原发性小肠腺癌临床诊治和病理特征分析

Analysis of clinical diagnosis and pathological features of primary small intestinal adenocarcinoma

目的探讨原发性小肠腺癌的临床诊治和病理特点。方法回顾性分析2000年1月至2012年12月在本院行手术治疗的37例原发性小肠癌患者的临床资料。结果本组患者中男性25例(67.6%),女性12例(32.4%),年龄介于45~67岁,中位年龄53.8岁。肿瘤位于空肠26例(70.3%),回肠11例(29.7%)。大体病理中隆起型5例(13.5%),缩窄型23例(62.2%),溃疡型2例(5.4%),浸润型7例(18.9%)。组织学中高分化腺癌17例(45.9%),中分化腺癌11例(29.7%),低分化腺癌6例(16.2%),未分化癌3例(8.1%)。术后病理TNM分期包括Ⅲ期27例(73.0%),Ⅳ期10例(27.0%)。术后1、2、3、5年总体生存率分别为78.4%、37.8%、5.4%、5.4%。结论原发性小肠腺癌早期发现困难,容易出现淋巴转移,治疗效果差。

Objective To investigate the clinical diagnosis and pathological features of primary small intestinal adenocarcinoma. Methods From January 2000 to December 2012, the clinical data of 37 patients with primary small bowel carcinoma in our hospital were analyzed retrospectively. Results There were 25 （67.6%） males and 12 （32.4%） females. The age of onset ranged from 45-67 years, and the median age of onset was 53.8 years. 26 （70.3%） cases were located in the j ejunmn and 11 （29.7%） cases locat- ed in the ileum. In the general pathology, there were five cases of eminent type （ 13.5% ）, 23 cases of eon- strictive type （62.2%）, two cases of ulcerative type （5.4%）, and seven cases （18.9%） of infiltrative type. There were 17 cases of well-differentiated adenocarcinoma （45.9%）, 11 cases of moderately differentiated adenocarcinoma （29,7%）, six cases of poorly differentiated adenocarcinoma（ 16.2% ）, and three cases of undifferentiated carcinoma （8.1% ）. Postoperative pathological TNM staging included 27 cases of stage Ⅲ （73%）, 10 cases of stage Ⅳ （27%）. The overall survival rates of 1, 2, 3 and 5 years after operation were 78.4%, 37.8%, 5.4% and 5.4% respectively. Conclusions The primary small intestinal adenocarcinoma is difficult to be diagnosed at early stage. It is prone to lymphatic metastasis and has a poor prognosis.