原发性十二指肠恶性肿瘤143例临床特征及诊治分析  

Analysis on clinical features,diagnosis and treatment of 143 cases with primary malignant tumor of the duodenum

作　　者：姜丹[1] 梁先 梁志海[1] 黄振宁[1] JIANG Dan;LIANG Xian;LIANG Zhi-hai(Department of Gastroenterology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院消化内科,南宁530021

出　　处：《中国临床新医学》2022年第8期738-743,共6页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西卫生健康委中医药科技专项资助项目(编号:GZLC16-33)。

摘　　要：目的分析143例原发性十二指肠恶性肿瘤(PMTD)的临床特征及诊治情况。方法回顾性分析2012年1月至2019年6月广西医科大学第一附属医院收治的143例PMTD患者的临床资料,并分析影响患者预后的指标。结果143例PMTD患者中,男83例,女60例;发病年龄以50~59岁年龄段人数占比最大(52例,36.36%)。主要发病部位为十二指肠降部(120例,83.92%),其次为球部(16例,11.18%)。病理分型以腺癌为主(103例,72.03%)。临床表现以黄疸、腹痛最常见。超声内镜、经内镜逆行胰胆管造影(ERCP)和CT的阳性检出率分别为98.34%、95.83%和91.67%。糖类抗原199(CA199)阳性率为46.15%,而癌胚抗原(CEA)、甲胎蛋白(AFP)和糖类抗原125(CA125)的阳性率均低于10.00%。134例患者完成随访,出现局部复发7例,中位复发时间为28个月。发生转移12例,死亡24例。1、3、5年累积生存率分别为86.10%、84.02%、82.09%。首发症状至诊断时间≥4个月及发生淋巴结转移与PMTD患者预后不良具有显著关联(P<0.05)。结论PMTD临床表现以黄疸、腹痛多见,发病部位主要在十二指肠降部,消化内镜检出率高。首发症状至诊断时间长、发生淋巴结转移影响PMTD患者预后,值得临床医师关注。Objective To analyze the clinical features,diagnosis and treatment of primary malignant tumor of the duodenum(PMTD)in 143 cases.Methods The clinical data of 143 PMTD patients admitted to the First Affiliated Hospital of Guangxi Medical University from January 2012 to June 2019 were retrospectively analyzed,and the indicators affecting the prognosis of the patients were analyzed.Results Among the 143 PMTD patients,there were 83 males and 60 females,and the number of the patients aged 50 to 59 years accounted for the largest proportion of the patients in the age group of onset(52 cases,36.36%).The main site of the disease was the descending part of the duodenum(120 cases,83.92%),followed by the bulbar part(16 cases,11.18%).Adenocarcinoma was the main pathological type(103 cases,72.03%).Jaundice and abdominal pain were the most common clinical manifestations.The positive detection rates of PMTD examined by endoscopic ultrasonography,endoscopic retrograde cholangiopancreatography(ERCP)and computed tomography(CT)were 98.34%,95.83%and 91.67%,respectively.The positive rate of carbohydrate antigen199(CA199)was 46.15%,while the positive rates of carcinoembryonic antigen(CEA),alpha fetoprotein(AFP)and carbohydrate antigen 125(CA125)were below 10.00%.Among the 134 patients who were followed up,7 patients had local recurrence,and the median recurrence time was 28 months;12 patients had metastasis,and 24 patients died.The1-,3-,and 5-year cumulative survival rates were 86.10%,84.02%,and 82.09%,respectively.The time from the first symptom to diagnosis≥4 months and the occurrence of lymph node metastasis were significantly correlated with the poor prognosis of PMTD patients(P<0.05).Conclusion The clinical manifestations of PMTD are jaundice and abdominal pain.The main site of the disease is the descending part of the duodenum,and the detection rate of the PMTD examined by digestive endoscopy is high.The long time from the first symptom to the diagnosis and the occurrence of lymph node metastasis affect the prognosis of PMTD pa

关 键 词：原发性十二指肠恶性肿瘤 临床特征 诊断 治疗 预后 

分 类 号：R735.31[医药卫生—肿瘤]