十二指肠转移癌患者临床特征分析

Clinical characteristics of patients with duodenal metastatic carcinoma

目的探讨十二指肠转移癌患者的临床特征,为临床诊治提供参考。方法收集2013年1月至2018年12月于本院住院诊断为十二指肠转移癌的12例患者的临床及病理资料,总结临床及病理特征。结果12例患者中男11例(91.7%),女1例(8.3%),平均年龄(68.8±9.1)岁。临床表现:腹痛7例(58.3%),上消化道出血3例(25.0%),皮肤黄染3例(25.0%);体征:腹部压痛4例(36.3%),黄疸3例(27.3%),贫血3例(27.3%),腹部包块2例(16.7%)。肿瘤原发病灶:结肠癌3例(25.0%),胰腺癌2例(16.7%),胃癌2例(16.7%),肾癌2例(16.7%),胆囊癌、胆管癌及肝癌各1例(均占8.3%)。血CEA增高者7例(58.3%),CA19-9增高者5例(41.7%)。十二指肠病变位于降部者8例(66.7%)、球部者4例(33.3%)。3例患者行消化道造影检查,表现为十二指肠上段管腔狭窄、十二指肠降段与水平段交接部病变并与升结肠之间形成瘘管及十二指肠降段梗阻;11例患者腹部CT检查显示十二指肠肠壁增厚、占位及狭窄、梗阻,1例患者PET-CT检查见胰头及十二指肠区肿块,氟代脱氧葡萄糖代谢(FDG)异常增高。7例患者胃镜检查提示为十二指肠溃疡或隆起型病变,6例患者病理提示为腺癌,经免疫组织化学检测1例患者确诊为肾癌转移、1例为肝癌转移。5例患者采用支架置入治疗,2例患者进行外科姑息手术,5例患者采取内科保守治疗。结论十二指肠转移癌患者老年男性多见,多为消化系统肿瘤转移。

Objective To analyze the clinical characteristics of patients with duodenal metastatic cancer,and to provide reference for clinical diagnosis and treatment.Methods The clinical and pathological data of 12 patients diagnosed with duodenal metastatic carcinoma admitted to hospital from January 2013 to December 2018 were collected,and the clinical and pathological characteristics were summarized.Results Among the 12 patients,there were 11 males(91.7%)and 1 female(8.3%),the mean age was 68.8±9.1 years.7 cases(58.3%)presented with abdominal pain,3 cases(25.0%)with upper gastrointestinal bleeding,and 3 cases(25.0%)with yellow skin.The patients with physical signs included abdominal tenderness in 4 cases(36.3%),jaundice in 3 cases(27.3%),anemia in 3 cases(27.3%),and abdominal mass in 2 cases(16.7%).The primary lesions were colon cancer in 3 cases(25.0%),pancreatic cancer in 2 cases(16.7%),gastric cancer in 2 cases(16.7%),renal cell carcinoma in 2 cases(16.7%),gallbladder carcinoma,cholangiocarcinoma,and liver cancer 1 case(8.3%)each.There were 7 cases(58.3%)with increased serum CEA and 5 cases(41.7%)with increased CA19-9.The lesions were located in the descending part of duodenum in 8 cases(66.7%),and the duodenal bulb in 4 cases(33.3%).Three patients underwent gastroenterography,which showed stenosis of the upper segment of duodenum,lesions at the junction of the lower segment of the duodenum and the horizontal segment,fistula with the ascending colon and obstruction of the lower segment of duodenum.The results of CT scans of 11 patients showed thickening,space occupying,stenosis and obstruction of duodenal intestinal wall.PET-CT examination of 1 patient showed a mass in the pancreatic head and duodenum,and abnormal increase of fluorodeoxyglucose metabolism(FDG).Gastroscopy showed duodenal ulcer or protuberant lesion in 7 patients,and pathology showed adenocarcinoma in 6 patients.One patient was diagnosed with renal cancer metastasis and one patient was diagnosed with liver cancer metastasis through immunohistochemical detection.Five patients were treated with stent implantation,two patients underwent surgical palliative surgery,and five patients were treated with medical conservative treatment.Conclusion Duodenal metastatic cancer is common in elderly men and mostly digestive system tumor metastasis.