原发性小肠肿瘤诊治体会(附108例临床分析)

DIAGNOSIS AND MANAGEMENT OF SMALL BOWEL TUMOR-A REPORT OF 108 CASES.

目的 探讨原发性小肠肿瘤诊治问题。方法 对经手术及病理证实的 10 8例原发性小肠肿瘤进行回顾性分析 ,其中小肠良性肿瘤 2 5例 ,恶性肿瘤 83例。结果 术前诊断为小肠肿瘤 3 8例 (3 5 .0 % )。诊断方法为消化道造影 ,纤维内镜检查加活检 ,选择性动脉造影 ,CT、B超检查 ,余均为手术后病理学检查确诊。小肠良性肿瘤 2 4例行局部切除 ;十二指肠肿瘤 3 3例行 Whipple/ Child术 ,7例行手术探查 ;空回肠恶性肿瘤 44例中 ,18例行根治术 ,4例行姑息切除术 ,2例行手术探查 ,恶性淋巴瘤 2 0例均行手术切除 ,术后行正规化疗。结论 原发性小肠肿瘤术前误诊率高 ;纤维内镜检查和十二指肠低张造影对十二指肠肿瘤诊出率高 ;小肠分段造影和选择性动脉造影是空肠、回肠肿瘤的重要诊断手段。手术为小肠肿瘤的主要治疗手段 。

Objective To explore the diagnosis and treatment of primany small intestinal tumor.Methoeds 108 cases with primany small intestinal tunor verified through operation or/and pathology were reviewed.Benign tumors made up 25/108 and malignant ones accounted for 83/108.Results:Before operation,38(35.0%) cases were given confirmed diagnousis of small intestinal tumor by the following examinations:radiography of digestive tract,fiber endoscopy accompanned by biopsy,selective arteriography, computered tomography(CT) and B ultrasonography.The diagnosis of the other 70(70/108) cases were confirmed by pathology after operation.Partial excision were administered in 24 cases with benign small intestinal tumor.Among the cases with duodenal tumor,33 cases were given whipple's/child's operation and 7 cases,explorative operation.As to the 44 cases with jejunal and/or ileal malignant tumors,radical excaision were performed in 18 cases,palliative excision in 4 cases and explorative operation in 2 cases.Excision operations accompanied by pastoperative standard chemotherapy were given to all of the 20 cases with malignant lymphoma.Conclusions Before operation,the erroneous diagnostic rate of primary small intestinal tumor was high.Fiber endoscopy and lower tension duodenography may bring a high diagnostic rate of duodenal tumor.Radiography and selective arteriography may be very important to the diagnosis of jejunal and/or ileal tumors.Operation is the major treatment to small intestinal tumor and pestoperative chemotherapy should be added to malignant lymphoma.