原发性十二指肠恶性肿瘤12例临床分析

目的：总结原发性十二指肠恶性肿瘤常见临床表现，诊断和治疗方法。方法；回顾性分析我院自1990年1月-1999年10月收治并经手术及病理证实的12例原发性十二指肠恶性肿瘤。结果：患者男9例，女3例。平均发病年龄51.4岁；平均发病时间3.4个月，肿瘤位于十二指肠降部者11例，其中腺癌10例，平地滑肌肉瘤1例，位于横部者1例，为腺癌。常见临床表现主要有上腹部疼痛（10/12），黄疸（9/12），上消化道出血（7/12），恶心呕吐（7/12），消瘦（10/12），诊断方法主要有胃肠钡餐造影，纤维十二指肠镜，ERCP、B型超声和CT。结论：原发性十二指肠恶性肿瘤好发于十二指肠降部。以腺癌为主，早期诊断较为困难，根据临床症状选择诊断方法，治疗方法以胰十二指肠切除术为主。

Clinical Analysis of Primary Duodenal Malignant Tumor in 12 Cases

Objective: To investigate the clinical presentations, diagnosis and treatment of primary duodenal malignant tumor. Methods: 12 case of primary duodenal malignant tumor confirmed by operation and pathology from January 1990 to October 1999 were retrospectively analyzed. Results: Among 12 patients (male: female ratio, 9:3), the mean age was 51.4 years, and the mean course of disease was 3.4 months. Eleven patients had tumor locating in second portion of duodenum, 10 cases of adenocarcinoma and 1 case of leiomysarcoma. One in the third portion was adenocarcinoma. The main clinical manifestation of 12 cases included: upper abdominal pain (10/12), jaundice(9/12), upper gastrointestinal hemorrhage (7/12), nausea and vomitting (7/12) and emaciation (10/12). Primary diagnostic modality for the duodenal tumours include gastrointestinal barium meal examination, duodenscopy, endoscopic retrograde cholangiopancreatography(ERCP),B ultrasonography and computed tomography(CT). Conclusion: Primary duodenal malignant tumor is usually adenocarcinoma arising in the second portion of the duodenum. Because of the difficulties in early diagnosis, we must choose proper diagnostic investigation according to clinical presentation. Pancreatoduodenectomy is the standard procedure for the treatment of primary duodenal malignant tumor.