原发性十二指肠恶性肿瘤的诊断与治疗

The diagnosis and treatment of primary malignant tumors of the duodenum

目的加强对十二指肠恶性肿瘤的临床表现、诊断与治疗的认识。方法回顾性分析我院 1990～ 2 0 0 2年收治的 81例原发性十二指肠恶性肿瘤的临床资料。结果本组肿瘤位于乳头上部 13例 (16 % ) ,乳头周围部 6 3例 (78% ) ,乳头下部 5例 (6 % )。常见临床表现有上腹痛、黄疸、上消化道出血、呕吐及体重下降等。术前诊断率为 80 %。行胰十二指肠切除术 5 4例 ,节段性肠切除术和剖腹探查 +活检术各 2例 ,毕Ⅱ式胃大部切除术和乏特壶腹局部切除术各 1例 ,旁路转流术 2 1例 ,手术切除率为 70 %。行胰十二指肠切除术患者术后 3年和 5年生存率分别为 36 %和 2 1% ,行节段性肠切除术患者于 1年内死亡 ,毕Ⅱ式胃大部切除术生存 2 5个月 ,乏特壶腹局部切除术生存 18个月 ,旁路转流术均于 1～ 18个月死亡。结论原发性十二指肠恶性肿瘤的临床表现多样 ,早期诊断困难 ,加强对本病的认识和实施根治性胰十二指肠切除术是改善预后的关键。

Objective To intensify clinical evaluation on the manifestation, diagnosis and treatment of primary malignant duodenal tumors. Method The clinical data of 81 patients with primary malignant duodenal tumors from 1990 to 2002 were analyzed retrospectively. Result Tumors located above, around and below the duodenal papilla accounted for 16%, 78%, 6% respectively. The common clinical presentations were weight loss(72%)?abdominal pain(64%)?jaundice(45%)?alimentary tract bleeding(40%)?vomiting(33%) and anemia(24%). The preoperative diagnosis rate was 80%. Pancreatoduodenectomy was performed in 54 cases, bypass operation in 21 cases, segmental duodenectomy and simple laparotomy in 2 cases each. The postoperative 3- and 5- year survival rate was 36% and 21% for patients undergoing curative resection. In those with bypass operation, the survival time was between 1～18 months. Two cases undergoing segmental duodenectomy died within one year. Conclusion Patients usually lack special symptoms and signs, early diagnosis is fairly difficult, pancreaticoduodenectomy performed for purpose of curative resection could improve the prognosis of this malignancy.