原发性十二指肠肿瘤86例的诊断和治疗
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原春辉

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The diagnosis and treatment of 86 cases of primary duodenal tumors〖STBZ〗
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    目的:探讨原发性十二指肠肿瘤的诊断及治疗方法。方法:回顾分析26年间收治的86例原发性十二指肠肿瘤患者的资料,其中良性18例,恶性68例。诊断依赖于肠镜和影像学检查,治疗有赖于外科切除术。结果:临床表现包括胃肠道症状、胆道梗阻症状和非特异性的发热贫血及消瘦等。术前确诊率十二指肠镜为91.3%,气钡造影为88.5%,磁共振胰胆管造影为84.6%,B超为31.9%,CT为51.9%,磁共振为76.2%,ERCP为100%;联合十二指肠镜、气钡造影检查确诊率可达95.0%。71例发生于十二指肠降部。18例原发性十二指肠良性肿瘤全部被切除,5年生存率为92.3%;68例原发性十二指肠恶性肿瘤中35例行胰十二指肠切除,8例行十二指肠节段切除,切除率为63.2%;切除术后5年生存率为31.0%;25例行旁路手术,5年生存率为0。结论:原发性十二指肠肿瘤缺乏特异性症状,经内镜、气钡造影等联合检查,可提高术前阳性诊断率。对良性肿瘤可行十二指肠节段切除或局部切除,恶性肿瘤首选胰十二指肠切除术。

    Abstract:

    ObjectiveTo investigate the diagnosis and therapeutic methods of primary tumors of duodenum(PTD). MethodsClinical data of 86 patients with primary duodenal tumors who were hospitalized in the First Affiliated Hospital of China Medical University during 26 years were analyzed retrospectively. Of all the tumors,18 cases were benign tumors and 68 cases were malignant tumors. ResultsThe clinical manifestationswere symptoms of bile duct obstruction, GI and nonspecific symptoms, and signs included fever, anemia and weight loss. The correct preoperative diagnostic rate by auxiliary examinations were:duodenalendoscopy 92%, air barium double radiography 89%, MRCP 85%, BUS 33%, CT 51%, MRI 75%, and duodenal endoscopy combined with air barium double radiography were 95%. Tumors were mostly located in the descending portion of duodenum(71 cases). Eighteen cases of benign PTDs were resected completelywith a 5year survival of 92.3%. Among the 68 maligant PTD cases, 35 cases underwent pancreatoduodenectomy, and 8 cases received segmental duodenectomy, with a resection rate of 63.2% and the 5year survival rate of 31.0%. The remaining 25 cases, in which the tumors were unresectable, were treated by bypass operations, the 5year survival rate was 0%. ConclusionsPatients with PTD usually lack specific symptoms and signs, but combination of endoscopy, GI air barium double radiography and other examinationscan improve the preoperative positive diagnostic rate. Segmental duodenectomy and simple tumor resection are curable for primary benign tumors of duodenum; while for primary malignant tumors of duodenum, the therapy of choice should be pancreatoduodenectomy.

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原春辉,刘永锋,何三光.原发性十二指肠肿瘤86例的诊断和治疗[J].中国普通外科杂志,2005,14(10):12-759.
DOI:10.7659/j. issn.1005-6947.2005.10.012

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  • 在线发布日期: 2005-10-25