原发性十二指肠癌101例的诊断与治疗

Diagnosis and treatment of primary duodenal carcinoma:a report of 101 cases

目的提高原发性十二指肠癌的早期诊断及治疗水平。方法回顾性分析1990～2002年间经手术及病理证实的原发性十二指肠癌患者101例的临床资料。结果肿瘤位于十二指肠乳头上区9例,乳头下区15例,乳头区77例。主要临床表现为上腹隐痛、上消化道梗阻和出血及黄疸症状。术前纤维十二指肠镜确诊率为97.7%,低张十二指肠造影为91.2%,B超及CT检查阳性率为80.0%。59例行胰十二指肠切除术,24例行十二指肠乳头癌局部切除术,5例行十二指肠部分切除术,4例行远端胃大部切除术,9例行姑息性探查及胆肠或胃肠吻合术。结论纤维十二指肠镜、低张十二指肠造影及CT是诊断十二指肠癌的主要手段,早期诊断有赖于提高对本病的认识,一旦确诊则手术彻底切除肿瘤是首选的治疗方法。

Objective To improve early diagnosis and treatment of primary duodenal carcinoma. Methods One hundred and one cases of primary duodenal carcinoma were confirmed by operation and pathology from 1990 to 2002, and their clinical data were analyzed retrospectively. Results The tumors were located at upper,around and lower duodenal papilla regions in 9(8 9%),77(76 2%) and 15(14 9%)cases respectively.The common clinical manifestations were dull pain and distension in upper abdomen,upper digestive tract obstruction and hemorrhage, and jaundice. The accuracy of fiberoptic duodenoendoscopy,upper gastrointestinal radiography, BUS and/or CT for diagnosis was 97 7%, 91 2% and 80 0% respectively. Curative resection was performed on 92 cases,including 59 cases of pancreaticoduodenectomy, 24 cases of local resection, 5 cases of partial duodenum resection, 4 cases of distal subtotal gastrectomy. The other 9 cases received palliative surgery.Conclusions Fiberoptic duodenoendoscopy,upper gastrointestinal radiography and CT are major methods for diagnosis of primary duodenal carcinoma. Early diagnosis depends on sufficient understanding of the disease. Operation is the best choice of treatments.