原发性十二指肠恶性肿瘤76例临床分析

目的分析原发性十二指肠恶性肿瘤临床表现、病理类型,探讨如何进行辅助检查的选择与减少病例的误诊。方法回顾性分析1997年3月至2008年3月收治的76例确诊为原发性十二指肠恶性肿瘤患者的临床资料。结果临床表现无特异性,可有腹痛、腹胀、黄疸、呕吐以及消化道出血等表现。从起病到入院确诊平均病程6.5个月。肿瘤好发于十二指肠降部,共64例,另外球部6例,水平部6例,升部0例,病理类型以腺癌为主,占90.8%。辅助检查以胃镜加十二指肠镜检出率最高91.2%,造影检查为87.1%,CT83.3%,B超70.4%,CA-19973.6%。结论提高原发性十二指肠恶性肿瘤预后的关键是早期诊断,对上述临床表现不能用常见疾病解释者应提高警惕,结合RECP、Gl、胃镜、CT、B超等多项辅助检查,可望达到早期诊断的目的。

Analysis of 76 cases of primary malignant of tumor of the duodenum

Objective To analyze the clinical manifestation and pathological type of primary malignant tumor of duodenum,and investigate how to select the auxiliary examination and decrease misdiagnose of cases.Methods Clinical data of 76 cases of the primary malignant tumor of duodenum in our department from March 1997 to March 2008 were retrospectively analyzed.All the cases were followed up for 1-84 months (average 38.2 months).Results Clinical manifestation was non-specificity,they can be abdominal pain,abdominal distention,jaundice,bowl obstruction or bleeding.The average internal from onset to be diagnosed was 6.5 months.The tumor was predilection in the descending part of the duodenum,65 cases,while 6 in bulbar zone,6 in the horizontal part and none in the ascending part.The main pathological type is adenocarcinoma,90.8%.Correct diagnose rates of image examination were gastroscope 91.2%,image examination 87.1%,CT 83.3%,ultrasound 70.4%and CA-199 73.6%.We should bind these auxiliary examinations exactly to raise the diagnostic rate.Conclusion Early diagnose is the key point to increase the survival rate of the primary malignant tumor of duodenum,so we should vigilant some clinical manifestation that could not be explained by the normal disease and use multiple auxiliary examinations to achieve this purpose.