原发性十二指肠恶性肿瘤的诊断与治疗:附82例报告

目的　探讨原发性十二指肠恶性肿瘤的临床表现、病理学特征及诊治手段。方法　对10年间收治的经病理证实的 82例原发性十二指肠恶性肿瘤患者的临床资料进行回顾性分析。结果　发病部位 :乳头区 64例 ,降段 11例 ,其他部位 7例。临床主要表现为上腹疼痛 (5 7例 ) ,黄疸 (5 3例 )和消化道出血 (4 1例 )。病理学类型以腺癌多见 (72例 ) ,胃肠道间质瘤 (5例 ) ,恶性淋巴瘤 (3例 )次之。 3 6例行肿瘤根治性切除术 ,3 1例行姑息性手术 ,15例未进行外科治疗。本组病例随访患者 5a生存率 2 .4%。结论　原发性十二指肠恶性肿瘤临床以上腹痛、黄疸、消化道出血为主要表现 ,但缺乏特征性。病理类型以腺癌为主 ,好发于十二指肠乳头区及降段。CT和B超及内镜检查是诊断检查原发性十二指肠恶性肿瘤的主要手段 ,手术切除是主要治疗方法。原发性十二指肠恶性肿瘤的预后甚差。

Diagnosis and treatment of primary malignant tumors of the duodenum:a report of 82 cases

Objective To investigate the clinical manifestations, histopathological patterns, and methods of diagnosis and treatment of primary malignant duodenal tumors. Methods The data of 82 patients with primary malignant duodenal tumors confirmed by pathology and admitted to our hospital over a 10-year period were analyzed retrospectively. Results Tumor location:Tumors were located in the peripapilla region in 64 cases, at the descending portion of the duodenum in 11 cases, at other regions of the duodenum in 7 cases. The common presenting symptoms and signs were abdominal pain in 57 cases, jaundice 53 cases, and gastrointestinal bleeding in 41 cases. In these patients, radical resection of tumor was performed in 36 cases, palliative resection of tumor in 31cases,and operative intervention was not done in 15 cases.The 5-year survival rate of followed-up patients in this group was 2.4%. Conclusions The common presenting symptoms and signs of patients with primary malignant duodenal tumors were abdominal pain, jaundice and GI bleeding, but these patients usually lack specific symptoms and signs. The chief pathologic type is adenocarcinoma and the predisposed site of occurrence is the duodenal papillary region and the descending duodenum . CT, B ultrasonography and gastroduodenoscopy are the chief measures for the diagnosis of primary duodenal malignant tumors, and surgical resection is the main modality of treatment of this disease. The prognosis of primary duodenal malignant tumors is very poor.