原发性十二指肠癌的临床特征及预后分析  

Clinical characteristics and prognostic factors of primary duodenal carcinoma

作　　者：王利东[1] 田忠[1] 刘金钢[1] 

机构地区：[1]中国医科大学附属盛京医院第十普通外科病房,沈阳110022

出　　处：《中华消化外科杂志》2015年第12期1020-1025,共6页Chinese Journal of Digestive Surgery

摘　　要：目的 总结原发性十二指肠癌临床表现特点及探讨影响预后的因素.方法 回顾性分析2007年11月至2013年5月中国医科大学附属盛京医院收治的122例原发性十二指肠癌患者的临床资料.患者均行手术治疗,根据肿瘤特点选择不同的手术方式,术后通过病理学诊断证实为原发性十二指肠癌.采用电话和门诊方式进行术后随访,记录患者治疗过程、影像学和实验室检查结果以及患者术后生存情况.随访时间截至2014年11月30日.分别从临床表现、诊断依据、治疗方案及预后等方面进行分析.采用Kaplan-Meier法计算生存率并绘制生存曲线,采用Log-rank检验法进行单因素分析,COX比例风险回归模型进行多因素分析.结果 122例原发性十二指肠癌患者中,首发症状为黄疸57例,腹痛及腹上区不适37例,消化道梗阻症状14例,厌食及体质量下降4例,消化道出血3例,腹泻3例,发热3例,腹部包块1例.CT检查阳性率为69.67％（85/122）,内镜检查阳性率为85.56％ （77/90）,MRCP检查阳性率为79.76％（67/84）,B超检查阳性率为12.73％（7/55）,上消化道造影检查阳性率为75.00％（36/48）.122例患者中,48例出现不同程度的贫血,94例大便潜血试验阳性,71例CA19-9升高,22例CEA升高,9例AFP升高.122例患者中,86.07％（105/122）患者肿瘤位于十二指肠降段,7.37％（9/122）患者肿瘤位于十二指肠球部,6.56％（8/122）患者肿瘤位于十二指肠水平部.肿瘤平均直径为2.3 cm（1.0- 15.0 cm）.122例患者均行手术治疗.100例患者行胰头十二指肠切除术,其中17例术中联合行空肠营养造瘘术,7例行保留幽门的胰头十二指肠切除术.5例行十二指肠节段切除＋胃空肠吻合术,6例行十二指肠乳头局部切除术,11例行姑息性胃空肠吻合术.19例患者出现术后并发症,经对症支持治疗后痊愈.122例患者中,腺癌116例,类癌2例,淋巴瘤、小细胞癌、内瘤样癌伴横纹肌分化、未分化Objective To summarize the clinical characteristics and investigate the prognostic factors of primary duodenal carcinoma.Methods The clinical data of 122 patients with primary duodenal carcinoma who were admitted to the Shengjing Hospital Affiliated to China Medical University from November 2007 to May 2013 were retrospectively analyzed.All the patients received different operations according to the characteristics of tumors.Primary duodenal carcinomas of patients were confirmed by the postoperative pathological diagnosis.All the patients were followed up by outpatient examination, telephone interview and correspondence till November 30,2014.The treatment process, results of imaging examination and laboratory examination and postoperative survival were recorded.The clinical features, diagnostic criteria, therapeutic regimens and prognostic factors were analyzed.The survival rate and survival curve were analyzed and drawn by the Kaplan-Meier method.The univariate analysis was done using the Log-rank test, and multivariate analysis was done using the COX regression model.Results Among the 122 patients with primary duodenal carcinoma, jaundice as the first symptom was detected in 57 patients, abdominal pain and upper abdomen discomfort in 37 patients, gastrointestinal obstruction in 14 patients,anorexia and reduction of body weight in 4 patients, gastrointestinal hemorrhage in 3 patients, diarrhea in 3 patients, pyrexia in 3 patients and abdominal mass in 1 patient.The positive rates of CT examinations, endoscopic examinations, magnetic resonanced cholangio-pancreatography （MRCP）, B-ultrasound examinations and upper gastrointestinal contrast examinations were 69.67% （85/122）, 85.56% （77/90）, 79.76% （67/84）, 12.73% （7/55） and 75.00% （36/48）, respectively.Among the 122 patients, anemia was detected in 48 patients,positive fecal occult blood test in 94 patients, increasing level of CA19-9 in 71 patients, increasing level of CEA in 22 patients and increasing level of AFP in 9 patients.The tumors

关 键 词：十二指肠肿瘤 诊断 治疗 预后 

分 类 号：R735.31[医药卫生—肿瘤]