原发性十二指肠水平部癌16例临床分析  

The clinical features of 16 cases of primary adenocarcinoma of the third portion of duodenum

作　　者：冯云路[1] 吴东[1] 费贵军[1] 舒慧君[1] 李景南[1] 钱家鸣[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化科,100730

出　　处：《中华内科杂志》2013年第12期1045-1047,共3页Chinese Journal of Internal Medicine

摘　　要：目的提高原发性十二指肠水平部癌的早期诊断率，减少误诊、漏诊。方法对北京协和医院2009年12月至2012年12月确诊的16例原发性十二指肠水平部癌病例进行回顾性分析。结果上腹痛（12／16）、呕吐（9／16）和腹胀（7／16）是该病最常见的症状。患者中位病程5．5个月，中位诊断周期2．5个月。中一高分化腺癌患者起病一诊断周期为8（2，32）个月，低分化腺癌为4（3，8）个月（P=0．57），前者手术根治率为6／8，后者仅为1／8（P=0．04）。CT对十二指肠水平部癌有较高的诊断阳性率（11／14）；上消化道造影诊断率仅为2／7，且易误诊为肠系膜上动脉综合征（3／7）。结论原发性十二指肠水平部癌无特异性表现，早期诊断有一定难度。对于可疑高位消化道梗阻且胃镜和造影阴性者，需警惕该病。CT可作为无创性检查的首选。缩短诊断周期对于肿瘤恶性度高者尤其有意义。Objective To summarize the clinical features of the third portion of duodenum （PATD） for improving the understanding of PATD. Methods Sixteen cases with PATD in Peking Union Medical College Hospital（PUMCH） were retrospectively analyzed. Results The most common symptoms of PATD were upper abdominal pain （ 12/16 ）, vomiting （ 9/16 ） and distention （ 7/16 ）. On average, the disease had progressed 5.5 months （including 2. 5 months of diagnostic workup ） before the diagnosis was established. Patients with pathologically poorly differentiated PATD had shorter course of disease （ 6. 5 vs 16. 6 months ,P = 0. 56 ） and lower chance of cancer-directed surgery （ 1/8 vs 6/8, P = 0. 04 ） than those with well differentiated PATD. The diagnostic rate was 11/14 by CT scan while only 2/7 by upper gastrointestinal radiography. Three cases were misdiagnosed as superior mesenteric artery syndrome by barium examination. Conclusions PATD should be considered in patients presenting upper abdominal symptoms with negative gastroendoscopy and barium examination. Overall, CT scan plays a pivotal role in diagnosing PATD. Making a correct diagnosis timely can improve the outcome of PATD patients, particularly, in those with poorly differentiated pathology.

关 键 词：十二指肠肿瘤 上肠系膜动脉综合征 体层摄影术 X线计算机 上消化道造影 

分 类 号：R735.3[医药卫生—肿瘤]