内镜诊断原发性十二指肠球部腺癌1例

目的： 探讨原发性十二指肠球部腺癌的临床特点及诊治方法。方法：对中国人民解放军第163医院消化内科2012年诊断的1例十二指肠球部腺癌的临床资料进行回顾性分析。结果：胃镜检查见十二指肠球部大弯侧一乳头样肿物,表面凹凸不平,质脆触之易出血;病理检查报告为十二指肠球部低分化腺癌,侵犯至外膜,腺管内癌栓形成,两断缘未见癌细胞,胃大弯侧淋巴结有转移（2/2）,胃小弯侧淋巴结有转移（3/7）;其余检查结果均为阴性。结论：内镜活组织病理检查或术中活组织病理检查是确诊原发性十二指肠球部腺癌的依据;早期诊断及手术是彻底治疗本病,提高患者生存率,改善预后的关键。

A case report of primary adenocarcinoma at duodenal bulb diagnosed by endoscopy

Objective： To investigate the clinical manifestations, effective methods for diagnosis and treatment of primary adenocarcinoma at duodenal bulb. Methods： One case of primary adenocarcinoma at duodenal bulb in Department of Gastroenterology, 163rd Hospital of PLA was retrospectively analyzed. Results： There was a papillary mass with uneven surface, crisp touch of easy bleeding in duodenal greater curvature by gastroscopy. The pathological diagnosis was poorly differentiated duodenal adenocarcinoma with invasion to the outer membrane, glandular thrombus formation within the tube, lymph node metastasis in the greater （2/2）/lesser （3/7） curvature of the stomach and no cancer cells in the two edges-off. The remaining of them were negative. Conclusion： Endoscopic biopsy or surgical biopsy was necessary for the disease diagnosis. Early diagnosis and surgery are critical to the treatment of this disease and to the improvement of survival rate and prognosis.