十二指肠球部恶性肿瘤14例误诊分析

Misdiagnosis analysis of the malignant tumor in the duodenal bulb

[目的]总结十二指肠球部恶性肿瘤的临床特征,分析误诊原因,以降低其误诊率。[方法]回顾性总结本院2007-01-01—2013-12-31期间被误诊的十二指肠球部恶性肿瘤14例的临床资料。[结果]首发症状:腹痛6例,黑便3例,反酸3例,腹胀2例。病理类型:腺癌8例,黏液细胞癌3例,类癌2例,鳞状细胞癌1例。肿瘤部位:十二指肠球部前壁7例,小弯侧3例,后壁2例,弥漫型2例。内镜分型:溃疡型7例,隆起型5例,平坦糜烂型2例。误诊分布:十二指肠球部良性溃疡8例,息肉3例,十二指肠球炎2例,腺癌1例。[结论]十二指肠球部恶性肿瘤易误诊为十二指肠球部良性溃疡及息肉;提高对十二指肠球部恶性肿瘤的全面认识,重视上消化道内镜检查及组织学检查,可降低十二指肠球部恶性肿瘤的误诊率。

[Objective]To analyze the clinical characteristics and misdiagnosis of the malignant tumor in the duodenal bulb and to improve the diagnosis and treatment, also to avoid the diagnostic errors. [Methods]Fourteen cases of patients suffered from the malignant tumor of the duodenal bulb treated in Henan Honli Hospital from January 2007 to December 2013 retrospectively were investigated. All the cases were diagnosed by pathology. [Results]The primary symptoms of duodenal bulb malignant tumors were abdominal pain（6/14）, sour regurgitation（3/14）, melena（3/14）, abdominal distension（2/14）respectively. Seven of the mass were located in the antetheca of the duodenal bulb,two were in backwall,three were in the lesser curvature side. For the classifications of pathology, eight were adenocarcinoma, three were mucinous cell carcinoma, two were neuroendocrine neoplasm and one was squamous cell carcinoma. According to the form of malignant tumor by endoscopic classification, the majority types was ulcerative type（7/14） ,the next was apophysis type. Eight were misdiagnosed as duodenal bulb ulcers,three were as duodenal polyps,two were duodenal bulb inflammation and one was duodenal adenocarcinoma. [Conclusion]It seems easy to misdiagnose the malignant tumor in the duodenal bulb as duodenal bulb ulcers and duodenal polyps. The esophagogastroduodenoscopy and pathology will help the clinician to correctly diagnose the malignant tumors in the duodenum bulb.