原发性十二指肠恶性肿瘤的诊治

目的：探讨原发性十二指肠恶性肿瘤的诊治方法。方法：回顾性分析29例患临床资料，并结合有关献分析原发性十二指肠恶性肿瘤的发病情况，癌前病变，误诊原因、手术及再手术的选择。结果：十二指肠恶性肿瘤以降部乳头区和腺癌最为常见；十二指肠绒毛状瘤是癌前病变之一；主要误诊疾病为阻塞性黄疸、消化性溃疡、胆总管结石、消化道出血及小肠梗阻；29例中行胰十二指肠切除术13例及改道短路手术9例，根治性切除率为44．83％。结论：原发性十二指肠恶性肿瘤发病率低，易误诊；术前最有效的诊断方法为十二指肠镜加活检和十二指肠气钡双重造影；治疗首选胰十二指肠切除术。

Diagnosis and treatment of primary malignant tumor of the duodenum: a report of 29 cases

ObjectiveTo investigate diagnosis and surgical treatment of primary malignant tumor of the duodenum(PMTD).Methods The clinical data of 29 cases of PMTD were analyzed retrospectively.ResultsPMTD mostly were adenocarci-noma and located in the descending portion of the duodenum. The duodenal villous tumors were considered to be one of the precursorof PMTD. Most of the confused diseases in diagnostic procedure were obstructive jaundice, peptic ulcer, common duct stones,gastrointestinal bleeding and intestinal obstruction. Among the 29 cases, 13 cases underwent pancreaticoduodenectomy, 9 cases weretreated with bypass, and the radical resection rate was 44.83%.ConclusionsThe morbidity in patients with PMTD is lower andit is easy to be misdiagnosed. The duodenal endoscope plus biopsy and air barium double radiography are main steps for the diagnosis.The first choice of therapy for PMTD is pancreaticoduodenectomy.