原发性十二指肠癌的诊断与外科治疗

Diagnosis and surgical treatment of primary duodenal carcinoma

目的 探讨原发性十二指肠癌 (PDC)的诊断与外科治疗。 方法 回顾分析 1983～1997年间外科手术治疗的PDC 2 2例。腹痛及上腹部不适 11例、黄疸 5例、恶性呕吐 4例、上腹部胀满感 2例 ,内镜、十二指肠低张造影、B超及CT扫描诊断正确率分别为 90 0 % ( 9/ 10 )、86 7% ( 13/ 15 )、33 3% ( 4/ 12 )及 5 8 3% % ( 7/ 12 )。本组 2 2例患者均行开腹手术 ,包括行胰头十二指肠切除术 (PD) 12例、节段性肠管切除术 (SR) 4例及短路手术 6例。 结果 PDC无特异临床表现 ,诊断主要依靠内镜及十二指肠低张造影。本组随访率为 86 4% ( 19/ 2 2例 ) ,无肿瘤残留的根治性切除病例 (包括PD 12例及SR 4例 ,1例PD患者失访 )的 1、3、5年生存率分别为 86 7% ( 13/ 15 )、46 7% ( 7/ 15 )及 2 6 7% ( 4/15 )。PD组 5年生存率为 2 7 3% ( 3/ 11)、SR组 4例患者 5年后存活 1例 ,而短路手术者 ( 2例失访 )无一例生存超过 1年 ,2者之间的差异有非常显著性意义 ( χ2 =6 84,P <0 0 1)。 结论 根治性外科切除治疗可提高原发性十二指肠癌的长期生存率。

Objective To investigate the early diagnosis of primary duodenal carcinoma and its outcome after surgical procedure. Methods Twenty-two patients with primary duodenal carcinoma treated operatively between 1983 and 1997 were analyzed retrospectively. Eleven patients complained of epigastric pain and discomfort, 5 jaundice, 4 nausea and vomiting and 2 epigastric fullness. The correct diagnosis rate for endoscopy was 90.0%(9/10), for duodenography 86.7%(13/15), for ultrasound examination 33.3% (4/12) and for computerized tomography (CT) scanning 58.3%(7/12), respectively. All of the22 patients received surgery including pancreaticoduodenectomy (12 patients), segmental resection (4) and bypass operation (gastrojejunostomy and cholecystojenostomy or cholangiojejunostomy) (6). Results Primary duodenal carcinoma was characterized nonspecifically, and the correct diagnosis was based on endoscopy and duodenography. The follow-up rate of this group was 86.4% (19/22). The 1-, 3-, 5-year survival rates of patients receiving radical resection (n=16, 1 patient lost follow-up) were 86.7%(13/15), 46.7% (7/15), and 26.7% (4/15), respectively. The 5-year survival rate of patients receiving pancreaticoduodenectomy was 27.3% (3/11), and the 5-year survival rate of patients having segmental resection was 1/4. No patient (n=6, 2 lost follow-up) with primary duodenal carcinoma treated by bypass procedure survived more than one year. There was a significant difference between patients receiving radical procedure and bypass operation (χ2=6.84, P<0.01). Conclusion Radical resection might improve the survival of patients with primary duodenal carcinoma.