十二指肠良性肿瘤15例诊治体会

目的　探讨十二指肠良性肿瘤的诊断和治疗方法。方法　回顾分析本院收治的 15例十二指肠良性肿瘤并进行随访研究。结果　Brunner瘤 3例 ,平滑肌瘤 3例 ,间质瘤 3例 ,管状腺瘤 2例 ,管状绒毛状腺瘤 1例 ,胃泌素瘤 1例 ,血管瘤 1例 ,错构瘤 1例。十二指肠良性肿瘤临床症状不典型 ,术前确诊困难。胃十二指肠镜检查和上消化道造影确诊率不高。本组 14例手术切除肿瘤 ,总体1年、3年、5年生存率分别为 91.7%、81.8%、77.8%。结论　反复腹痛和黑便是十二指肠良性肿瘤最常见的症状 ;胃十二指肠镜检查和上消化道造影是主要的诊断方法 ;手术切除是首选治疗方法 ,预后良好。     

原发性十二指肠良性肿瘤的诊断和外科治疗

目的探讨十二指肠良性肿瘤的诊断及治疗方法。方法回顾分析1988年10月至2001年10月经手术、病理证实的14例十二指肠良性肿瘤的临床资料。结果Brunner腺瘤5例,间质瘤4例,平滑肌瘤2例,血管瘤2例,脂肪瘤1例。上腹部不适(64%)、原因不明的上消化道出血(50%)和腹痛(20%)为本组患者的主要表现。本组患者术前均行胃镜检查,仅发现1例十二指肠球部肿瘤;5例行十二指肠镜检查,4例发现肿瘤;9例行十二指肠低张造影检查,8例明确见到肠腔内占位性病变;3例予急诊数字减影血管造影检查均发现病灶;2例行B超、CT检查,1例提示十二指肠肿瘤;11例患者(79%)术前经检查获确诊。全组患者均行外科手术切除肿瘤,围手术期死亡1例;13例术后获2～11年随访,未见复发。结论上腹部不适或上消化道出血是十二指肠良性肿瘤最常见的症状;十二指肠低张造影及十二指肠镜检查是最主要的检查手段;手术切除肿瘤是首选的治疗方法。     

十二指肠良性肿瘤的诊治体会(附26例报告)

目的　探讨十二指肠良性肿瘤的临床表现、病理学特征、诊断和治疗方法。方法　对我 院收治的经病理证实的26例十二指肠良性肿瘤病人的临床资料进行回顾分析并进行随访。结果　 本组病例息肉样腺瘤9例,间质瘤5例,管状腺瘤5例,管状绒毛状腺瘤2例,异位胰腺、胰岛细胞瘤、 神经鞘瘤、胃泌素瘤、血管瘤各1例。内镜检查发现17例,上消化道钡气双重对比X线造影检查发现 4例,数字减影血管造影(DSA)检查发现3例,因腹部包块行剖腹探查发现2例。9例病人在内镜下 行肿瘤切除术,7例行肿瘤局部切除术,5例行肿瘤局部切除加括约肌成形术,4例行胰十二指肠切除 术,1例行肿瘤切除加胃大部切除术。随访6个月～10年,除1例局部肿瘤切除术后复发并癌变、2 例死于非相关恶性肿瘤、2例失访外,其余病人生活质量良好。结论　十二指肠良性肿瘤临床症状不 典型,术前确诊困难。反复腹痛和黑便是十二指肠良性肿瘤最常见的症状,内镜检查和X线造影是 主要的诊断手段,内镜下切除或手术治疗是十二指肠良性肿瘤的首选治疗方法。十二指肠良性肿瘤 预后良好。     

十二指肠良性肿瘤的诊治（附10例报告）

目的 探讨十二指肠良性肿瘤的诊断与治疗。方法 对1992-1998年间收治的10例患者的临床资料回顾性总结分析。结果 术前经纤维十二指肠镜确诊7例。上消化道X线钡餐确诊3例。肿瘤位于十二指肠降部7例,球部3例。其中6例行手术治疗,4例因心肺脑等严重合并症行保守治疗,手术为十二指肠肿瘤局部切除连同周围肠壁组织部分切除,术后病理报告2例为平滑肌瘤,2例为布鲁氏纳氏腺瘤,2例为间质瘤,结论 十二指肠良性肿瘤可引发严重并发平,如出血、腹痛、肠梗阻、穿孔等,并约有15%的病例可发生恶变,一经诊断,应及早手术治疗,手术一般宜行局部切除。     

原发性十二指肠癌的诊断与治疗

目的提高原发性十二指肠癌的诊断及治疗水平。方法回顾性地总结分析了１８例原发性十二指肠癌的临床资料。结果７例行胰十二指肠切除,１例行节段性肠切除,手术死亡１例,术后１５个月死亡１例、１９个月死亡１例,生存３年者２例,５年者３例;７例行胃肠或胆肠吻合术,分别于术后３～１１个月死亡;３例仅行探查活检,均于术后６个月内死亡。结论早期诊断的关键是提高对本病的认识,对可疑患者,应作相应特殊检查,确诊后及时手术,方可提高疗效     

原发性气管肿瘤的诊断与外科治疗

目的：探讨原发性气管肿瘤的诊断与外科治疗问题。方法：分析１１例气管肿瘤的临床资料,其中９例为手术病例,行气管开窗取瘤术２例,气管侧壁切除肌瓣填塞修补术１例,气管环行切除对端吻合术６例。结果：本组病例早期全部误诊,误诊时间３个月～２年,手术病人均术后恢复顺利,无手术死亡,无切口感染及呼吸、循环系统严重并发症,随访１～５年,４例良性肿瘤病人均存活,５例恶性肿瘤病人手术切除者术后生存５年以上１例,１～３     

十二指肠平滑肌肿瘤的诊断及治疗

目的：探讨十二指肠平滑肌瘤的诊断及治疗方法。方法：回顾性分析1987年至2001年手术切除并经病理证实的7例十二指肠平滑肌肿瘤。结果：十二指肠平滑肌瘤4例、平滑肌肉瘤3例。本病缺乏典型症状，早期诊断困难。本组病人均行手术治疗，取得良好疗效。结论：上消化道出血是本病常见的症状，上消化道造影、胃十二指肠镜及CT扫描是主要的诊断方法。外科手术是首选的治疗方法。     

十二指肠间质瘤的诊断与外科治疗22例报告

目的 探讨十二指肠间质瘤的临床特征、外科治疗方法.方法 回顾分析2000~2012年收治的22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,其次为水平部、球部、升部.临床表现以上消化道出血多见,其次为腹痛、饱胀、贫血.诊断方法的选择为上消化道钡餐造影、胃镜、超声内镜及CT.22例患者均获得手术治疗.术后随访9个月至12年,其中20例获得完整随访,1年、3年生存率分别为100% 和70%.结论 十二指肠间质瘤以恶性者多见,术前诊断主要依据上腹部增强CT、胃肠道钡剂造影、胃镜以及超声内镜检查.手术切除是治疗十二指肠间质瘤有效的方法,应根据十二指肠间质瘤大小和位置采取不同的手术方式.     

十二指肠良性肿瘤的诊断和治疗

目的 探讨十二指肠良性肿瘤(BTD)的诊断和治疗方法。方法 回顾性分析21年间经手术和病理证实的24例BTD患者的临床资料。行肿瘤局部切除术l8例，十二指肠节段切除术4例，毕I式胃大部切除术l例，保留幽门的胰十二指肠切除术l例。结果 BTD临床上多表现为腹痛、上消化道出血和高位肠梗阻。气钡双重造影和十二指肠镜检查对十二指肠良性肿瘤的确诊率分别为82．4％和93．3％。手术后疗效满意，l例于术后6d死于心肌梗塞。病理检查结果为绒毛状腺瘤8例，间质瘤6例，Brunner腺瘤5例，平滑肌瘤和家族性腺瘤性息肉病十二指肠腺瘤各2例，血管瘤l例。结论 十二指肠气钡双重造影及十二指肠镜检查是诊断本病的主要方法；治疗首选手术切除。     

原发性十二指肠肿瘤的诊断与治疗

目的 探讨原发性十二指肠肿瘤的诊断和选择适当的手术方法。方法 对２２例原发性十二指肠肿瘤的临床资料进行分析。结果 十二指肠气钡造影１３例,１０例（７６．９％）诊断肿瘤;十二指肠镜检查１４例,发现肿瘤１３例（９３％）。肿瘤位于十二指肠降部者１１例,占５０％。良性肿瘤８例,恶性肿瘤１４例。恶性肿瘤中行胰十二指肠切除６例,有２例生存已达６年。良性肿瘤７例行肿瘤及局部肠管切除已有２例生存１２年。结论 内窥     

A very rare case of duodenal hemolymphangioma presenting with iron deficiency anemia

INTRODUCTION

Intraabdominal lymphangiomas account for less than 5% of all lymphangiomas and small intestinal hemolymphangioma is a very rare benign tumor.

PRESENTATION OF CASE

Here we describe the first case of primary ulcerated duodenal hemolymphangioma in a 24-year-old woman, causing occult bleeding from gastrointestinal tract. She presented with an unexplained refractory iron-deficiency anemia and gastroduodenoscopy revealed an ulcerated and polypoid lesion of the second portion of the duodenum. Partial resection of the duodenum was thus performed and the final pathological diagnosis was hemolymphangioma.

DISCUSSION

There were only two reports, one of a hemolymphangioma of the pancreas invading to the duodenum and another of a small intestinal hemolymphangioma, presenting with gastrointestinal bleeding until May 2012.

CONCLUSION

The aim of this case report is to highlight the difficulty in making an accurate preoperative diagnosis and describe the surgical management of an unusual location for a very rare tumor. To arrive at a definitive diagnosis and exclude malignancy, partial resection of the duodenum was considered to be the required treatment.     

Solitary cavernous hemangioma of the duodenum: Report of a case

Vascular lesions of the duodenum, including hemangioma, are rare causes of gastrointestinal bleeding. We herein describe a 52-year-old woman with a solitary cavernous hemangioma of the duodenum that caused chronic gastrointestinal bleeding. Repeated upper gastrointestinal endoscopy and a barium meal study revealed a solitary vascular tumor in the fourth portion of the duodenum, although the initial investigations including selective angiography were unsuccessful. A wedge resection of the duodenum was performed and microscopical examination showed a cavernous hemangioma. Vascular lesions should therefore also be considered in the differential diagnosis of patients with gastrointestinal bleeding of unknown origin.     

A case of lung squamous cell carcinoma with metastases to the duodenum and small intestine

Gastrointestinal metastasis of lung cancer is fairly rare, and metastasis to the duodenum is very uncommon. We report a case of duodenum and small intestine metastases of lung squamous cell carcinoma. The patient was a 66-year-old man. He was diagnosed with lung squamous cell carcinoma (T4N3M1 [mediastinum, cervical lymph node, and duodenum metastases], stage IV). He noted a sense of abdominal fullness on the evening of the day chemoradiotherapy was given, and emergency surgery was performed for suspected perforation of the digestive tract. Intraoperative findings included a tumor in the small intestine with a perforation at the tumor site; partial resection of the small intestine, including the tumor, was performed. Small intestine metastasis of lung cancer was diagnosed following histopathologic examination. When lung cancer patients complain of abdominal symptoms, it is important to consider gastrointestinal metastases in diagnosis and treatment.     

原发性十二指肠恶性肿瘤的诊断与治疗:附82例报告

目的　探讨原发性十二指肠恶性肿瘤的临床表现、病理学特征及诊治手段。方法　对10年间收治的经病理证实的 82例原发性十二指肠恶性肿瘤患者的临床资料进行回顾性分析。结果　发病部位 :乳头区 64例 ,降段 11例 ,其他部位 7例。临床主要表现为上腹疼痛 (5 7例 ) ,黄疸 (5 3例 )和消化道出血 (4 1例 )。病理学类型以腺癌多见 (72例 ) ,胃肠道间质瘤 (5例 ) ,恶性淋巴瘤 (3例 )次之。 3 6例行肿瘤根治性切除术 ,3 1例行姑息性手术 ,15例未进行外科治疗。本组病例随访患者 5a生存率 2 .4%。结论　原发性十二指肠恶性肿瘤临床以上腹痛、黄疸、消化道出血为主要表现 ,但缺乏特征性。病理类型以腺癌为主 ,好发于十二指肠乳头区及降段。CT和B超及内镜检查是诊断检查原发性十二指肠恶性肿瘤的主要手段 ,手术切除是主要治疗方法。原发性十二指肠恶性肿瘤的预后甚差。     

Primary aortoduodenal fistula complicated by abdominal aortic aneurysm

A 74-year-old male patient was operated in Vakif Gureba Hospital for aortoduodenal fistula developing from abdominal aortic aneurysm. The patient was diagnosed as abdominal aortic aneurysm after physical examination and computed tomography in another center. Appearing of melena and hematemesis gastroduodenoscopy and radionuclide scanning was performed as diagnosis. After 6 days gastrointestinal bleeding recurred in massive haemorrhage and the patient was operated with a diagnosis of aortoenteric fistula as emergency. A midline laparotomy was performed. There was a fistula between infrarenal abdominal aortic aneurysm (with diameter 8x10 cm) and the 3rd portion of the duodenum. The duodenum was resected segmental and the fistula was disconnected. Following aneurysmotomy a prosthetic graft was placed in the aortobiiliac position. The patient was discharged at the 42nd postoperative day. Primary aortoenteric fistula is a very rare consequence of untreated abdominal aortic aneurysm. The segments of intestine most frequently involved in aortoenteric fistula are the 3rd and 4th portions of the duodenum. Clinical presentation is recurrent episodes of gross gastrointestinal haemorrhage. These cases have high mortality and morbidity unless evaluated as quickly as possible and appropriate surgical intervention performed.     

胃肠道间质瘤的诊断和治疗

目的 总结胃肠道间质瘤的诊断与治疗经验。方法 回顾性总结分析27例胃肠道间质瘤的临床和病理资料。结果 本组胃间质瘤21例,十二指肠间质瘤4例,小肠间质瘤2例。临床表现为消化道出血者16例(59.3％),其中腹痛伴消化道出血者7例;腹痛13例(48.1％),其中上腹部疼痛者6例;以腹部肿块就诊者5例(18.5％)。25例行胃镜检查,确诊为间质瘤2例,发现病变部位22例。2例伴消化道大出血者急诊数字式减法血管造影(DSA)发现病变部位。病理诊断为良性间质瘤12例、交界性13例、恶性2例;良性间质瘤核分裂像和肿瘤直径均显著小于交界性和恶性者(P<0.05)。本组均行手术局部切除治疗,术后发生肺部感染2例,胃排空障碍1例。21例患者术后随访3～24个月,除1例小肠恶性间质瘤患者术后20个月腹壁切口复发外,其余20例均无肿瘤转移复发。结论 内镜和影像学检查对胃肠道间质瘤病变定位有重要作用,胃肠道间质瘤的确诊依靠病理学检查。手术局部切除是治疗胃肠道间质瘤的有效手段。     

Bleeding lipomas of the upper gastrointestinal tract. A diagnostic challenge

Submucosal lipoma of the upper gastrointestinal tract is a rare benign tumor. However, it may present as both a diagnostic problem and as a life threatening lesion due to exsanguinating hemorrhage. The authors report four patients with significant upper gastrointestinal bleeding due to ulcerating lipomas. In two patients the lesions were gastric and in two patients the lesions were duodenal in origin. In no instance could the diagnosis of lipoma be accurately established short of operative intervention because of unusual morphologic features. Surgical extirpation was necessary to stop the bleeding and establish the histologic diagnosis of the tumor.