72例原发性小肠肿瘤的临床分析

Clinical analysis of patients with primary intestinal tumours: a report of 72 cases

目的 探讨小肠原发性肿瘤的外科诊治经验 ,以提高对原发性小肠肿瘤的诊治水平。方法 回顾性分析 1988～ 2 0 0 2年收治的 72例原发性小肠肿瘤的临床资料。结果 72例中 ,良性肿瘤占 2 0 .8% (15 / 72 ) ,恶性肿瘤占 79.2 % (5 7/ 72 )。良性肿瘤以腺瘤及平滑肌瘤多见 ,各占 40 .0 %(6/ 15 )。恶性肿瘤以腺癌多见 ,占 36.8% (2 1/ 5 7) ,其次为恶性淋巴瘤 ,占 30 .0 % (17/ 5 7)。X线检查是主要诊断手段 ,B超、CT、内镜、肠系膜血管造影也有助于诊断。本组术前误诊率为 62 .5 %。全组均行手术治疗 ,其中急诊手术率为 33.3% (2 5 / 72 ) ,术前主要以急性肠梗阻、消化道出血、穿孔、急性阑尾炎等为主要诊断。本组无手术死亡。恶性肿瘤 1,3,5年生存率分别为 72 .5 % ,47.5 % ,2 5 .0 %。结论 小肠肿瘤术前诊断困难 ,误诊率与急诊手术率高。选择性动脉造影和小肠分段造影是空回肠肿瘤的重要诊断手段 ;低张造影和纤维内镜检查是诊断十二指肠肿瘤的最佳选择。一经诊断 。

Objective To explore the diagnosis and surgical treatment of primary intestinal tumors (PIT), to improve the diagnosis and treatment. Methods Retrospectively analysis was made on the clinical data of 72 patients with PITs admitted to our hospital from 1988 to 2002. Results Out of the 72 cases, 20.8% (15/72) had benign tumors, while the remaining 79.2% (57/72) were malignancies. The former were mostly adenoma and liomyoma, each accounting for 40.0% (6/15) of the benign tumors. Adenocarcinoma was the most common type of malignancy (36.8%,21/57), following lymphadenoma (30.0%, 17/57). The main diagnostic methods were X-ray,B-ultrasonic,CT, endoscopy and superior mesenteric arteriography.The misdingnosis rate was 62.5% before operation in this series.Of the 72 cases underwent operation,25 underwent emergent operation (33.3%, 25/72), because acute intestinal obstruction, digestive tract bleeding or perforation,acute appendicitis were diagnosed before the operation.In this series,there was no operative death;the 1,3,5 year survial rates of malignance were 62.5%,47.5%,25.0%,respectively. Conclusions PIT is not easily diagnosed before operation, and the misdiagnosis rate and emergent operation rate are high. Superior mesenteric arteriography,radiologic contrast examination of the small bowel are the important means of diagnosis in jejunum or ileum tumour, and the best way to diagnosis duodenal neoplasms is hypotonic duodenography and endoscopy. Once the diagnosis of PIT is made, the best choice of treatment is operation.