摘要
目的探讨原发性十二指肠癌的诊断和治疗方法。方法回顾性分析我院1995—2005年间治疗的原发性十二指肠癌54例的临床资料。结果本组肿瘤位于球部6例（10％）、降部44例（82％）、水平与升部各2例（4％），其中降部乳头区为38例，占降部86％。病理类型为腺癌50例（92％），黏液腺癌2例（4％），类癌与低分化腺鳞癌各1例（2％）。主要临床表现为黄疸、腹痛、消瘦、食欲减退、腹胀、恶心、呕吐、上腹部压痛及腹部包块。经纤维十二指肠镜及ERCP确诊率分别为94％和78％。合并胆囊病变率为37％。行胰十二指肠切除38例，节段性十二指肠切除1例，姑息性手术9例，失去手术时机6例。手术切除率为89％，其中根治性切除率为72％。行胰十二指肠切除患者的3年和5年生存率分别为41％和22％，姑息性手术3～24个月死亡，未行手术者6个月内死亡。结论原发性十二指肠癌以降部乳头区最多见，以腺癌为主，临床表现特异性差，易合并胆囊病变。纤维十二指肠镜和ERCP是诊断的主要手段，治疗首选胰十二指肠切除术。
Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum. Methods The clinical data of 54 cases with primary malignant tumor of the duodenum at Peking University People＇s Hospital from 1995 to 2005 were analyzed retrospectively. Results Tumors located in the first, second, third and fourth parts in 6 cases （10%） ,44 cases （82%）, 2 cases （4%）, and 2 cases （4%） respectively, and among them, tumors within papillary area accounted for 86% （38 cases） of all cases. Fifty cases （92%） were of adenocarcinoma, 2 cases （4%） of mucinous adenocarcinoma carcinoid and undifferentiated carcinoma for 1 case each （2%） respectively. The main clinical presentations included jaundice, upper abdominal pain, weight loss, abdominal distention, nausea and vomiting, gastrointestinal obstruction and abdominal mass. The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94% , and 78% respectively. Preoperative associated cholecystopathy accounted for 37%. Panceatieoduodenectomy was performed in 38 cases, duodeneetonmy in 1 case, palliative resection of tumor in 9 cases, and tumor was inoperable in 6 cases. Resection rate was 89% , and radical resection rate was 72%. The postoperative 3- and 5- year survival rate was 41% and 22% respectively. Patients after palliative resection died from 3 months to 24 months and all patients who did not undergo a surgery died within 6 months. Conclusions Tumors located in papillary region account for the majority of primary malignant tumors of the duodenum and are mainly of adenoearcinoma. Specific signs on abdominal examination are few. The symptoms of advanced stage are complicated, associated cholecystopathy is relatively frequent. Endoscopy and ERCP examination are the main diagnostic tools, the pancreatoduodenectomy is the first choice of therapy for patients with primary duodenal carcinoma.
出处
《中华普通外科杂志》
CSCD
北大核心
2009年第2期125-127,共3页
Chinese Journal of General Surgery
