原发性十二指肠恶性肿瘤19例诊治分析

目的:提高原发性十二指肠恶性肿瘤的诊断与治疗水平。方法:回顾性分析19例原发性十二指肠恶性肿瘤的临床资料。其临床表现:黄疸9例,上腹部痛7例, 消化道出血6例,上腹部包块3例,呕吐1例。结果:诊断手段及确诊率:纤维十二指肠镜的确诊率为83.3%(15/18)；十二指肠X线低张造影检出率为82.3%(14/17)；9例行腹部CT检查,7例显示肿瘤；1例行 MRI检查,显示肿瘤。手术治疗16例,肿瘤切除率68.8%(11/16)。行胰十二指肠切除术9例,行肿瘤局部切除及区域肿大淋巴结切除1例,十二指肠球部加部分胃切除术1例,胃肠、胆肠吻合术5例,根治性切除率为62.5%(10/16)。根治术后1，3，5年生存率分别为90.0%(9/10)，40.0%(4/10)，30.0%(3/10)。行胃肠、胆肠吻合术后生存期时间6~15个月。结论:联合纤维十二指肠镜和十二指肠低张造影能诊断各段十二指肠恶性肿瘤；胰十二指肠切除术可获得原发性十二指肠恶性肿瘤患者的长期生存率。

Analysis of the diagnosis and treatment of 19 cases of primary duodenal malignant neoplasms

Objective To improve the diagnosis and treatment of primary duodenal malignant (neoplasms)(PDMN).Methods The clinical data of 19 patients with primary malignant neoplasms of the (duodenum) were anayzed retrospectively.Results The clinical manifestations were jaudice in 9 cases, upper abdominal pain in 7 cases, gastrointestinal hemorrhage in 6 cases,abdominal mass in 3 cases,and vomitting in 1 case. Diagnostic procedure and detection rate: The detection rate of PDMN by duodenoscopy was 83.3%(15/18), by hypotonic duodenography was 82.3%(14/17), 77.8%(7/9) by CT, and 1 case by MRI.16 cases (underwent) surgery with resection rate of 68.8 %(11/16).Pancreaticoduodenectomy was (performed) in 9 (cases), simple tumor resection and regional lymphadenectomy in 1 case,resection of duodenal bulb plus partial gastrectomy in 1 case,and gastroenterostomy or choledochojejunostomy in 5 cases.The radical resection rate was 62.5%(10/16).The postoperative 1-,3-,and 5-year survival rate in radical (resection) (patients) was 90.0%(9/10),40.0%(4/10) and 30.0%(3/10),respectively.In those with (gastroenterostomy) or (choledochojejunostomy), the survival time was 6~15 months. Conclusions (Duodenoscopy) and hypotonic (duodenography) are ideal tools for the diagnosis of all locations of PDMN.(Pancreaticoduodenectomy) might result in prolonged survival of patients with PDMN.