十二指肠球部癌临床观察(附11例报告)

The clinical characteristics of the malignant tumor of theduodenal bulb

[目的]分析十二指肠球部癌的内镜及临床特点,以提高对十二指肠癌的认识和早期诊断率。[方法]回顾性分析河南宏力医院2007年1月1日至2012年12月31日经病理确诊为十二指肠球部癌11例患者的临床资料。[结果]首发症状表现为腹痛6例,反酸3例,黑便2例。肿瘤位于十二指肠球部前壁3例,小弯侧4例,后壁2例,弥漫型2例。病理类型腺癌9例,黏液细胞癌1例,鳞状细胞癌1例。11例患者全部经组织学检查确诊。血液肿瘤标志物癌胚抗原(CEA)检查10例,其中升高8(占72.72%),正常2例。6例患者具有典型的上消化道并发症,分别是食管癌术后复发、食管静脉曲张(重度)、食管高级别上皮内瘤变、胃角癌、贲门癌术后复发、反流性食管炎(LA-D级)。治疗方式:外科手术治疗7例,内科化疗2例,保守治疗2例。[结论]十二指肠球部癌的首发症状多为腹痛,病变主要位于前壁及小弯侧,病理类型以腺癌为主,血肿瘤标志物CEA多升高,部分病例并发严重上消化道疾病,治疗方式主要为外科手术。总之,提高对十二指肠球部癌的全面认识,重视上消化道内镜检查及组织学检查,以便提高其诊断率。

[Objective]To analyze the endoscopic and clinical characteristics of the malignant tumor of the duodenal bulb and to improve the diagnosis and treatment.[Methods]The clinical data of eleven cases who suffered from the malignant tumor of the duodenal bulb confirmed by pathology in Henan Honliv Hospital from January 2007 to December 2012 were studied retrospectively.[Results]The primary symptoms of duodenal bulb tumors were abdominal pain in 6 cases,sour regurgitation in 3 cases,and melena in 2 cases.Three of them were located in the antetheca of the duodenal bulb,four were in the lesser curvature side and two in backwall.Two were diffuse type.For the classifications of pathology,nine were adenocarcinoma,one was mucinous cell carcinoma and one was squamous cell carcinoma.CEA,one of tumor markers was detected in 10 cases.It increased in eight cases and remained normal in 2 cases.Six patients showed typical complications of upper gastrointestinal tract,which were recurrence after the operation of esophageal carcinoma,severe esophageal pile,angle of stomach cancer,recurrence after resection of cardiac carcinoma,and reflux esophagitis（LA-D grade）.Seven cases underwent surgical treatment,two cases underwent chemotherapy and two cases received conservative medical management.[Conclusion]The common clinical symptoms were abdominal pain.Most of tumors were located in the antetheca and lesser curvature side of duodenal bulb.Adenocarcinomas were major pathological type.Surgical treatment was the main method to manage the tumors.The esophagogastroduodenoscopy and pathology will help the clinicians to to make early diagnosis of the maligment tumors of the duodenum bulb.