原发性十二指肠癌22例诊治分析

材料和方法１．１材料１９８７０２／１９９７１２我院共收治原发性十二指肠癌２２例,全部病例均经病理证实,其中男１３例,女９例,年龄４２岁～６８岁．１．２方法全组病例均行手术探查,１２例行胰十二指肠切除术（其中Ⅰ期３例,Ⅱ期１例,Ⅲ期８例）,其中位于...     

原发性十二指肠肿瘤26例诊治分析

目的回顾性分析26例原发性十二指肠肿瘤的诊治情况。方法收集本院内镜室近两年来所检出的原发性十二指肠肿瘤患者26例,对其一般情况、临床症状、肿瘤发生部位及病理检查、诊治情况进行分析。结果原发性十二指肠肿瘤临床上以腹痛、黄疸多见;病变多发于十二指肠乳头周围部;良性肿瘤者病理多表现为腺瘤,而恶性肿瘤者多表现为腺癌;内镜（包括胃镜和十二指肠镜）结合十二指肠低张造影可显著提高该病的诊出率,而其他检查方法检出率不高;外科手术切除是最基本的治疗方法。结论本病的误诊率相对较高,对于40岁以上患者出现腹痛、黄疸、上消化道出血、高位肠梗阻及溃疡症状而又不能用肝、胆、胃等疾病解释时,要考虑该病的可能,从而针对本病做详细地检查,减少误诊,提高早期诊出率。     

原发性十二指肠恶性肿瘤13例诊治体会

原发性十二指肠恶性肿瘤少见，起病隐匿，表现无特异性，早期诊断较困难，由于其解剖和生理的特异性，治疗上亦有一定的难度。1980-1997年，我院和我市中心医院共诊治经病理检查证实为原发性十二指肠恶性肿瘤患者13例，现将诊治体会报告如下。     

原发性十二指肠肿瘤37例临床分析

目的探讨原发性十二指肠肿瘤(PDT)的临床表现、病理特征和诊断方法,总结经验,以减少误诊。方法回顾分析我院2005年1月-2010年12月收治的37例PDT的临床资料。结果本组病例常见症状表现为上腹痛、黄疸、发热、呕吐、消化道出血、纳差、消瘦等。肿瘤好发部位以十二指肠降部尤其是乳头周围居多,占62.1%,病理以腺癌为主,占64.9%。各种检查方法确诊率分别是胃镜44.0%、GI 40.0%、CT 56.3%、MRI+MRCP 41.7%、B超16.0%、ERCP 66.7%、超声内镜100%。29例行手术联合化疗,5例化疗加ERCP支架术,2例动脉血管造影下止血、化疗。结论 PDT以恶性肿瘤为主,早期症状隐匿,误诊率高,诊断首选内镜检查,联合GI、CT等检查可提高检出率,超声内镜对黏膜下肿瘤诊断价值高,胰、十二指肠切除是主要治疗手段。     

原发性十二指肠恶性肿瘤11例诊治体会

1985年 1月至 1998年 1月我院共收治原发性十二指肠肿瘤 11例 ,现将诊治体会报告如下。 　　临床资料：本组男 5例,女 6例,年龄 39～ 71岁,平均年龄 57岁。病程 10天至 8个月,平均 2.4个月。临床表现有腹痛 8例,呕吐 6例,黄疸 3例。腹部包块 2例,黑便 1例。胃肠钡餐检查 7例中 ,6例诊断十二指肠恶性肿瘤,另 1例诊断为十二指肠球部溃疡。胃镜检查 3例中 ,2例诊断十二指球部恶性肿瘤,另 1例未发现病灶。 B超检查 9例中 ,3例发现胆道扩张, 4例发现右上腹包块（其中 2例考虑十二指肠肿瘤, 1例考虑结肠肿瘤, 1例诊断胆总管下端肿瘤…     

原发性十二指肠肿瘤23例报告

原发性十二指肠肿瘤较少见，因十二指肠的解剖生理特点，使该病的诊断治疗有一定难度。现报告我院1985年—1995年外科收治的23例，均经手术或／和活检证实。     

结肠癌行胰十二指肠切除术一例报道

结肠癌常常侵及邻近器官,在能进行根治性切除的情况下,通常能够改善患者的预后。结肠癌侵犯胰头时需要在进行结肠癌切除的同时行胰十二指肠切除术,往往是一个巨大的挑战。在手术适应证、患者是否获益及围手术期处理等方面需要仔细权衡。本文就一例结肠癌侵犯胰腺行胰十二指肠切除术的病例进行汇报。     

原发性十二指肠肿瘤17例诊断分析

十二指肠肿瘤由于发病率较低，常规胃镜和钡餐x线检查常不能发现病灶，成为临床诊断的一大难题。本文回顾性总结近6年来经外科手术及病理证实的17例进行分析，就其临床特点和诊断探讨如下。     

原发性十二指肠癌诊断措施探讨—附41例分析

原发性十二指肠癌患病率低，由于早期症状元特异性，极易误诊，多数报道术前诊断率很低‘’‘。我们总结了1980年～1994年间经手术及病理证实的原发性十二指肠癌41例，本文结合临床、胃镜、X线钡餐检查对照分析，探讨误诊原冈从而为早期诊断提供依据。临床资料41例患者中男27例，女14例，平均年龄为56．2岁（32～72岁），其中40岁以上34例（82．9％），平均病程12．8个月（2个月～3年）。41例中腺癌39例，类癌1例，鳞状上皮细胞癌1例。病变位于球部10例，降段24例，水平段7例。内镜检查：术前经胃镜或十二指肠镜检查33例，27例得以确诊（8…     

原发性十二指肠球部腺癌1例

1 病例报告 男,57岁。因反复黑便3个月,进行性消瘦1个月于1994-07-30入院。入院前33d外院内镜诊断十二指肠球部溃疡。给予抑酸、抗炎等药物治疗,效果不佳。入院后体检:消瘦,重度贫血外貌,锁骨上淋巴结不肿大。心肺未见异常。腹软,全腹无压痛,上腹偏右可扪及一边界不清,质较硬,大小约7cm×6cm的包块,包块固定,无明显压痛。肝脾肋下未触及,无腹水征。血红蛋白63g/L,大便潜血试验阳性,肝胆脾胰B超及胸片正常。外院CT提示:十二指肠球部占位性病变,肝胆脾胰及肺部未见占位性病变。复查内镜见:十二指肠球部后壁小弯侧有一个约3.5cm×4cm的溃疡样肿物,周边隆起,边界不平整,底部凹凸不平,覆盖有污秽苔,组织接触易出血。刷片细胞学检查发现癌细胞。手术治疗,术中见十二指肠球部至球后部有一6cm×5cm×2cm的肿块,质硬,侵及浆膜,与胰腺组织粘连,肿块中央有一3cm×4cm     

Case report of early duodenal cancer with segmental resection and longterm survial. Review of 122 reported Japanese cases

We report a case of early duodenal cancer (2.5 cm in diameter, located in the proximal part) in a 65-year-old female whom segmental resection was performed and a 7- year disease-free survival was achieved. The surgical specimen, showed and a 2.5 × 1.5 × 1.0cm exophytic lesion histopathological examination revealed highly differentiated intramucosal adenocarcinoma. We also report or our review of 122 cases of early duodenal cancer reported in Japan. Intramucosal carcinoma was found in 66%, and submucosal carcinoma in 34% of the patients. The location of the lesion was bulbar in 73 patients (60%), supraampullary in 33 (27%), periamupllary in 5 (4%), and infraampullary in 11 (9%). Distal gastrectomy, including the bulb, was performed in 46 patients, pancreatoduodenectomy in 23, partial resection in 24, endoscopic polypectomy in 25, and segmental resection in 4, including our patient. The frequency of lymph node metastasis is low in early duodenal cancer, so that segmental resection appears to be a reasonable treatment method.     

十二指肠黏膜下肿瘤的内镜治疗

目的 总结内镜治疗十二指肠黏膜下肿瘤( SMT)的经验,探讨其临床价值.方法 回顾分析2006年5月至2011年5月复旦大学附属中山医院内镜中心行内镜治疗的十二指肠SMT患者资料,了解病变特点、手术过程、术后并发症及复发情况.结果 共67例患者接受了69例次内镜治疗,其中男性36例,女性31例,中位年龄55岁,病变平均最大径(1.34±0.50) cm.69例病变中,位于球部38例、球降交界部12例、降部19例.均成功完成内镜治疗,其中电切治疗11例,内镜黏膜切除术(EMR) 12例,内镜黏膜下剥离术(ESD) 45例,尼龙绳结扎1例.并发症发生率14.5％(10/69),其中术中发生活动性大出血1例,穿孔2例,延迟性出血3例,一过性淀粉酶水平增高3例,迟发性穿孔1例.67例获病理诊断,其中最常见的是Brunner腺瘤(36例).60例患者术后随访,中位随访时间为13个月.1例类癌患者ESD术后病理诊断提示脉管内有肿瘤细胞,再行择期扩大切除术.1例Brunner腺瘤患者EMR术后1年复发,再行ESD治疗后好转.结论 内镜治疗安全、微创、有效,可成为部分十二指肠SMT的治疗方案之一.     

35例原发性十二指肠癌的诊断及治疗分析

目的总结原发性十二指肠癌的诊治经验,提高其诊治水平。方法回顾分析2001年1月～2007年12月我院经内镜及手术确诊的35例原发性十二指肠癌患者的临床资料。结果本组病例肿瘤位于十二指肠球部6例;十二指肠降部26例;十二指肠水平部3例。其中乳头状腺癌8例、管状腺癌23例、黏液腺癌2例,类癌1例,恶性间质瘤1例。胃镜确诊率为77.4%;上消化道钡餐造影确诊率为52.4%。CT确诊率为46.7%;B超确诊率为10.3%;MRCP确诊率为6.9%。行胰十二指肠切除术22例,十二指肠乳头切除、乳头成形术6例,胃空肠吻合术3例,单纯肿物切除术1例,姑息性旁路手术2例。结论原发性十二指肠癌发病部位以十二指肠降部尤其乳头周围部为多,病理以腺癌为主;本病诊断首选内镜检查,其次是十二指肠气钡双重造影;手术切除尤其是胰十二指肠切除术是最常用、最可靠的治疗方法。     

Endoscopic diagnosis and treatment of superficial nonampullary duodenal tumors

The diagnostic and treatment guidelines of superficial non-ampullary duodenal tumors have not been standardized due to their low prevalence.Previous reports suggested that a superficial adenocarcinoma(SAC) should be treated via local resection because of its low risk of lymph node metastasis,whereas a highgrade adenoma(HGA) should be resected because of its high risk of progression to adenocarcinoma.Therefore,pretreatment diagnosis of SAC or HGA is important to determine the appropriate treatment strategy.There are certain endoscopic features known to be associated with SAC or HGA,and current practice prioritizes the endoscopic and biopsy diagnosis of these conditions.Surgical treatment of these duodenal lesions is often related to high risk of morbidity,and therefore endoscopic resection has become increasingly common in recent years.Endoscopic mucosal resection(EMR) and endoscopic submucosal dissection(ESD) are the commonly performed endoscopic resection methods.EMR is preferred due to its lower risk of adverse events;however,it has a higher risk of recurrence than ESD.Recently,a new and safer endoscopic procedure that reduces adverse events from EMR or ESD has been reported.     

Application of laser scatering spectrumin diagnosis and treatment of gastric and duodenal malignant tumors

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十二指肠乳头肿瘤的内镜下切除

随着内镜下逆行胰胆管造影(ERCP)的广泛应用,十二指肠乳头肿瘤越来越多地被发现。该病手术治疗创伤大,并发症和死亡率高,采用内镜下切除则创伤小、恢复快,且安全、疗效肯定。此文就内镜下对十二指肠乳头肿瘤的诊断、切除的适应证、技术、安全和有效性及并发症作一综述。     

新生儿十二指肠梗阻诊治方法探讨

目的 探讨新生儿十二指肠梗阻的诊治方法与病理特点。方法 总结近10年来56例新生儿十二指肠梗阻的临床资料,对术前诊断、病理分型及治疗方法进行回顾性分析。结果 56例患儿术前均行X线腹部平片检查,51例行上消化道造影检查,28例行钡灌肠检查．22例行超声检查。56例患儿均在全麻下实施手术治疗,手术证实先天性肠旋转不良28例(50％),十二指肠膜状狭窄、闭锁18例(32．1％),环状胰腺8例(14．3％),先天性异常索带2例(3．6％)。治愈52例,死亡4例(7．14％)。结论 术前X线检查是诊断新生儿十二指肠梗阻的有效方法,先天性肠旋转不良为首发病理类型,一旦确诊宜积极早期手术。     

Clinical characteristics and course of sporadic non-ampullary duodenal adenomas: A multicenter retrospective study

Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into “no-resection” and “resection” groups based on the initial treatment approach. We investigated the long-term outcome of the “no-resection” group and treatment results of the “resection” group, with particular interest in endoscopic resection.Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31–88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2–60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.