十二指肠乳头肿瘤79例临床分析

Clinical study in 79 cases of duodenal papilla tumor

目的:提高十二指肠乳头肿瘤的早期诊断及治疗水平。方法:回顾性分析自1992年至2002年收治的79例经手术及病理证实的十二指肠乳头肿瘤的临床资料。结果:十二指肠乳头癌71例、腺瘤5例、不典型增生3例,主要首发临床表现为进行性无痛性黄疸(61例)、消化道症状(14例)及上消化道出血(4例)。术前纤维十二指肠镜确诊率为92.4％,逆行性胆胰管造影(ERCP)为100％,磁共振胰胆管成像(MRCP)检查阳性率为86.7％,B超为84.8％,CT为72.2％。46例行胰十二指肠切除术(Whippie),30例行十二指肠乳头肿瘤局部切除术,3例行姑息性胆-肠吻合术。结论:纤维十二指肠镜、ERCP是诊断十二指肠乳头肿瘤的有效检查方法,早期诊断、早期选择合理的根治性切除手术是治疗的关键。

Objective:To improve early diagnosis and treatment of duodenal papilla tumor. Methods;79 cases of duodenal papilla tumor were confirmed by operation and pathology from 1992 to 2002, and their clinical data were analyzed retrospectively. Results:There were 71 cases of duodenal papilla carcinoma, 5 cases of duodenal adenoma and 3 cases of atypical hyperplasia in these series. The first clinical manifestation were painless jaundice (61 cases) , dull pain and distention in upper abdomen( 14 cases) and hemorrhage of upper digestive tract(4 cases). The accuracy of ERCP, Fiberoptic duodenoendoscopy , MRCP.BUS and CT were 100% , 92.4% , 86.7% , 84.8% and 72. 2% respectively. 46 cases underwent pancreatoduodenectomy, 30 cases received local resection, the remaining 3 cases were treated by palliative surgery. Conclusion: Fiberoptic duodenoendoscopy and ERCP are major methods for diagnosis of duodenal papilla tumor. It is essential to diagnose early and select rationale operation to improve the results of surgical treatment.