原发性小肠肿瘤的诊断与治疗

目的 探讨小肠肿瘤的临床特点以及影响小肠恶性肿瘤预后的因素。方法 回顾分析1974年－1999年收治的42例原发性小肠肿瘤病例（不包括壶腹周围癌）的临床资料。结果 本组小肠性肿瘤6例中5例为平滑肌瘤，1例为腺瘤；恶性肿瘤36例，其中恶性淋巴瘤17例（47．2％），腺癌11例（30．6％），平滑肌肉瘤6例（16．7％），类癌1例（2．8％），神经纤维肉瘤1例（2．85）。临床症状无特异性，内镜和消化道钡餐是主要诊断手段。50％的恶性病例在手术时已有远处转移，仅18例（50％）根治性切除。36例获随访。小肠恶性肿瘤患者术后5年生存率为47．3％。远处转移和肿瘤大小对生态率有显著影响。结论 早期诊断、早期治疗是提高小肠恶性肿瘤预后的主要手段，对无远处转移后应争取行根治术。

Diagnosis and treatment ofprimary small bowel tumors

Objective To study the clinical manifestation of small bowel tumors and the prognostic factors. Methods Retrospective analysis of the clinical data were made on 42 cases of primary small bowel tumors (except periampullary tumors) admitted to our hospital from 1974 to 1999. Results In this series, there were 6 cases of benign small bowel tumors, 5 of them were leiomyoma and 1 adenoma. Of the 36 cases of malignant tumors, there were malignant lyphoma in 17 cases (47.2%), adenocarcinoma in 11 (30.6%), leiomyosarcoma in 6(16.7%), carcinoid tumor in 1 (2.8%) and neurofibrosarcoma in 1 (2.8%). There was no characteristic clinical sign in small bowel tumors; endoscopy and barium series were the main diagnostic methods. About 50 per cent of patients with malignancy had metastasis, and only 18 cases (50%) received radical resection. Follow up were available on 36 cases. The overall 5 year survival rate in the patients with malignant small bowel tumors was 47.3%. Multivariate analysis showed that metastasis and diameter of tumors were the main prognostic factors of the 5 year survival. Conclusions Early diagnosis and early treatment play the key roles in improving the prognosis of malignant small bowel tumors. Radical resection should be taken if no metastasis is found.