原发性十二指肠恶性肿瘤47例临床分析  

Clinical analysis of primary malignant tumors of the duodenum

作　　者：刘全达[1] 蔡志民[1] 余佩武[1] 姜军[1] 吴国庆[1] 

机构地区：[1]第三军医大学西南医院普通外科,重庆400038

出　　处：《中华普通外科杂志》2000年第3期136-138,共3页Chinese Journal of General Surgery

摘　　要：目的　总结原发性十二指肠恶性肿瘤常见临床表现、病理学特征及诊断手段 ,探讨腺癌发生的机制。方法　回顾性分析 1978～ 1998年我院收治并经病理学证实的 47例原发性十二指肠恶性肿瘤。结果　患者平均发病年龄 5 4 6岁 (2 0～ 84岁 ) ,男女之比 1 94∶1,中位病程 10 6d(7～6 40d)。病理学类型为腺癌 42例 ,平滑肌肉瘤 4例 ,类癌 1例。好发于十二指肠降部 (35例 ,75 % ) ,尤其是乳头区 (2 8例 )。常见临床表现依次为上腹疼痛 (6 8% ) ,黄疸 (6 0 % ) ,消化道出血 (47% ) ,呕吐(45 % ) ,体重减轻 (32 % ) ,乳头区以外肿瘤常有呕吐、消化道出血 ,平滑肌肉瘤多有腹块。诊断手段主要有纤维胃镜、胃肠钡餐、B型超声、CT和内窥镜逆行胰胆管造影 (ERCP) ,纤维胃镜对球部肿瘤确诊率高 ,B型超声和ERCP联合检查可提高十二指肠乳头区肿瘤检出率 ,胃肠钡餐对其它部位肿瘤有帮助。结论　原发性十二指肠恶性肿瘤以腺癌为主 ,好发于十二指肠降段 ,早期临床表现无特异性 ,可根据症状选择系列或联合应用诊断手段 ;十二指肠腺癌与血型无关。Objective[WT5”BZ] To investigate clinical manifestations, histopathological patterns and effective diagnostic methods for primary malignant duodenal tumors and pathogenesis for duodenal adenocarcinomas.[WT5”HZ] Methods[WT5”BZ] The data of 47 cases of primary malignant duodenal tumors confirmed by pathology admitted during 20 years in Southwest Hospital were retrospectively analyzed.[WT5”HZ] Results[WT5”BZ] The average age of the patients was 54 6 (20～84) years, 31 were male and 16 female, the median interval from onset of symptoms to surgery was 106 (7～640) days. Of the 47 primary malignant tumors, 42 were adenocarcinoma, 4 leiomyosarcoma, and 1 carcinoid.Tumors mostly located in the descending portion of the duodenum (35 cases,75%), especially around the peripapilla region (28 cases). The common presenting symptoms and signs were abdominal pain (68%), jaudice (60%), GI hemorrhage (47%), vomitting (45%), and weight loss (32%). In addition, except for those with peripapilla tumors, patients were more likely to present with vomitting and bleeding, those with leiomyosarcomas commonly presented with abdominal mass. The main diagnostic procedures were gastroscopy, GI barium meal, ultrasounography, CT and endoscopic retrograde cholangiopancreatography (ERCP). Gastroscopy were highly diagnostic for bulb tumors, BUS and ERCP were especially useful in diagnosing the papilla tumors, GI barium meal was also useful for tumor detection.[WT5”HZ] Conclusions[WT5”BZ] Adenocarcinoma predominates among primary malignant duodenal tumors,which locating most often in the descending portion.Patients usually lack specific symptoms and signs.Diagnosis relies on a combination of intervensive and imaging means.No individual blood type was found to predispose one to primary malignant duodenal tumors. [WT5”HZ]

关 键 词：十二指肠肿瘤 腺癌 平滑肌肉瘤 类癌瘤 诊断 

分 类 号：R735.31[医药卫生—肿瘤]