十二指肠乳头部肿瘤术前检查方法评价

目的评估十二指肠乳头部肿瘤术前各种检查方法的应用价值，探索一种有较高价值的诊断方法。方法回顾性分析我院1983年12月至2006年5月行十二指肠乳头部肿瘤局部切除术的25例患者术前影像学、十二指肠镜检查资料及术后病理资料。结果25例行B型超声检查的患者中，8例发现壶腹部低回声结节，肿物检出率为32．0％（8／25）；13例行CT检查的患者中3例显示壶腹部肿物图像，肿物检出率为23．1％（3／13）。20例十二指肠镜检查的患者中，6例镜下见乳头部菜花样肿物，10例见瘤样肿物，经术后病理证实均为乳头肿瘤；4例镜下仅见乳头增大，术后病理结果亦为肿瘤。十二指肠镜检乳头肿物检出率为80．0％（16／20），与B型超声或CT比较，差异有统计学意义（均P〈0．01）。20例患者均在十二指肠镜下取活组织检查，结果12例为恶性病变，与术后病理一致；8例活组织检查提示良性病变，其中4例与术后病理一致，另4例术后病理为恶性。十二指肠镜活组织检查与最终病理诊断比较，定性诊断敏感度为80．0％（16／20）。结论十二指肠镜检和镜下活组织检查诊断敏感度较高，是诊断十二指肠乳头部肿瘤有较高价值的方法。

Diagnosis of duodenal papilla tumor

Objective To observe the diagnosis of duodenal papilla tumor. Methods Clinical material of preoperative imaging、endoscopic examination and final post-operative pathologic diagnosis in 25 patients with tumor of the major duodenal papilla were included. Results The detection rate of the papillary mass in 20 duodenoscopic appearance was 80% , meanwhile the detection rate in 25 ultrasound(US) and 13 computed(CT) were 32% and 23%. The detection rate between duodenoscopic appearance and US or CT was significantly different( P>0.01 ). The duodenoscopic biopsy had a diagnostic accuracy rate of 80% and a false-negative rate of 20%. Conclusion Duodenoscopic appearance and duodenoscopic biopsy are of great value for the diagnosis of duodenal papilla tumor.