原发性十二指肠癌45例的诊断与治疗

The diagnosis and treatment of primary carcinoma of the duodenum:a report of 45 cases

目的提高原发性十二指肠癌的诊断与治疗水平。方法回顾性分析 1987～ 2 0 0 0年间收治的 4 5例原发性十二指肠癌的临床资料。结果本组中有乳头周围区癌 2 9例 (6 4 % ) ,乳头下部癌10例 (2 2 % ) ,乳头上部癌 6例 (13% )。纤维十二指肠镜的确诊率为 71% (15 / 2 1)。行胰十二指肠切除术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 3%。行胰十二指肠切除术患者的术后 3年和 5年生存率分别为 4 1%和 2 4 % ,行胃肠、胆肠吻合术患者均于术后 6～ 15个月死亡 ,平均生存期为 9个月 ,行剖腹探查术患者均于术后 6个月死亡。结论原发性十二指肠癌以乳头周围区癌多见。

ObjectiveTo improve the diagnosis and treatment of primary duodenal carcinoma.MethodThe clinical data of 45 patients with primary carcinoma of the duodenum from 1987 to 2000 were analyzed retrospectively.ResultAccording to the site of cancer, tumors around, below and above the duodenal papilla accounted for 64%, 22% and 13% of all cases. The diagnosis rate of duodenoscopy was 71%(15/21). Pancreatoduodenectomy was performed in 22 cases, segmental duodenectomy in 2 cases, simple tumor resection in 3 cases, gastroenterostomy or choledochojejunostomy in 12 cases and simple laparotomy in 4 cases. In patients of curative resection, the postoperative 3 and 5 years′ survival rate was 41 4% and 23 6%. In those with gastroenterostomy or choledochojejunostomy, the average survival time was 6～15 months. All cases undergoing biopsy only died within six months.ConclusionPrimary duodenal carcinoma mainly occurs around duodenal papilla. The long time survival of Whipple′s procedure is favourable.