原发性十二指肠癌38例的诊治体会

目的探讨原发性十二指肠癌的诊断与治疗方法。方法回顾性分析38例原发性十二指肠癌的临床资料。结果肿瘤位于球部4例，降部30例，水平部2例，升部2例。腺癌33例。上腹部压痛22例，无阳性体征3例，腹块3例，黄疸10例。钡餐、B型超声、CT、纤维十二指肠镜以及经内镜逆行胰胆管造影（ERCP）对十二指肠肿瘤有诊断价值。38例中30例行胰十二指肠切除术，3例行节段性十二指肠切除术，5例行姑息性手术。切除率为86．8％。23例得到随访，随访率为60．5％，1年生存率为76．4％，3年生存率为43．7％，5年生存率为33．5％。结论纤维十二指肠镜和ERCP是诊断本病的可靠方法，手术切除是治疗的主要手段。肿瘤部位不同，手术方法也不一样。十二指肠乳头上方肿瘤以胃十二指肠切除为主，乳头下方以十二指肠节段性切除为主，乳头周围肿瘤根据肿瘤生物学特性选择胰十二指肠切除术或经十二指肠肿瘤局部切除。

Diagnosis and treatment of primary duodenal carcinoma: 38 cases

Objective To investigate the diagnosis and treatment of primary duodenal carcino- ma. Methods Clinical data of 38 cases of primary duodenal carcinoma were analyzed retrospectively. Results Of all the tumors, lesions were located in the duodenal bulb in 4 cases, in the descending por- tion in 30 cases, in the horizontal portion in 2 cases, and in the ascending part in 2 cases. There were 33 cases of adenocarcinoma. Twenty-two cases complained of upper abdomen pain, 3 cases had no positive signs, abdominal mass was found in 3 cases and jaundice was detected in 10 cases. Barium meal examination, BUS, CT, duodenoscope and ERCP were very useful in the diagnosis of primary duodenal carcinoma. Thirty out of 38 patients received pancreaticoduodenctomy, 3 cases received segmental duodenctomy, and 5 eases underwent palliative surgery. Removal rate was 86. 8 %. Twenty- three cases （60. 5 %） were followed up. One-, 3- and 5-year survival rate was 76. 4 %, 43. 7 % and 33. 5 %respectively. Conclusion Duodenoscope and ERCP are the principle methods for diagnosis of duodenal tumor. Surgical resection is the main means of treatment. The therapy varies as the different location of the tumors. The gastroduodenoteetomy is advisable mainly for the tumor above the papilla, the duodenal segmental excision is for the tumor below the papilla, and either the pancreatoduodenectomy or the local excision of the local excision of the duodenal carcinoma is the choice for the papilla periphery carcinoma according to the biological property of the tumor itself.