原发性十二指肠恶性肿瘤98例临床特征分析  

Clinical Characteristics of Primary Malignant Duodenal Neoplasm： Analysis of 98 Cases

作　　者：李春艳[1] 郭世斌[1] 刘丽娜[1] 

机构地区：[1]大连医科大学附属第一医院消化科,116011

出　　处：《胃肠病学》2009年第2期107-109,共3页Chinese Journal of Gastroenterology

摘　　要：背景：原发性十二指肠恶性肿瘤临床表现隐匿,不易早期发现,误诊率高。目的：总结原发性十二指肠恶性肿瘤的临床特征,探讨其诊断线索。方法：回顾性分析大连医科大学附属第一医院2002年1月～2008年6月收治的98例经病理检查证实的原发性十二指肠恶性肿瘤患者的临床资料。结果：本组患者临床表现主要为上腹痛、梗阻性黄疸、贫血、肠梗阻、消瘦、上消化道出血。内镜检查确诊率为86.6%,内镜逆行胰胆管造影（ERCP）对乳头区癌的确诊率为100%,上消化道钡餐检查、CT、MRI的病变检出率分别为81.6%、74.2%和89.7%。病变部位以十二指肠降部多见（69.4%）;病理类型以腺癌为主（80.6%）,其次为间质瘤（10.2%）。结论：对于无规律的上腹痛、无胆石和胰头病变的黄疸、不明原因的贫血或上消化道梗阻,应考虑原发性十二指肠恶性肿瘤的可能。合理选择内镜结合影像学检查可提高诊断率。Primary malignant duodenal neoplasm is often clinically latent, which is difficult for early diagnosis and the misdiagnosis rate is high. Aims： To summarize the clinical characteristics of primary malignant duodenal neoplasm and to appraise its diagnostic clues. Methods： The clinical data of 98 patients with pathologically proven primary malignant duodenal neoplasm admitted from January 2002 to June 2008 to the First Affiliated Hospital of Dalian Medical University were analyzed retrospectively. Results： The major clinical manifestations of these patients were epigastric pain, obstructive jaundice, anemia, intestinal obstruction, weight loss and upper gastrointestinal bleeding. The diagnostic accuracy rate of endoscopy was 86.6%, and that of endoscopic retrograde cholangiopancreatography （ERCP） for papillary cancer was 100%. The detection rate of upper gastrointestinal barium meal examination, CT and MRI was 81.6%, 74.2% and 89.7%, respectively. The most frequent lesion site was the descending portion of duodenum （69.4%）; the major pathologic type was adenocarcinoma （80.6%） and stromal tumor （10.2%） being the next. Conclusions： Primary malignant dnodenal neoplasm should be considered when patient shows unidentified epigastric pain, jaundice in absence of gallstone or pancreatic head lesion, obscure anemia or upper gastrointestinal obstruction. Endoscopy combined with imaging examination can improve the diagnosis rate.

关 键 词：十二指肠肿瘤 诊断 回顾性研究 

分 类 号：R735.31[医药卫生—肿瘤] R657.4[医药卫生—临床医学]