原发性十二指肠肿瘤37例临床分析

Clinical analysis of 37 cases of primary duodenal tumor

目的探讨原发性十二指肠肿瘤(PDT)的临床表现、病理特征和诊断方法,总结经验,以减少误诊。方法回顾分析我院2005年1月-2010年12月收治的37例PDT的临床资料。结果本组病例常见症状表现为上腹痛、黄疸、发热、呕吐、消化道出血、纳差、消瘦等。肿瘤好发部位以十二指肠降部尤其是乳头周围居多,占62.1%,病理以腺癌为主,占64.9%。各种检查方法确诊率分别是胃镜44.0%、GI 40.0%、CT 56.3%、MRI+MRCP 41.7%、B超16.0%、ERCP 66.7%、超声内镜100%。29例行手术联合化疗,5例化疗加ERCP支架术,2例动脉血管造影下止血、化疗。结论 PDT以恶性肿瘤为主,早期症状隐匿,误诊率高,诊断首选内镜检查,联合GI、CT等检查可提高检出率,超声内镜对黏膜下肿瘤诊断价值高,胰、十二指肠切除是主要治疗手段。

Objective To discuss the clinical, pathologic characteristics and diagnostic method of primary duodenal tumor （PDT） , and to summarize the experiences and decrease diagnostic errors. Methods 37 cases of PDT patients from Jun. 2005 to Dec. 2010 at Shanghai First People＇ s Hospital were enrolled. Results The common symptoms of these cases were upper abdominal pain, jaundice, fever, vomiting, alimentary tract hemorrhage, eating decrease and e- maciated etc. The predilection site of PDT was always at descendant duodenum, especially ambient of duodenal papilla, the percentage was 62.1%. Most of the pathology of PDT was adenocarcinoma, the percentage was 64.9%. The final diagnosis rates of different methods were gastroscope 44% , GI 40% , CT 56.3% , MRI ＋ MRCP 41.7% , type-B ultra- sonic 16.0% , ERCP 66.7% , ultrasonic endoscope 100%. 29 cases had operation combination chemotherapy, 5 cases chemotherapy combination ERCP stenting, 2 cases hemostasis and chemotherapy by angiography. Conclusion The ma- jority of PDT are malignant, the symptoms of PDT are delitescence in early time. The rate of misdiagnosis is high. The diagnosis prefers endoscopy, including gastroscope, ERCP etc. It can improve detection rates when we combine with GI and CT scan. The diagnostic value of submucous tumor is high by ultrasonic endoscope. The main treatment of PDT is pancreaticoduodenectomy.