基层医院原发性小肠肿瘤24例诊治分析

目的:探讨基层医院原发性小肠肿瘤的诊治方法。方法:回顾性分析我院1993年6月~2007年1月经手术和病理证实的原发性小肠肿瘤24例的临床资料。结果:腹痛、腹胀、梗阻、消化道出血、腹块、黄疸是主要的临床表现,胃、十二指肠镜/上消化道造影对十二指肠肿瘤诊断的阳性率100%,全消化道造影对空回肠诊断阳性率66.7%,B超+CT对小肠肿瘤的诊断阳性率63.2%,术前未能确诊20.8%,恶性肿瘤的根治率33.3%。结论:原发性小肠肿瘤早期诊断困难,对腹痛,腹胀,梗阻,消化道出血,腹块,黄疸的病人,应进行B超、CT、消化道造影、内镜组合检查,无法确诊者,应行剖腹探查。手术是主要的治疗方式,甲磺酸伊马替尼对胃肠间质瘤治疗有重要的作用。螺旋CT、双气囊小肠镜、球囊内镜对提高诊断率甚至早期诊断率有很大的帮助。

Diagnosis and treatment of primary small intestinal tumor in primary hospital: A report of 24 cases

Objective:To explore the diagnosis and treatment of primary small intestinal tumors(PSIT) in primary hospital.Methods: Retrospective analysis was used in this study by reviewing the clinical and pathological data of 24 PSIT cases from June 1993 to January 2007.Results: The most common symptoms in this disease were abdominal pain and distension,intestinal obstruction,hemorrhage of digestive tract and abdominal mass with jaundice as major clinical manifestation.The upper gastrointestinal radiography or fiberoptic gastroduodenoscopy for diagnosis of primary duodenal neoplasms suggested 100% accuracy,but 66.7% were confirmed by gastrointestinal barium meal examination while B-mode ultrasound tomography with CT confirmation for jejunum and ileum tumor was 63.2%.Unfortunately 20.8% patients failed to be identified before operation.33.% patients received radical cure in total cases.Conclusion: Early diagnosis of primary small intestinal tumor is difficult.Therefore,for those who suffer from abdominal pain and distension,intestinal obstruction,hemorrhage of digestive tract,abdominal mass and jaundice must be undergone combined examination of B-mode ultrasound tomography,CT scanning,gastrointestinal radiography and endoscope.Exploratory laparotomy must be carried out if it is incapable of diagnose.Surgical intervention must be the first choice in the management.The use of imatinib mesylate is effective to GISTs.Multi-slice spiral CT,double-balloon endoscopy,saccule endoscope can increase the diagnosis rate and even early diagnosis.