原发性十二指肠癌的外科诊断治疗和预后分析

摘要：目的 探讨原发性十二指肠癌(PDC)的诊断与外科治疗。方法 回顾分析近10年来手术治疗的85例原发性十二指肠癌患者的临床资料。 结果 内镜、十二指肠低张造影、B 超及CT 扫描诊断正确率分别为86.8%(66/76)，84.3%(16/19)，28.2%(24/85)，39.6% (21/53)。全组85例患者均行开腹手术，包括行胰头十二指肠切除术(PD) 61例，肿瘤肠管节段切除术(SR) 8例，胃次全切除(毕Ⅱ式)并十二指肠肿瘤切除2例，短路手术14 例。患者术后总1，3，5年累积生存率分别为84.4%，58.3%，31.9%。PD和SR术后的 的1，3，5 年累积生存率分别为100.0%，67.7%，41.6%和100.0%，60.0%，0。单因素分析显示：根治性手术(PD和SR)、肿瘤浸润深度和淋巴转移是影响原发性十二指肠癌术后生存率的重要因素。多因素分析显示：根治性手术、淋巴转移和肿瘤局部浸润深度是影响术后生存率的独立因素。结论 十二指肠低张造影和内镜检查可提高原发性十二指肠癌早期诊断率；根治性手术治疗可提高原发性十二指肠癌的长期生存率。

Diagnosis, surgical treatment and prognosis of primary duodenal carcinoma

Objective To investigate the diagnosis of primary duodenal carcinoma and its outcome after surgical treatment.Methods The clinical data of 85 patients with primary duodenal carcinoma treated operatively between 1997 and 2006 were analyzed retrospectively.Results The correct diagnosis rate for endoscopy was 86.8 %(66/ 76),for duodenography 84.3 %(16/ 19),for ultrasound examination 28.2 %(24/85) and for computerized tomography(CT) scanning 39.6 %(21/53),respectively.All of the 85 patients received surgery including pancreaticoduodenectomy(PD) in 61 patients,duodenal segmental resection(SR) in 8,subtotal gastrectomy in 2 and bypass operation in 14.The 1-,3-,and 5-year survival rate of all patients was 84.4 %,58.3 %,and 31.9 % respectively.The 1-,3-,and 5-year survival rates of patients receiving PD and SR were 100.0 %,67.7 %,41.6 % and 100.0 %,60.0 %,0.0 %,respectively.With univariate analysis,radical resection(PD and SR),infiltration and lymph node metastases were found to be significant factors associated with overall postoperative survival.With multivariate analysis,radical resection,lymph node metastases and depth of local tumor infiltration independently affected the overall postoperative survival.Conclusions Duodenography and endoscopy can increase the rate of early diagnosis of primary duodenal carcinoma.Radical resection can improve the long-term survival of patients with primary duodenal carcinoma.