原发性小肠腺癌31例临床分析

Clinical analysis of primary small bowel adenocarcinoma in 31 cases

目的：分析原发性小肠腺癌（primary small bowel adenocarcinoma,PSBA）的临床表现、诊断治疗及预后因素。方法：回顾性分析31例PSBA患者的临床资料并进行生存分析。结果：31例患者中男性17例,女性14例,中位发病年龄为67岁,好发于十二指肠并以贫血为主要表现。术前确诊率为38.7%,Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期患者分别占9.7%、22.6%、35.5%、32.2%。31例患者中20例行根治性手术,5例行姑息性手术,11例接受化疗,中位生存期为22个月,5年生存率仅为19%。年龄〉65岁、Ⅲ~Ⅳ期、局部淋巴结转移数≥4个患者的中位生存期分别低于年龄≤65岁、Ⅰ~Ⅱ期、局部淋巴结转移数≤3个患者的中位生存期,差异有统计学意义（P〈0.05）;性别、病理分级、肿瘤原发部位、肿瘤标志物及根治术后有无化疗等因素对患者中位生存期影响的差异无统计学意义（P值分别为0.396、0.141、0.082、0.877、0.599）。结论：PSBA临床表现无特异性,确诊时多为进展期,预后差。外科手术是主要的治疗方式。年龄、临床分期及局部淋巴结转移数目等因素可能成为临床评估生存期的指标。

Objective：To analyze the clinical manifestations,diagnosis,treatment and prognosis of primary small bowel adenocarcinoma（PSBA）. Methods：The clinical data and survival analysis of PSBA in 31 cases were retrospective analyzed. Results：Among the 31 cases,17 cases were male,14 cases were female;the median age was 67 years;mainly originated from duodenum and manifested as anemia. Preoperative diagnosis rate was 38.7%;the proportions of stagesⅠ,Ⅱ,Ⅲand Ⅳ were 9.7%,22.6%,35.5% and 32.2%,respectively. Curative resection was performed on 20 patients;palliative surgery was performed on 5 patients;11 patients received chemotherapy. The median survival time was 22 months and the 5-year survival rate was only 19%. The median survival time of patients over 65 years,with stageⅢ-Ⅳ or with local invaded lymph-node ≥4 was respectively lower than that of patients below 65 years,with stageⅠ-Ⅱor with local invaded lymph-node ≤3 with statistically significant differences（P 0.05）. However,in terms of gender,pathological grade,primary site,tumor maker and chemotherapy after curative resection,no statistical difference was observed（P=0.396,0.141,0.082,0.877,0.599,respectively）. Conclusion：The clinical manifestations of PSBA are unremarkable;diagnosis is mainly obtained at advanced stages,which indicates the poor prognosis. Surgical resection is the mainly treatment. Age,clinical stage and number of local invaded lymph-node may become the clinical index of survival time.