy of choice should be pancreatoduodenectomy.