116例原发性十二指肠恶性肿瘤的诊治分析  

Clinical analysis on diagnosis and treatment of 116 patients with primary duodenal malignant tumor

作　　者：邓顺 尹彬 贺卓 王双 王进峰 罗建红 欧阳永忠 谢江波 黄波 白飞 肖科 左朝晖 Deng Shun;Yin Bin;He Zhuo;Wang Shuang;Wang Jinfeng;Luo Jianhong;Ouyang Yongzhong;Xie Jiangbo;Huang Bo;Bai Fei;Xiao Ke;Zuo Chaohui(Department of Gastroduodenal and Pancreatic Surgery,Translational Medicine Research Center of Liver Cancer,Laboratory of Digestive Oncology,the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University/Hunan Cancer Hospital,Changsha 410013,China;Xiangya School of Medicine,Central South University,Changsha 410013)

机构地区：[1]中南大学湘雅医学院附属肿瘤医院暨湖南省肿瘤医院胃十二指肠胰腺外科,湖南省肿瘤医院(湖南省肿瘤防治研究所)肝癌转化医学联合研究中心和消化道肿瘤实验室,长沙410013 [2]中南大学湘雅医学院,长沙410013

出　　处：《中国医师进修杂志》2021年第11期999-1004,共6页Chinese Journal of Postgraduates of Medicine

基　　金：长沙市科技项目2020年科研资助项目(KQ2004130)。

摘　　要：目的探讨原发性十二指肠恶性肿瘤的诊断、手术方法和疗效。方法回顾性分析2010年1月至2018年12月116例原发性十二指肠恶性肿瘤患者的临床资料。结果116例患者中,腺癌74例,间质瘤25例,类癌9例,其他8例。术前行十二指肠镜检查107例,CT检查76例。行胰十二指肠切除术57例,十二指肠节段性切除术15例,胃大部分切除并十二指肠球部切除术13例,十二指肠部分切除术13例,姑息性短路手术18例。术后总并发症发生率为31.9%(37/116),其中胰瘘8例(B级5例,C级3例),胆瘘6例,腹腔感染5例,肺部感染4例,肠瘘3例,胃排空延迟3例,出血8例。围手术期死亡4例(3.4%)。单因素Cox回归分析结果显示,术后生存时间与肿瘤分化程度、手术方式、肿瘤浸润程度和淋巴转移情况有关(P<0.05或<0.01),多因素Cox回归分析结果显示,手术方式、肿瘤浸润程度和淋巴转移是影响原发性十二指肠恶性肿瘤患者术后生存时间的独立危险因素(P<0.05)。患者随访截止2021年6月,失访9例。Kaplan-Meier生存曲线分析结果显示,术后1、3和5年总体生存率分别为82.11%、57.56%和33.11%。结论原发性十二指肠恶性肿瘤以腺癌为主;十二指肠镜和CT是主要检查方法。根治性切除术是原发性十二指肠恶性肿瘤最有效的治疗方法,首选胰十二指肠切除术。手术方式、肿瘤浸润程度和淋巴转移是影响患者预后的独立危险因素。Objective To explore the diagnosis,surgical methods and therapeutic effect of primary duodenal malignant tumor.Methods The clinical data of 116 patients with primary duodenal malignant tumor from January 2010 to December 2018 were retrospectively analyzed.Results Among 116 patients,adenocarcinoma was in 74 cases,interstitial tumor was in 25 cases,carcinoid was in 9 cases,the others was in 8 cases.Before operation,duodenoscopy was performed in 107 cases,and CT examination was performed in 76 cases.There were 57 cases of pancreaticoduodenectomy,15 cases of duodenal segmental resection,13 cases of subtotal gastrectomy and duodenal bulbar resection,13 cases of duodenal partial resection,and 18 cases of palliative short circuit operation.The total incidence of postoperative complication was 31.9%(37/116),including pancreatic fistula in 8 cases(grade B 5 cases,grade C 3 cases),biliary fistula in 6 cases,abdominal infection in 5 cases,pulmonary infection in 4 cases,intestinal fistula in 3 cases,delayed gastric emptying in 3 cases,and hemorrhage in 8 cases.Four cases(3.4%)died during the perioperative period.Single factor Cox regression analysis result showed that the postoperative survival time was related to the tumor differentiation degree,operation method,tumor infiltration degree and lymphatic metastasis(P<0.05 or<0.01);multi-factor Cox regression analysis results showed that the operation method,tumor infiltration degree and lymphatic metastasis were the independent risk factors for the postoperative survival time of patients with primary duodenal malignant tumor(P<0.05).The patients were followed up until June 2021,and 9 cases were lost to follow-up.Kaplan-Meier survival curve analysis result showed that the postoperative overall 1-,3-and 5-year survival rates were 82.11%,57.56%and 33.11%,respectively.Conclusions Adenocarcinoma is the main primary malignant tumor of duodenum.Duodenoscopy and CT are the main examination methods.Radical resection is the most effective treatment for primary duodenal malignant tumor,a

关 键 词：十二指肠肿瘤 胰十二指肠切除术 诊断 治疗结果 回顾性研究 

分 类 号：R735.31[医药卫生—肿瘤]