原发性十二指肠肿瘤14例临床分析

Clinical analysis about primany duodenal neoplasm in 14 cases

目的 探讨提高原发性十二指肠肿瘤的诊断率及治疗水平。方法 对近 10年来经手术证实的 14例原发性十二指肠肿瘤 (本组不包括十二指肠乳头肿瘤 )临床表现、手术及病理进行回顾性分析。结果 原发性十二指肠肿瘤恶性肿瘤 12例 ,良性肿瘤 2例 ,良、恶性之比为 1∶6。恶性肿瘤主要为腺癌 ( 8例 ) ,平滑肌肉瘤 ( 3例 ) ,恶性淋巴瘤 1例。上腹隐痛、隐匿性体重下降、大便隐血 (“三隐”症状 )是最常见临床表现。术前纤维或电子十二指肠镜确诊率为 70 % ,上消化道造影为 67% ,CT发现率为 60 % ,全组中行胰十二指肠切除术 5例 ,扩大十二指肠节段切除术 (包括胃十二指肠切除术及十二指肠第 3、4段加空肠上段切除术 ) 6例 ,十二指肠节段切除术 2例 ,1例行旁路手术 ,切除率 93 %。结论 纤维或电子十二指肠镜和上消化道造影是诊断PTD的主要手段 ,恶性肿瘤首选胰十二指肠切除术 ,十二指肠第 3、4段肿瘤未浸润胰腺者可行扩大十二指肠节段切除术。十二指肠良性肿瘤可行节段切除术。

Objective To Study how to improve the diagnostic and therapeutic level of primary tumors of duodenum.(PTD) Methods Data of 14 patients with PTD in the last 10 years were studied retrospectively.Results 14 patients include 12 malignant PTD and 2 benign PTD.The consist of malignant PTD included adenocarcinoma(8)、leiomyosarcoma(3) and lymphoma(1).The common features of those patients include abdominal pain,gradual body weight loss and occult bleeding in stool.The correct diagnostic rate of auxiliany examination were:70% in duodenal endoscopy,67% in gastrointestinal air barium double radiography,60% in CT scan and 50% in ultrasonography.5 patients received pancreatoduodenectomy,6 patients received enlarged segmental duodenectomy,2 patients received segmental duodenectomy and 1 patient received gut shunt.The resectable rate is 93%.Conclusions PTD is rare in the alimentary tract and the clinical features are not typical.Attention shoud be paid to abdominal pain,gradual body weight loss and occult bleeding in stool.Duodenal endoscopy and gastrointestinal air barium double radiography are main methods in the diagnosis of PTD.Patients with malignent PTD should undergo pancreatoduodenectomy and if the pancreatum is not invaded,enlarged segmental duodenctomy can be received.Patients with benign PTD should undergo segmental duodenectomy.