小肠肿瘤并发症的诊断和治疗

Complications of small bowel tumors

目的 探讨小肠肿瘤并发症的发生及其诊治。方法 回顾性分析 1980年 1月至 2 0 0 1年 6月间收治的 47例有并发症的小肠肿瘤的临床资料。结果 47例中恶性肿瘤 33例 (70 % )。并发症包括出血 17例、穿孔 8例、肠套叠 11例、肠梗阻 8例、肠扭转 1例、腹内疝 1例、肠扭转加肠套叠1例。腹痛为主要症状。X线检查是主要诊断手段 ,B超、CT、MRI也有助于诊断。良性肿瘤行局部肠段切除 ,恶性肿瘤 2 5例行根治性切除 ,7例行姑息性切除。2例死于术后全身衰竭。结论 小肠肿瘤早期诊断困难 ,多数因并发症就诊 ,外科手术是主要的治疗方法。

Objective To study the complications of small bowel tumors (SBT) and their diagnosis and treatment. Methods A retrospective study was carried out among 47 SBT patients suffering from complications of SBT during the last two decades. Results Thirty-three cases (70%) were of malignant tumors. Complications included bleeding in 17 cases, perforation in 8, intussusception in 11, bowel obstruction in 8, volvulus, internal hernia and volvulus plus intussusception in one each. Abdominal pain was the most common presenting sign and symptom (40 cases). The mean interval from the onset of signs and symptoms to exploration was 4.7 months for those with malignant SBT and 3.1 months for benign ones. Roentgenography was the mainstay for diagnosis. Ultrasound, CT and MRI were also helpful. Benign tumors were treated with segmental resection of the affected bowel. Out of 33 malignant SBT patients, curative resection was performed in 26 and palliative resection in 7. Two patients died postoperatively.Conclusions Most patients with SBT were not correctly diagnosed until complications popped up. Surgery remains as the therapy of choice. [