原发性小肠恶性肿瘤52例术前诊断分析

目的：探讨原发性小肠恶性肿瘤的术前诊断方法。方法：回顾性分析52例原发性小肠恶性肿瘤患者的临床资料。结果：十二指肠20例，其中十二指肠球部癌4例，乳头部癌10例，降段癌5例，水平段癌1例。空肠恶性肿瘤13例，回肠恶性肿瘤19例。术前胃镜及镜下活检确诊十二指肠球部癌4例，乳头部癌8例；十二指肠及镜下活检确诊乳头部癌2例，降段癌1例；小肠气钡双重造影确诊15例，螺旋CT确诊3例；B超确诊1例，剖腹探查确诊18例。结论：原发性小肠恶性肿瘤因临床表现无特征性，术 前诊断较困难。胃镜及十二指肠镜诊断阳性率高，对空肠和回肠恶性肿瘤患者术前诊断首选小肠气钡双重造影，必要时可结合螺旋CT、B超检查。对于高度疑诊患者可适当放宽剖腹探查指征。

Preoperative Diagnosis for 52 Cases of Primary Intestinal Malignant Tumor

Objective To discuss the preoperative diagnosis of primary intestinal malignant tumor.Methods Retrospective analysis was performed in 52 patients with primary intestinal malignant tumor from Jan.1980 to Jan.2002.Results 20 cases were duodenal carcinoma(4 cases in duodenal bulb,10 in papilla,5 in descending part and 1 in horizontal part).13 were jejunum cancer and 19 ileum carcinoma.Before operation,4 cases with duodenal bulb cancer and 8 with papilla cancer were confirmed by gastroscopy and pathological examination,2 cases with papilla cancer and 1 in descending part were confirmed by duodenoscopy,15 by pneumobarium double contrast examination,3 by screw CT and 1 by B ultrasonic examination.The left 18 cases were confirmed after exploratory laparotomy.Conclusion As the clinical manifestation of primary intestinal malignant tumor is of non specificity.It is more difficult to diagnosis before operation.The positive rate of diagnosis for duodenal carcinomas was higher by gastroscopy and duodenoscopy.For the preoperative diagnosis of malignant tumor of jejunum and ileum pneumobarium double contrast examination is the first choice,combined screw CT and B ultrasonic examination at necessary.The indication of exploratory laparotomy for high suspected patients may extend accordingly.