原发性小肠腺癌的临床特点及文献分析

Clinical characteristics of primary small bowel adenocarcinoma

背景小肠腺癌是消化系统少见病,但近年来发病率呈上升趋势.因其临床表现无明显特异性,漏诊及误诊率仍较高.深入探讨该病的临床特点及诊治对提高早期确诊率、改善预后有重要意义.目的探讨原发性小肠腺癌的临床特点,以提高其早期诊断率,改善预后.方法回顾性分析郑州大学第一附属医院2012-01/2017-09收治的98例经组织病理证实为原发性小肠腺癌患者的病例资料.结果肿瘤位于十二指肠58例,空肠29例,回肠11例.主要临床症状包括腹痛47例,黄疸31例,肠梗阻25例,消化道出血7例.检查方法有消化道造影、CT、内镜等.误诊35例,误诊率为35.7%.单因素分析提示误诊与肿瘤部位、生长方式、肿瘤大小有关(P<0.05). 96例行手术治疗.结论原发性小肠腺无特异性表现,临床误诊率较高,手术切除是主要治疗方法.

BACKGROUND Adenocarcinoma of the small bowel is rare in comparison with other gastrointestinal malignancies but its incidence is rising.The non-specific symptoms with which they present often pose a high rate of missed diagnosis and misdiagnosis.It is of great significance to explore the clinical characteristics of small bowel adenocarcinoma in order to improve its early diagnosis and prognosis.AIM To analyze the clinical characteristic of primary small bowel adenocarcinoma,in order to improve its early diagnosis and prognosis.METHODS From January 2012 to September 2017,98 patients with pathologically diagnosed primary small bowel adenocarcinoma at the First Affiliated Hospital of Zhengzhou University were retrospectively enrolled.RESULTS There were 58,29,and 11 cases of adenocarcinoma in the duodenum,jejunum,and ileum,respectively.The common clinical manifestations included abdominal pain(47 cases),jaundice(31 cases),intestinal obstruction(25 cases),and gastrointestinal bleeding(7 cases).The examination methods included digestive tract angiography,CT,endoscopy and so on.Preoperative misdiagnosis occurred in 35(35.7%)cases.Univariate analysis showed that misdiagnosis was related to tumor location,growth pattern,and tumor size(P<0.05).Ninety-six patients underwent surgical treatment.CONCLUSION The preoperative misdiagnosis rate of primary small bowel adenocarcinoma is high due to the absence of specific clinical manifestations.The main therapy is still surgery.