十二指肠间质瘤12例诊治体会

目的：探讨十二指肠间质瘤的临床病理特征及外科治疗效果。方法：回顾性分析我院1999年1月至2006年12月12例十二指肠间质瘤患者的临床资料。结果：十二指肠间质瘤主要集中在降部和水平部．临床表现为反复黑使（7／12）、右上腹隐痛不适（5／12）、右上腹肿物（2／12）、黄疸（1／12）。行胰十二指肠切除3例．行十二指肠节段切除9例，肿块直径平均（5、5±4．6）cm，〈5cm者7例，≥5cm者5例。术后随访8～96个月，1例术后20个月死于肿瘤复发合并肝转移，其余已健康存活8个月～8年。结论：十二指肠间质瘤是一种低度恶性肿瘤,根据肿瘤大小和位置采取不同的手术方式,肿瘤完全切除者预后良好     

原发性十二指肠腺癌影像学诊断(附11例分析)

原发性十二指肠腺癌影像学诊断（附１１例分析）姜法伟，姚林果，王建平原发性十二指肠恶性肿瘤很少见。现将资料完整的１１例原发性十二指肠腺癌报告如下：１一般资料本组１１例中男７例，女４例，年龄３０～６４岁（平均５２岁）。病程１５天～８个月。双对比低张造影７...     

原发性十二指肠腺癌43例诊治体会

目的 :探讨原发性十二指肠腺癌的诊断、治疗方法和预后。方法 :对我院 1987年 5月～ 1997年 5月43例原发性十二指肠腺癌的诊断、治疗和预后等临床资料进行回顾性分析。结果 :原发性十二指肠腺癌最常见的临床表现为阻塞性黄疸 (占 5 5 8% )。术前确诊率胃十二指肠镜为 86 8% ,上消化道钡餐为 79 5 % ,CT为 46 7% ,经皮肝穿刺胆道造影为 41 5 % ,B超为 2 9 0 %。肿瘤位于十二指肠第二段占 44 2 %。 2 8例行根治性手术 ,10例行姑息性手术 ,5例仅行剖腹探查活检术。所有病例 5年生存率为 2 7% ,平均存活 18个月。手术切除组和非切除组5年生存率分别为 42 %和 0 ,平均存活 62个月和 7个月 (P <0 0 5 )。结论 :胃十二指肠镜和上消化道钡餐是诊断原发性十二指肠腺癌的主要检查方法。提高生存率的唯一办法是尽可能行根治性胰十二指肠切除术。     

原发性十二指肠恶性肿瘤32例分析

目的：探讨原发性十二指肠恶性肿瘤的临床和病理特点、诊断及治疗选择。方法：回顾性分析1979－1999年经治的32例原发性址二指肠恶性肿瘤的临床和病理资料。结果：本组病理类型为腺癌占75％,平滑肌肉瘤12．5％,类癌9．4％,恶性淋巴瘤3．1％。且56．3％发生于乳头区（均为腺癌）。32例均予手术治疗,手术切除率为71．9％。手术切除组1,3,5年生存率分别为90％,69．2％,42．9％;行姑息性转注手术者,平均存活7．5个月。结论：十二指肠低张气钡造影和纤维十二指肠镜是本病的首选有效检查方法,结合病史并联用多项检查方法可望提高诊断率。手术方式取决于肿瘤的病量类型、发生部位、浸润深度和淋巴结转移情况。早期诊断和及时手术切除是提高生存率的关键。     

原发性十二指肠恶性肿瘤九例误诊分析

原发性十二指肠恶性肿瘤少见，因其临床上缺乏特异性症状，往往容易漏诊、误诊。我们将1984年以来收治的经病理证实的9例原发性十二指肠恶性肿瘤误诊病例报告并分析如下。1临床资料1.1一般资料本组男6例，女3例；年龄41～76岁。平均55．2岁。误诊时间：最短2个月，最长16个月。其中原发性十二指肠降部腺癌5例，球部腺癌2例，水平部腺癌和球部平滑肌肉瘤各1例。误诊疾病：误诊为慢性胃炎、溃疡病4例。胆石症、胆囊炎2例，胰腺炎、幽门梗阻、钩虫病各1例。1．2症状和体征9例病人均有不同程度恶心、呕吐，食欲不振和腹胀；6例有上腹部疼痛，其…     

原发性十二指肠恶性肿瘤11例临床分析

原发性十二指肠恶性肿瘤临床症状少 ,早期缺乏特异性表现 ,诊断比较困难。作者将我院1985～2001年间经手术及病理确诊的11例原发性十二指肠恶性肿瘤分析报告如下。1临床资料1.1一般资料本组11例中男6例 ,女5例 ,男 :女=1.2:1。年龄28～76岁 ,平均55.8岁 ,>50岁8例 (72.7 % )。肿瘤以腺癌为主 ,共9例 (81.8 % ) ;部位 :十二指肠降部8例(72.7 % ) ,详见表1。表111例原发性十二指肠恶性肿瘤类型及部位病理类型球部降部水平部升部腺癌1611未分化癌1平滑肌肉瘤11.2临床症状上腹痛8例 (72.7 % )、纳差、消瘦6例(54.5% )、黄疸5例 (45.5 % )、贫血3…     

原发性十二指肠恶性肿瘤的诊断与治疗(附45例报告)

目的 探讨和总结原发性十二指肠恶性肿瘤(PMTD)的临床表现，诊断方法和术式选择。方法 对我院198l～1997年收治的45例PMTD患者的临床资料进行回顾性分析。结果 平均发病年龄53．5岁，男女比为2．2l：l。临床表现为上腹部疼痛32例(7l％)。黄痘28例(62％)，上消化道出血24例(53％)，呕吐19例(42％)，便血24例(53％)，腹部肿块8例(18％)。好发部位为十二指肠降部(37例，82％)。术前十二指肠镜诊断率为93％，胃十二指肠气钡双重造影为87％，B超及CT分别为37％、47％。45例原发性十二指肠恶性肿瘤中28例行胰十二指肠切除术，2例行节段性十二指肠切除术，15例行旁路手术。切除率为67％，5年生存率为30．8％。结论 原发性十二指肠恶性肿瘤好发于十二指肠降段，早期临床表现无特异性，十二指肠镜和胃肠气钡双重造影是诊断PMTD的主要方法，术式应首选胰十二指肠切除术。     

原发性十二指肠恶性肿瘤的诊断

目的 :探讨原发性十二指肠恶性肿瘤的临床特点及其诊断。方法 :对 1 979年以来诊治的 37例原发性十二指肠恶性肿瘤的临床资料及随访结果进行回顾性分析。结果 :37例中 ,肿块位于十二指肠乳头周围者 2 9例。最常见的临床表现为腹痛、腹胀、黄疸、便血、呕血和腹部包块等。 37例均经手术治疗 ,术前诊断率为56 .7% (2 1 / 37) ,根治切除率为 62 .1 % (2 3/ 37) ,其中 31例获随访 ,死亡 2 2例 ,平均存活 (1 9± 8.1 )个月 ,存活9例。内镜检查的诊断符合率最高 ,为 75 % (1 2 / 1 6)。结论 :原发性十二指肠恶性肿瘤早期诊断较为困难 ,内镜是重要的诊断方法 ,改善病人预后的关键是加强对本病的重视和认识。     

原发性小肠恶性肿瘤28例临床分析

目的探讨小肠原发性恶性肿瘤的临床特点,拓宽不明原因消化道出血的诊断思路,提高诊治水平。方法回顾性总结经手术及病理诊断的28例原发性小肠肿瘤的临床资料。结果十二指肠恶性肿瘤14例,其中恶性间质瘤3例,腺癌9例,淋巴瘤1例,类癌1例。空肠恶性肿瘤10例,其中腺癌1例,平滑肌肉瘤1例,恶性间质瘤4例,淋巴瘤4例。回肠淋巴瘤3例、恶性间质瘤1例。28例中术前确诊仅4例(14.3%)。有2例术中行内镜检查协助诊治。小肠恶性肿瘤临床表现以消化道出血、腹痛、腹胀、呕吐、腹部肿块、黄疸为主。结论小肠肿瘤缺乏特异性临床表现,诊断较为困难,必要时考虑手术探查及术中内镜协助诊断治疗。     

胃镜诊断十二指肠降部病变207例分析

目的：探讨十二指肠降部病变发病情况、主要临床表现及胃镜下改变。方法：分析本院近10年来胃镜诊断十二指肠降部病变207例，探讨其主要疾病及临床特点，胃镜诊断情况。结果：降部病变男多于女；以降部溃疡最常见(40．6％)，其次为降部息肉(16．9％)、降部癌(包括乳头癌)占14％、降部炎(11．6％)、降部憩室(4．8％)，还有降部乳头炎、黏膜下肿块、钩虫感染、蛔虫、结石、血管病变等；临床表现无明显特异性，胃镜 病理可以发现病变位置、大小、形状、性质等。结论：十二指肠降部病变多样，临床表现不典型，胃镜有重要诊断价值。     

十二指肠间质瘤30例外科治疗分析

目的:探讨十二指肠间质瘤的临床特征、外科治疗方法及效果。方法:回顾分析复旦大学附属中山医院1995—2006年间收治的30例十二指肠间质瘤患者的临床资料。结果:肿瘤最常见于十二指肠降部60%(18/30),其次为水平部20%(6/ 30),球部10%(3/30),升部10%(3/30)。肿瘤以恶性多见,占76.7%(23/30),交界性13.3(4/30),良性10%(3/30)。细胞类型以梭形细胞型多见,占73.3%(22/30),混合型次之,占23.3%(7/30),上皮细胞型少见,占3.3%(1/30)。临床表现无特异性,以黑便多见,占40%(12/30),其次为腹痛30%(10/30)、饱胀13.3%(7/30)、贫血20%(6/30)。诊断方法的选择依次为上消化道钡餐造影、胃镜、内镜超声及CT。30例患者均获得手术治疗,15例行胰十二指肠切除术,其中13例为降部肿瘤,2例为横部肿瘤,术后病理检查均无淋巴结转移;5例降部和2例球部肿瘤行肿瘤及十二指肠壁局部切除术,4例水平部和3例升部肿瘤行十二指肠节段切除术,另有1例球部肿瘤行远端胃大部切除术。术后随访15个月～9年,其中24例获得完整随访,1年生存率、3年生存率分别为100%和87.5%。结论:十二指肠间质瘤以恶性者多见,其局部侵袭性不如消化道癌,淋巴结转移少见,术前诊断主要依据上腹部增强CT、胃肠道钡剂造影、胃镜以及内镜超声检查,其手术方式的选择更多取决于肿瘤的部位和大小。     

Laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor located in the second portion of the duodenum: A case report

Gastrointestinal stromal tumors of the duodenum are rare. For benign tumors, premalignant lesions, or malignant potential tumors located in the second portion of the duodenum close to the papilla of Vater, pancreaticoduodenectomy is sometimes performed. A case of laparoscopic segmental duodenectomy for a gastrointestinal stromal tumor at the second portion of the duodenum is reported. The surgical procedure was performed as follows: first, the second portion of the duodenum was separated from the pancreatic head; second, the duodenum was cut off with the linear stapler after having confirmed preservation of the papilla by intraoperative endoscopy; and third, reconstruction was carried out by a side‐to‐side duodenojejunostomy. Laparoscopic segmental duodenectomy for duodenal gastrointestinal stromal tumors is thought to be advantageous compared with pancreaticoduodenectomy in terms of low burden and organ function preservation. The present procedure is feasible for benign or low‐malignant tumors that do not infiltrate outside of the duodenal walls.     

Isolated duodenal varix: an unusual cause of gastrointestinal hemorrhage

We have reported an unusual case of upper gastrointestinal hemorrhage due to an isolated varix involving the second portion of the duodenum. The varix originated directly from the inferior vena cava and did not communicate with the portal venous system. The diagnosis was made preoperatively by upper gastrointestinal endoscopy. Surgical resection of the varix and the involved portion of the duodenal wall proved curative.     

Primary malignant melanoma of the duodenum: aggressive management and long-term survival of an unusual oncologic entity

Primary malignant melanoma originating in the small bowel is extremely rare. We report the case of a 55-year-old man who presented with a preoperative bleeding duodenal tumor. A standard pancreaticoduodenectomy was performed. Histopathological examination ascertained the diagnosis of a duodenal malignant melanoma with locoregional lymphatic spread. A thorough postoperative investigation did not reveal any primary melanotic lesions. Thus, the diagnosis of a primary melanoma originating from the duodenum was suggested. Fourteen months after surgery, the patient had no evidence of recurrence. Primary malignant melanoma of the duodenum is an existing, though unusual, oncologic entity. Aggressive surgery remains the treatment of choice offering both symptom palliation and long-term survival.     

Carcinoma of the duodenum

Primary duodenal carcinoma is an uncommon tumor that tends to be diagnosed late in its course because of a symptom complex compatible with many benign diseases. We reviewed the cases of five patients with duodenal adenocarcinoma treated at Norfolk General Hospital from 1973 to 1983. Periampullary tumors were excluded. The most common symptom, nausea and vomiting, was present in four patients, all of whom had microcytic anemia; in three, tests showed blood in stool specimens. The upper gastrointestinal series was suggestive of carcinoma in all patients. One of the lesions was proximal to the ampulla, while the other four were in the third and fourth portions of the duodenum. Only three of the lesions could be seen on upper GI endoscopy, and in only one of the three was the biopsy specimen positive for malignancy. At laparotomy, two patients had resectable lesions, but only segmental resection was done. Three patients had unresectable disease because of liver metastases and/or involvement of the root of the small bowel mesentery. Because delay in diagnosis of duodenal carcinoma may prevent successful resection, greater awareness of the possibility of these uncommon lesions, along with aggressive diagnostic work-up, may result in a higher percentage of cures.     

十二指肠恶性溃疡15例报告

目的调查十二指肠恶性溃疡的临床表现及病程特征,为早期确诊提供依据。方法回顾调查本院胃镜检查结果,病理结果及相关病历。结果1995年1月至2009年5月胃镜检出的15123例十二指肠球部溃疡中15例恶性溃疡,占0．1％。其中男9例,女6例,平均年龄62．3岁（49～75岁）,病变大多位于十二指肠球部（12例）。所有病例均为腺癌,其中低分化癌3例,黏液腺癌1例,未分化癌1例。临床表现为消化道出血4例,腹痛4例,体重下降3例,腹块1例,黄疸1例。结论十二指肠恶性溃疡发病率低,临床表现无特异性,胃镜检查是确诊的重要手段。     

十二指肠息肉的诊断治疗并文献复习:附14例报告

目的 探讨十二指肠息肉的临床诊治特点.方法 回顾性分析1987年8月至2006年10月我院收治的14例十二指肠息肉临床资料并文献复习.结果 常见临床表现为黑便,上腹不适,腹痛,体重减轻和腹胀.各项检查及确诊率为,十二指肠镜60%(6/10),上消化道造影56%(5/9),CT 44%(4/9).病变多位于十二指肠降部.8例腺瘤恶变,2例术后1年内复发.结论 内镜和上消化道造影是诊断十二指肠息肉的主要方法,超声内镜有助黏膜下肿瘤的诊断.对十二指肠腺瘤应采取积极的治疗态度.手术切除是主要治疗手段.重视十二指肠腺瘤患者的随访和早期处理.     

Sonographic detection of duodenal ulcer.

Using a wall thickness of greater than 5 mm for the first portion of the duodenum as the criterion for the sonographic diagnosis of duodenal ulcer, we studied the value of sonography in detecting this lesion. Endoscopy (88 patients) and upper gastrointestinal barium studies (12 patients) were used as the gold standards for the diagnosis. The study included 100 patients in whom gastrointestinal disease was suspected (20 with duodenal ulcer and 80 with normal findings). Of the 20 duodenal ulcers verified by endoscopy or upper gastrointestinal series, 13 patients had duodenal wall thickening, six had normal wall thickness, and one was nondiagnostic. Of the 80 subjects with normal findings on endoscopy or upper gastrointestinal series, 73 patients had a normal duodenum, four had wall thickening, and three were nondiagnostic. Considering the four nondiagnostic cases as sonographic errors, there were six false-negative cases and four false-positive cases (a sensitivity of 65%, specificity of 91%, positive predictive value of 76%, and negative predictive value of 92%). Our results show that sonography is not sufficiently sensitive to be used as a screening test, nor is it specific for duodenal ulcer, but a thickened duodenal wall of over 5 mm on sonography warrants additional work-up.     

A duodenal ampullary tumor with malignant transformation of papillary polyps: a case report and literature review

Periampullary carcinoma refers to a malignant tumor within 2 cm of the duodenal ampulla. Primary ampullary carcinoma is very rare, accounting for only 0.2% of malignant gastrointestinal tumors. The small intestine accounts for 75% of the length of the gastrointestinal tract, and primary tumors in the small intestine account for only 2% of all gastrointestinal tumors. Here, we report the case of a duodenal ampullary tumor with malignant transformation of parapapillary polyps. The patient had both a primary ampullary tumor and high-grade intraepithelial neoplasia of juxtapapillary adenomatous duodenal polyps.     

Overlooked lesions at emergency endoscopy for acute nonvariceal upper gastrointestinal bleeding

BACKGROUND AND STUDY AIMS: Excessive blood covering the examination field is a frequent cause of diagnostic failure in emergency endoscopy for acute upper gastrointestinal bleeding. The implications and outcome in these patients have not been well described. PATIENTS AND METHODS: The records for 1459 consecutive patients who presented at our medical center with acute nonvariceal upper gastrointestinal bleeding during a 15-month period were reviewed. All of the patients underwent emergency endoscopy within 24 h of initial presentation. Patients in whom an identifiable bleeding source was not found in spite of an overtly bloody lumen were designated as having a failure of diagnosis, and these cases were analyzed further. RESULTS: Diagnosis failed in 25 patients (1.7 %), 16 of whom underwent repeat endoscopy or surgical intervention. Bleeding vessels were identified in 13 of these patients. Gastric and duodenal ulcers were the most commonly overlooked lesions, with locations in the cardia (n = 3), fundus (n = 2), posterior wall of the antrum (n = 1), duodenal bulb (n = 3), second part of the duodenum (n = 2), and in the stoma of a Billroth II gastrectomy (n = 2). The rates for endoscopic complications, recurrent bleeding, surgery, and mortality were significantly higher in the group with diagnostic failure than in patients with acute upper gastrointestinal bleeding in whom diagnosis did not fail (8 % vs. 0.4 %; 20 % vs. 3.1 %; 16 % vs. 2.9 %; and 20 % vs. 3.6 %, respectively). CONCLUSIONS: In acute nonvariceal upper gastrointestinal bleeding, diagnostic failure is associated with higher morbidity and mortality. The data from this study emphasize the importance of good preparation before the procedure and adequate removal of blood during emergency endoscopy procedures.