原发性十二指肠癌的治疗问题

TREATMENT OF PRIMARY CARCINOMA OF DUODENUM

目的 提高对原发性十二指肠癌治疗的认识水平。方法 回顾我院 1987年以来收治的 4 5例原发性十二指肠癌的临床资料。结果 乳头周围区癌 6 4 .4 % (2 9/ 4 5 ) ,乳头下部癌占 2 2 .2 % (10 / 4 5 ) ,乳头上部癌占 13.3% (6 / 4 5 )。纤维十二指肠镜的确诊率为 71.4 % (15 / 2 1)。胰十二指肠切除术 2 2例 ,节段性肠切除术 2例 ,单纯癌肿切除术 3例 ,胃肠、胆肠吻合术 12例 ,剖腹探查术 4例 ,手术切除率为 6 2 .8% (2 7/ 4 3)。结论 对于早期可疑高危病人 ,应行纤维十二指肠镜检查 ,以提高手术切除率。胰十二指肠切除术为首选术式 ,节段性肠切除术和单纯癌肿切除术根据具体情况可酌情应用。

Objective To improve the treatment of primary duodenal carcinoma.Methods The records of 45 patients with primary carcinoma of duodenum from 1987 were analysed retrospectively.Results According to the site of cancer,tumors around below and above the duodenal papilla accounted for 64.4%(29/45),22.2%(10/45) and 13.3%(6/45) respectively.The diagnosis rate of fiberduodenoscopy was 71.4%(15/21).22 cases underwent pancreatoduodenectomy,2 cases underwent segmental duodenectomy,3 cases underwent simple tumor resection,12 cases underwent gastroenterostomy or choledochjejunostomy and 4 cases only underwent exploratory laparotomy.The rate of tumor excision was 62.8%(27/43).Conclusion Fiberduodenoscopy s suitable for the suspected patients with risk factors.The mainly surgical procedure of primary duodenal carcinoma is pancreatoduodenectomy,while segmental duodenectomy and simple tumor resection are applied by taking the circumstances into consideration.