原发性小肠肿瘤142例临床分析

目的总结原发性小肠肿瘤临床特点和诊断手段。方法回顾性分析北京大学人民医院2007年至2014年经手术和(或)病理确诊的142例原发性小肠肿瘤的临床资料。结果 142例原发性小肠肿瘤中,良性肿瘤16例,以腺瘤最常见。恶性肿瘤126例,以腺癌最常见。小肠肿瘤的临床特点缺乏特异性使其难以早期被诊断,且发病率有逐年增长的趋势。结论小肠肿瘤大部分为恶性肿瘤,需提高对小肠恶性肿瘤的警惕性,内镜检查和CT有助于小肠肿瘤的诊断。     

原发性小肠恶性肿瘤的诊治进展

近年来,原发性小肠恶性肿瘤的发病率有逐年提高的趋势.由于其临床表现缺乏特异性,故早期诊断困难,治疗效果也较差.随着双气囊电子小肠内镜和胶囊内镜的应用,小肠肿瘤的诊断率有了较大提高.但小肠恶性肿瘤的诊断和治疗水平的提高仍需重视.     

原发性小肠淋巴瘤10例临床分析

原发性小肠淋巴瘤(primary small intestinal lymphoma)占小肠恶性肿瘤的40.0%～75.0%.诊断困难,其放疗和化疗方案与小肠其他恶性肿瘤不同.我们回顾性地复习了解放军总医院1993年1月至2004年1月收治的10例原发性小肠淋巴瘤的资料,并对其进行了分析讨论.     

小肠恶性肿瘤的非手术治疗

小肠恶性肿瘤的非手术治疗陕西省人民医院（西安，７１００６８）李增烈小肠恶性肿瘤包括两大类：原发于小肠组织的恶性肿瘤与转移至小肠的恶性肿瘤，而后者多来自子宫颈、结肠、黑色素瘤、卵巢、肾脏与胃，偶见来自胰腺。总的说肿瘤发生率甚低，据美国材料，小肠恶性肿瘤...     

小肠癌分子生物学机制的研究进展

小肠约占胃肠道全长的75％，其黏膜总面积约占胃肠道表面积的90％以上，但小肠肿瘤的发病率低，占胃肠道肿瘤的5％左右，恶性肿瘤则更少见，仅占胃肠道恶性肿瘤的2％～3％。主要分为腺癌、类癌、恶性淋巴瘤和肉瘤。据国外文献报道，以腺癌和类癌最多，占小肠恶性肿瘤的55％～80％。小肠腺癌好发于十二指肠，类癌则好发于回肠。     

原发性小肠肿瘤的临床特点与诊断

小肠虽然占整个消化道长度的75～80%,但原发性小肠肿瘤很少见,一般认为小肠肿瘤发生率低,可能与小肠内碱性肠内容物通过快与粘膜接触时间短,小肠粘膜分泌免疫球蛋白,以及小肠粘膜上皮分泌一种酶——苯并芘水解酶使高度致癌物质苯并芘活性降低并被结合等有关.小肠良性肿瘤一般多位于近端小肠,恶性肿瘤好发于远端小肠.恶性淋巴瘤占小肠恶性肿瘤首位,尤以回肠末端为最常见,似与该部淋巴组织丰富有关,腺癌以腺体较多的十二指肠和上段空肠发生率高.但最近有报道认为小肠癌发生在靠近回盲瓣者有所增加。     

克罗恩病合并小肠恶性间质瘤穿孔1例

克罗恩病临床表现多样, 患者因炎症活动或继发感染可出现内瘘、腹腔脓肿、肠梗阻和肠穿孔等并发症, 结直肠癌、小肠腺癌等恶性肿瘤的发生风险也增加, 但该病合并小肠恶性间质瘤罕见。现回顾性分析1例克罗恩病合并小肠间质瘤穿孔患者的诊治过程, 为临床类似病例的处理提供参考和借鉴。     

小肠黑色素瘤一例及文献复习

小肠黑色素瘤（SIM）是一种罕见的恶性肿瘤,在临床上极易引起误诊和漏诊.我们现报道1例并综合国内文献1992至2005年5月间报道的临床病理资料完整的SIM 15例,对其组织发生、诊断与鉴别诊断进行讨论.     

原发性小肠恶性肿瘤11例临床分析

目的 探讨原发性小肠恶性肿瘤的诊断和治疗。方法 回顾性地分析我院1991-2001年11例小肠恶性肿瘤病例资料。结果 小肠恶性间质瘤6例。腺癌3例。淋巴瘤2例。均手术治疗。结论 对于恶性间质瘤。即使为复发性肿物。也应积极手术。由于早期症状不典型。小肠恶性肿瘤的早期诊断十分困难。     

空、回、结肠

本文就原发性小肠恶性肿瘤的有关问题作了介绍。1。发病率、发病年龄和性别、分类和分布。2.各种类型的特点,共中主要有小肠癌、类癌、淋巴瘤及平滑肌肉瘤。3.小肠恶性肿瘤     

Recurrent intussusception as initial manifestation of primary intestinal melanoma:Case report and literature review

Enteric intussusception caused by primary intestinalmalignant melanoma is a very rare cause of intestinalobstruction.We herein present a case of a 42-yearold female patient with no prior medical history ofmalignant melanoma,who was admitted with persistentabdominal pain,nausea,and vomiting.A computedtomography scan revealed an intestinal obstruction dueto ileocolic intussusception.An emergency laparoscopy and subsequent laparotomy revealed multiple small solid tumors across the whole small bowel.An oncologic resection was not feasible due to the insufficient length of the remaining small bowel.Only a small segment of ileum,which included the largest tumors causing the intussusception,was resected.The pathologic examination revealed two intestinal malignant melanoma lesions.A systematic clinical examination,endoscopic procedures,and fluorodeoxyglucose positron emission tomography-computed tomography scan all failed to reveal any indication of cutaneous,anal,or retinal melanoma.Hence,the tumor was classified as a primary intestinal malignant melanoma with multiple intestinal metastases.Since a complete oncologic resection of tumors was not possible,in order to prevent future intestinal obstruction,a surgical resection of the largest lesions was performed with palliative intention.The epidemiology,clinical m a n i fe s t a t i o n s,d i a g n o s i s a n d m a n a g e m e n t o f primary intestinal malignant melanoma,and intestinal intussusception in adults are discussed along with a review of the current literature.     

35例小肠间质瘤诊治分析

背景:小肠间质瘤的发病率低,临床症状不典型且缺乏简便有效的检查方法,术前确诊较为困难。目的:了解小肠间质瘤的临床表现,探讨如何提高小肠间质瘤的术前诊断率和合理的手术方式,以提高其诊治水平。方法:回顾性分析1993年4月～2004年6月仁济医院收治的35例小肠间质瘤的临床表现、诊治经过、病理学特点和预后,所有病例均经手术和病理证实。结果:脐周隐痛、消化道出血、贫血、腹部肿块和小肠梗阻是本组小肠间质瘤最常见的临床表现。小肠间质瘤多好发于十二指肠和空肠;80.0%的良性小肠间质瘤瘤体直径<5cm,93.3%的恶性小肠间质瘤瘤体直径>5cm;小肠间质瘤以肠腔外生长为主,良、恶性间质瘤在生长方式上无显著差异。空肠、回肠间质瘤的术前诊断率显著低于十二指肠间质瘤(P<0.01)。胃镜、增强螺旋CT和数字减影血管造影(DSA)对小肠间质瘤检出率较高。30例恶性间质瘤中20例(66.7%)行小肠肿瘤根治术,8例(26.7%)行小肠肿瘤减瘤荷手术,2例(6.7%)行姑息性手术。30例恶性间质瘤切除标本中9例有局部淋巴结转移,5例出现远处转移。结论:合理应用辅助检查方法可提高小肠间质瘤的术前确诊率,术中对间质瘤的良、恶性判断有困难者应行根治性切除术。     

手术证实86例小肠出血的病因及诊断方法探讨

目的:探讨小肠出血的病因和诊断方法。方法:收集我院确诊的小肠出血患者共86例,分析其病因及诊断方法。结果:86例小肠出血的患者中,小肠良性肿瘤、憩室、恶性肿瘤、炎性肠病、血管病变分别有25例(29.1%)、20例(23.3%)、16例(18.6%)、16例(18.6%)、9例(10.4%)。小肠ECT检查诊断小肠活动性出血的阳性率、定位诊断的准确率分别为82.4%、70.6%。肠系膜DSA检查对小肠病变的发现率、诊断小肠活动性出血的阳性率、定位、定性诊断的准确率分别为80.9%、59.6%、76.6%、74.5%。肠系检查定位和定性诊断的准确率分别为41.2%、38.2%。结论:小肠肿瘤是小肠出血的第一位原因,ECT诊断小肠活动性出血阳性率高于DSA,DSA、ECT定位诊断价值大,DSA定性诊断价值高于肠系检查。     

原发性小肠肿瘤44例临床分析

原发性小肠肿瘤非常少见，临床早期诊断困难。目的：探讨原发性小肠肿瘤的临床常见表现、诊断和治疗方法。方法：回顾性分析1990年1月-2007年1月北京友谊医院确诊的44例原发性小肠肿瘤患者的临床资料。结果：原发性小肠肿瘤患者男女比例为3：1。主要临床表现为柏油样便、腹部包块、腹痛和肠梗阻症状。原发性小肠肿瘤以空肠最为常见，良恶性比为1：3．4。44例原发性小肠肿瘤患者中，29例（65．9％）为间质瘤，其中良性6例，低度恶性7例，高度恶性16例；5例（11．4％）为非霍奇金淋巴瘤；4例（9．1％）为腺癌；3例（6．8％）为平滑肌瘤；1例（2_3％）为平滑肌肉瘤；1例（2．3％）为类癌；1例（2．3％）为绒毛管状腺瘤。所有患者均行手术治疗。结论：原发性小肠肿瘤临床表现无特异性，病理类型多样，结合常见临床表现和有效检查方法有助于尽早诊断该病。     

恶性黑色素瘤小肠转移、系膜淋巴结转移及脑转移1例

恶性黑色素瘤转移至胃肠道常见的部位为小肠结直肠肛门,同时转移至小肠、系膜淋巴结及颅内者未见文献报道.本例恶性黑色素瘤伴有系膜淋巴结转移及脑转移,没有典型的临床表现,术中所见颅内肿物与小肠及系膜淋巴结肿物颜色质地不一致,术后病理对确定腹部及颅内肿物来源至关重要,患者病史对鉴别原发或转移性黑色素瘤意义重大.     

A case of malignant melanoma simultaneously found in the lung and small intestine

Metastatic melanoma in the small bowel is a common cause of secondary intestinal tumors. We present a case of a 77-year-old man with melena resulting from melanoma in the small bowel that was simultaneously found with malignant melanoma in the lung. Abdominal contrast-enhanced computed tomography (CT) and position emission tomography (PET) revealed a 30 × 20 mm hypervascular lesion in the small bowel and a 9 × 9 mm right lobe lung mass with metastasis in the mediastinal and peritoneal lymph nodes, and the spleen. The bowel and lung tumor lesions were confirmed by enteroscopy and bronchoscopy, respectively, and were histologically diagnosed as malignant melanoma. In cases of small bowel malignant melanoma, an extraintestinal origin should always be suspected because intestinal melanomas are almost always metastatic. PET/CT is an effective tool for confirming intestinal melanomas because of its high sensitivity and specificity.     

Neoplasms of the small intestine

Our experience with small intestinal neoplasms at the Medical College of Virginia has been reviewed. There were 78 benign and malignant neoplasms observed in our surgical pathology laboratory over a 20-year period. There were 34 benign small-bowel tumors, but the majority of these lesions were asymptomatic incidental findings at the time of surgery for other conditions. There were 21 patients with malignant neoplasms of the small bowel and 23 patients with carcinoid, a potentially malignant lesion. Clinical observations and the results of treatment are reviewed.Clinical Fellows of the American Cancer Society.     

小肠原发癌造成多重癌患者术后肠梗阻一例

随着临床诊疗技术的发展、人类寿命的延长以及环境污染的逐渐加重,多重癌的发病率逐年增加,且极易漏诊或误诊。乳腺癌发病率较高,而十二指肠壶腹部癌及小肠癌发病率低,三种恶性肿瘤异时性的出现于同一患者并导致术后输入袢梗阻更属罕见。现将中国医科大学附属盛京医院肿瘤内科收治的1例由小肠原发癌造成多重癌患者术后输入袢肠梗阻的病例进行报道。     

Anasarca as presentation of lobular breast carcinoma

Metastatic tumors in the small intestine are rare. The most commonly implicated primitive tumors are malignant melanoma, lung cancer and colon cancer. Few cases of metastasis to the intestine as the first manifestation of metastasis have been described. We present a case of metastasis to the intestine of lobular breast carcinoma 9 years after surgical resection of the primary tumor. Metastasis presented as anasarca. Ray small bowel series revealed ileal stenosis. Diagnosis was confirmed by histopathologic analysis following surgical resection of the affected intestinal segment.     

Immunoproliferative small intestinal disease without alpha-chain disease: a pathological study

Biopsy specimens taken during exploratory laparotomy provided the material for a pathological study of 23 cases of nonsecreting immunoproliferative small intestinal disease (Mediterranean lymphomas without alpha-chain disease). The distinctive pathological feature of immunoproliferative small intestinal disease, i.e., a diffuse lymphoid infiltration, was present in the mucosa and submucosa of all or a major part of the small intestine. It was composed of a low- or intermediate-grade malignant lymphoid proliferation associated in 19 of 23 cases with benign-appearing follicular lymphoid structures. These follicular figures were surrounded and partially destroyed by the lymphoma cells. This association strongly resembles the newly described non-Hodgkin's lymphoma entities of perifollicular or parafollicular cell origin. Gross tumors of the small intestine were found in association with the diffuse lymphoid infiltration in 10 cases. They often constituted foci of lymphoma with a higher grade of malignancy. Mesenteric lymph node involvement was frequent and generally in direct ratio to the severity of intestinal involvement. A comprehensive study of the lesions observed in these cases led to the hypothesis that nonsecreting immunoproliferative small intestinal disease could result from the malignant change of perifollicular B cells; during an initial period the tumoral cells retain circulating and homing properties that explain their infiltrative and extensive method of spreading. The possible subsequent emergence of more aggressive subclones of noncirculating malignant cells could then explain the associated inconstant fungating tumor foci. Further studies using more sophisticated immunohistochemical techniques are necessary to establish the meaning of the hyperplastic lymphoid follicles, the possible etiologic role of benign nodular hyperplasia, the exact identification of the tumor cells, and the relationship of nonsecreting immunoproliferative small intestinal disease to closely related alpha-chain disease.