原发性十二指肠恶性肿瘤54例治疗分析

Treatment of 54 cases of primary malignant duodenal tumor

目的 探讨原发性十二指肠恶性肿瘤的治疗选择。方法 回顾分析 5 4例原发性十二指肠恶性肿瘤患者的临床资料。结果 恶性肿瘤主要表现为皮肤巩膜黄染、腹痛、十二指肠梗阻和上消化道出血。各种检查方法的诊断正确率分别为 :内窥镜逆行胰胆管造影 92 8%、消化道气钡造影70 8%、胃镜 5 0 %、CT 2 1 9%、MRI 2 1 4 %。能判断部位者肿瘤分布为十二指肠球部 1例、降部 4 5例 ,水平部 3例 ,升部 0例。恶性肿瘤行手术治疗 4 8例 ,胰十二指肠切除术 31例 ,胰十二指肠切除术加肠系膜上静脉部分切除术 1例 ,局部根治性十二指肠肠段切除 6例 ,姑息性十二指肠部分切除术 1例 ,肠壁楔形切除术 3例。胆肠内引流或 /和胃空肠吻合 5例 ,空肠造瘘术 1例。辅助化疗 13例。总体 5年生存率 4 5 4 % ,3年 4 5 4 % ,1年 6 3 2 %。根治手术组和姑息手术组的中位生存期分别为 2 4、10个月 ,术后化疗组中位生存期 38个月 ,无辅助治疗组中位生存期 16个月 ,但各组比较生存期差异无显著意义。胰十二指肠切除术与局部根治性肠段切除术二组生存期比较差异无显著意义。多因素回归分析淋巴结转移、肿瘤大小、肿瘤深度、脉管癌栓、病理类型、手术方法与生存时间的相关性 ,只有脉管内癌栓与生存期相关。

Objective To study the treatment of primary malignant duodenal tumor.Method The data of 54 cases of primary malignant duodenal tumor during 1993～2003 were analyzed retrospectively. Results Clinical manifestations were jaundice,abdominalgia,obstruction of digest tract and bleeding. Correct diagnosis rates of image examination were endoscopic retrograde cholangiopancreatography 92.8%,air barium double radiography 70.8%,gastroscopy 50.0%,CT 21.9%,MRI 21.4%. Tumor location was 1 in duodenal bulb,45 in descending portion, 3 in horizontail part and none in ascending portion. 48 malignant tumors were operated,31 pancreaticoduodenectomy,1 pancreaticoduodenectomy and partial resection of superior mesenteric vein,6 radical segmental duodenal resection,1 palliative segmental duodenal resection,3 duodenal wedge resection,5 bypass operation (gastrojejunostomy and/or cholangiojejunostomy),1 jejunostomy. Adjuvant chemotherapy was given in 13 cases. The survival rates were 5-year 45.4%,3-year 45.4%,1-year 63.2%. Median survival months were 24,10, 38 and 16 respectively for radical operation group,palliative operation group,with postoperative adjuvant therapy group and without postoperative adjuvant therapy group. No significant survival time was found between radical operation group and palliative operation group,adjuvant therapy group and without postoperative adjuvant therapy group,pancreaticoduodenectomy group and radical segmental duodenal resection group in statistics. Among lymphyaden metastasis,tumor size,tumor depth,tumor thrombi,pathologic type and operative methods,only tumor thrombi had prognostic significance in multivariate analysis. Conclusions Pancreaticoduodenectomy and radical segmental duodenal resection should be selected for primary malignant duodenal tumor. Bypass operation can prolong survival and improve life-quality. Postoperative adjuvant treatment is advocated.