十二指肠乳头癌临床分析：附80例报告

目的:探讨十二指肠乳头癌早期诊断及手术方法。方法:回顾分析中南大学湘雅医院2010年3月—2017年3月收治的80例十二指肠乳头癌患者资料,其中16例行局部切除术,64例行胰十二指肠切除术。结果:主要首发临床表现为皮肤瘙痒、进行性黄疸60例(75.0%),腹痛不适40例(50.0%),畏寒、发热4例(5.0%),食欲不振、消瘦3例(3.75%),检查发现十二指肠乳头肿物2例(2.5%)。术前B超、CT、MRI、胃镜/十二指肠镜、ERCP阳性率分别为82.26%、89.66%、91.3%、93.75%、94.29%。行十二指肠乳头局部切除术16例中,13例为十二指肠乳头腺癌,1例为十二指肠乳头神经内分泌癌,2例为十二肠乳头腺瘤局部癌变;行胰十二指肠切除术组共64例中,61例为十二指肠乳头腺癌,2例为十二指肠乳头神经内分泌癌,1例为十二指肠乳头腺瘤局部癌变。与十二指肠切除术患者比较,局部切除术患者术中出血量、住院费用、术后并发症发生率均明显降低(均P0.05),但平均住院时间无统计学差异(P0.05),术后1、3、5年生存率均无统计学差异(均P0.05)。结论:对于十二指肠乳头癌,十二指肠镜及ERCP是相对较可靠的诊断方法,应首选胰十二指肠切除术;对于某些特殊病例,局部切除术在严格掌握其适应证的前提下,术中确保切缘阴性,可以作为一种安全有效的手术方式。

Clinical analysis of cancer of the duodenal papilla: a report of 80 cases

Objective: To investigate the early diagnosis and surgical treatment of cancer of the duodenal papilla. Methods: The clinical data of 80 patients with cancer of the duodenal papilla treated in Xiangya Hospital of Central South University from March 2010 to March 2017 were retrospectively analyzed. Of the patients, 16 cases underwent local resection and 64 underwent pancreatoduodenectomy (PD). Results: The main initial clinical manifestations included pruritus and jaundice in 60 cases (75.0%), abdominal pain and discomfort in 40 cases (50.0%), chills and fever in 4 cases (5.0%), inappetence and emaciation in 3 cases (3.75%), and mass at the duodenal papilla found by examinations in 2 cases (2.5%). The positive rates of preoperative ultrasound, CT, MRI, gastroscope/duodenal endoscope and ERCP were 82.26%, 89.66%, 91.3%, 93.75%, 94.29%, respectively. Among the patients undergoing local resection, 13 cases were adenocarcinoma of the duodenal papilla, one case was neuroendocrine carcinoma of the duodenal papilla and 2 cases were local canceration of duodenal papilla adenoma; among those undergoing PD, 61 cases were adenocarcinoma of the duodenal papilla, 2 cases were neuroendocrine carcinoma of the duodenal papilla and one case was local canceration of duodenal papilla adenoma. In patients undergoing local resection compared with those undergoing PD, the average intraoperative blood loss, hospitalization cost and incidence of postoperative complications were significantly reduced (all P<0.05), but the average length of hospital stay showed no significant difference (P>0.05), and postoperative 1-, 3- and 5-year survival rates also showed no significant difference (all P>0.05). Conclusion: For cancer of the duodenal papilla, duodenoscopy and ERCP are relatively reliable diagnostic methods, and PD should be the first choice of treatment options. For some special cases, local resection can be used as a safe and effective surgical method based upon the premise of strict adherence to indications and ensuring the negative margins during operation.