原发性小肠肿瘤的诊断

THE DIAGNOSE OF PRIMARY SMALL INTESTINE NEOPLASM

为探讨如何提高对原发性小肠肿瘤的诊断水平 ,对我院 6 4例经手术和病理证实的原发性小肠肿瘤进行了回顾性分析。结果 :术前确诊 34例 ,确诊率为 5 3.1% ;误诊 30例 ,误诊率为 40 .9%。经手术及病理证实 ,良性 2 2例 ,恶性 42例 ,良恶性比为 1∶1.9。良性肿瘤以腺瘤、平滑肌瘤、脂肪瘤及胆管瘤多见 ,恶性肿瘤以腺癌、恶性淋巴瘤和平滑肌肉瘤多见。良性多位于空回肠 ,恶性腺癌多位于十二指肠 ,恶性淋巴瘤和肉瘤多位于空回肠。诊断方法主要依靠小肠插管气钡造影、纤维内镜、B超、CT和肠系膜上动脉造影检查。结论 :小肠肿瘤术前诊断困难 ,因此 ,有针对性地进行辅助检查可提高诊断阳性率 ;小肠分段造影可作为小肠肿瘤的常规检查 ;纤维内镜对十二指肠和近段空肠的阳性率高 ;肠系膜上动脉造影对血管瘤和平滑肌瘤的诊断阳性率高。

To improve the diagnosis of primary small intestine tumor, a retrospective analysis was made of 64 cases of primary malignant small intestine tumors confirmed by pathological examination in 309th Hospital of PLA. Results: The confirmed diagnosis rate was 53.1%(34 cases) and the misdiagosis rate was 40.9%(30 cases).22 were cases of benign tumors and 42 were cases of malignant tumors.Adenoma, leiomyoma, adipoma and bile duct adenoma predominated among the primary small intestine neoplasm. Then, adenocarcinoid lymphoma and leiomyoma were common among the primary malignant small intestine neoplasms. The carcinoid neoplasm was located often in jejunum and ileum, the adenocarcinoma often in duodenal,and the lynphoma and leiomyoma in the jejunum and ileum. The diagnosis was made mainly by contast examination of small bowel,endoscopy,B-ultrasonic,CT and superior mesenteric arteriography. Conclusion: The diagnosis of primary small intestine neoplasm is difficulty. Contrast examination of small bowel is helpful. Endoscopy is the best way to find out the tumor located in duodenum and jejunum, and superior mesenteric arteriography is the best way to find out angioma and leiomyoma.