十二指肠乳头肿瘤的CT诊断及治疗

目的 探讨十二指肠乳头肿瘤的CT表现及临床特征。方法 回顾性分析12例经病理学证实十二指肠乳头肿瘤的CT及临床资料。结果 12例中5例良性者均为腺瘤，7例恶性中5例腺癌，间质瘤及神经内分泌肿瘤各1例。5例腺瘤均呈边界较清楚的类圆形结节，CT平扫呈等或稍低密度，增强较均匀中等强化。5例腺癌中1例表现为十二指肠乳头不规则增厚，增强明显强化；4例表现为类圆形结节2例、不规则肿块2例，CT平扫呈等低密度，增强不均匀明显强化，3例见坏死囊变区，2例周边侵犯；1例间质瘤表现为类圆形肿块，CT平扫呈不均匀等、低密度，增强不均质强化；1例神经内分泌肿瘤表现类圆形等密度结节，增强明显均匀强化。12例均见程度不等的胆总管及主胰管梗阻，6例见程度不等的十二指肠不全梗阻，2例腺癌伴有胆总管结石及急性胰腺炎，其中1例伴有腹膜后单发淋巴结转移及腹腔积液。12例均以黄疸及右上腹痛为主要症状，并均接受手术治疗。3例腺瘤行内镜下肿瘤切除术，4例腺癌及1例间质瘤行 胰十二指肠切除术，其余行局部切除术，5例腺癌并行全身化疗6周期。术后随访6～18个月，1例腺瘤复发再次手术，其余均未见肿瘤复发及转移。结论 十二指肠乳头肿瘤以黄疸及右上腹痛为主要临床症状，往往早期出现胆胰管梗阻；CT对该类疾病的诊断有较大价值，早期手术切除预后较好。

CT diagnosis and treatment of duodenal papillary tumors

Objective To explore the CT manifestations and clinical features of duodenal papillary tumors.Methods The CT and clinical data of 12 cases of duodenal papillary tumors confirmed by pathology were analyzed retrospectively.Results Among the 12 cases,5 were with benign tumors,all of which were adenomas;and the other 7 were with malignant tumors,including 5 adenocarcinomas,1 stromal tumor and 1 neuroendocrine tumor.All the 5 adenomas showed oval nodule with equal or slightly low density and clear boundary on unenhanced CT,and with homogeneous moderate enhancement on enhanced CT.Among the 5 adenocarcinomas,1 case showed irregularly thickening of duodenal papilla and with obvious enhancement;4 cases showed oval nodule(2 cases)or irregular mass(2 cases)and with equal and low density on unenhanced CT,and heterogeneous obvious enhancement on enhanced CT.Peripheral invasion occurred in 2 cases,cystic degeneration and necrosis were observed in 3 cases.One case of stromal tumor presented as irregular mass with heterogeneous equal and low density on unenhanced CT and heterogeneous enhancement on enhanced CT.One case of neuroendocrine tumor presented as oval nodule of equal density and with obvious uniform enhancement.Obstruction of the common bile duct and the main pancreatic duct occurred in all the 12 cases,and incomplete obstruction of duodenal occurred in 6 cases.Choledocholithiasis and acute pancreatitis occurred simultaneously in 2 adenocarcinomas.Single metastasis of retroperitoneal lymph node and ascites were observed in 1 case.The main symptoms of the 12 cases were jaundice and right upper abdominal pain,and all the 12 patients received surgical treatment.The 3 patients with adenomas underwent endoscopic resection,4 patients with adenocarcinomas and 1 patient with stromal tumors underwent pancreatoduodenectomy and the remaining 4 cases underwent local resection.The 5 cases with adenocarcinomas were treated with systemic chemotherapy for 6 cycles.12 cases were followed-up for 6 to 18 months,during which the patient with adenoma recurred and underwent reoperation,and no recurrence or metastasis happened for the rest cases.Conclusion Jaundice and right upper abdominal pain are the main clinical symptoms of duodenal papillary tumors,and obstruction of biliary and pancreatic ducts occurs in the early stage generally.CT diagnosis of this type of lesions is of great value.Early surgical resection may obtain a better prognosis.