90例原发性十二指肠癌临床特征分析

目的探讨原发性十二指肠癌的诊断方法和治疗体会。方法回顾性分析安徽医科大学第一附属医院2004年4月至2010年10月收治的90例经内镜活检或术后病理证实的十二指肠癌患者的临床资料。结果本组病例主要临床表现为上腹疼痛不适、黄疸、发热、黑便;术前经十二指肠镜、上消化道造影、B超、CT、MRI(MRCP)检查其阳性确诊率分别为89.2%、81.6%、40.6%、73.1%、77.4%;内镜和造影联合检查阳性率为93.1%;肿瘤指标CA199阳性率为77.8%、CEA阳性率为73.0%,病理类型以腺癌为主(96.7%),本组误诊12例,本组病例行手术86例,其中胰十二指肠切除术61例,切除率为70.9%,术后随访资料1年生存率为70.9%。结论十二指肠癌易误诊和漏诊,对常见疾病如胰腺炎、胆管结石、十二指肠球部溃疡不应放松警惕;十二指肠镜、上消化道造影等多种检查方法合理选择对提高患者诊断率具有重要作用,肿瘤指标CA199可作为十二指肠癌是否侵犯胰腺的重要参考指标,早期手术仍是治疗十二指肠癌的主要治疗方法,其中以胰十二指肠切除术为首选。

Clinical characteristic of 90 cases with primary duodenal carcinoma

Objective To investigate the diagnosis methods and treatment experience of primary duodenal carcinoma.Methods The clinical data of 90 cases which were confirmed to be primary duodenal carcinoma after Endoscopic biopsy and Postoperative pathologic from April,2004 to October,2010 in Anhui medical university first affiliated hospital were analyzed retrospectively.Results The major clinical manifestations of these patients were epigastric pain,obstructive jaundice,fever and melena.The correct diagnostic rate of auxiliary examination were:Duod enoscopy of 89.2%,image examination of 81.6%,ultra-sound of 40.6%,CT of 73.1%,MRI or MRCP of 77.4%,Tumor Index The positive diagnose rates of CA19-9 was77.8% and the positive diagnose rates of CEA was 73.0%.The type of Pathological mostly were adenocarcinoma(96.7%).86cases were operated,61 cases underwent pancreastoduodenectomy,the Survival rate 1-year was 70.9%.Conclusion Primary duodenal carcinoma more easy to misdiagnosis.proper adoption of endoscopic and radiological studies are favorable for preoperative diagnosis.Tumor Index CA199 is the key reference index of whether primary duodenal carcinoma infringe upon the pancreas.Primary treatment,especially pancreaticoduodenectomy is still the major method of Primary duodenal carcinoma.