原发性十二指肠肿瘤的诊断与治疗

The diagnosis and prognosis of primary duodenal tumors

目的探讨原发性十二指肠肿瘤的诊断与治疗。方法回顾性分析北京大学人民医院1996-2015年收治的170例原发性十二指肠肿瘤患者的临床资料。结果本组170例患者中肿瘤位于十二指肠球部14例（8．2％），降部144例（84．7％），水平部9例（5．3％），升部3例（1．8％），其中降部乳头区为106例，占总例数的62．4％。主要临床表现为黄疸、腹痛、腹胀、恶心、呕吐。170例中获得明确肿瘤分期的125例，其中I期34例（27．2％），Ⅱ期45例（36．0％），Ⅲ期30例（24．0％），Ⅳ期16例（12．8％）。B超确诊率为27．6％，CT确诊率为72．3％。病理类型主要为腺癌，共144例（84．7％）。十二指肠肿瘤患者的1、3、5年生存率分别为69．1％、48．6％、33．9％。结论原发性十二指肠肿瘤以降部乳头区最多见，以腺癌为主．早期诊断是提高患者生存率的关键。

Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum. Methods The clinical data of 170 cases with primary malignant tumor of the duodenum at Peking University People＇s Hospital from 1996 to 2015 were analyzed retrospectively. Results Tumors located in the first, second, third and fourth parts in 14 cases （8.2%）, 144 cases （84.7%） ,9 cases （5.3%） , and 3 cases （ 1.8% ） respectively, and among them, tumors within papillary area accounted for 62.4% （106 cases）. The main clinical presentations included jaundice,upper abdominal pain,abdominal distention,nausea and vomiting. Among the 170 cases, 125 cases obtained accurate tumor stages, with 34 cases on stage Ⅰ （27.2%）, 45 cases on stage Ⅱ （36. 0% ）, 30 cases on stage Ⅲ （24. 0% ）, 16 cases on stage Ⅳ （12. 8% ）. The accuracy rate of ultrasound and CT in preoperative diagnosis was 27.6% , and 72.3% respectively. The pathological type of 144 cases （ 84. 7% ） was adenoearcinoma. The postoperative 1-, 3-and 5-year survival rate was 69. lifo , 48.6% and 33.9% . Conclusions Most primary malignant duodenal tumors are located in papillary region, necessitating radical panereatieoduodenecomy, early diagnosis remains the key for longterm survival.