原发性十二指肠恶性肿瘤的临床分析

目的：探讨原发性十二指肠恶性肿瘤的临床特点、诊断方法和预后影响因素。方法：回顾性分析随访资料完整的45例原发性十二指肠恶性肿瘤患者的临床病理资料。结果：腺癌33例（73.3％）为主要的病理类型。主要临床表现为腹痛、上腹部不适、黄疸、消化道出血等。胃十二指肠镜、内镜逆行胰胆管造影（Endoscopic Retrograde Cholangio—Pancreatography，ERCP）、十二指肠低张造影、超声内镜、CT及B超确诊率分别为91．1％（41／45），93．3％（42/45），82．2％（37／45），75．6％（34N5），68．9％（31／45）及26．7％（12／45）。本组45例均行开腹手术，包括根治性手术，胰十二指肠切除术36例；姑息性手术，胃肠吻合术2例、肿瘤局部切除术5例、短路手术2例。根治术和姑息术后5年生存率分别为46．7％和4．4％，两组生存率差异有统计学意义（P〈O．05）。对全组45例患者的预后因素进行Cox回归分析的结果显示，手术方式、肿瘤浸润深度和淋巴节转移是影响预后的独立危险因素（均P〈0．05）。结论：原发性十二指肠恶性肿瘤缺乏特异性临床表现；胃十二指肠镜、ERCP以及十二指肠低张造影等联合检查可提高诊断率；根治性手术远期疗效较好；淋巴结转移和局部侵犯是肿瘤预后不良的重要影响因素。

Clinical Analysis of Primary Malignant Duodenal Tumor

Objective： To investigate the Clinical features, diagnostic methods and prognosis of primary malignant tumor of the duodenum. Methods： We retrospectively analyzed the clinicopathological data from 45 patients with primary duodenal malignancy seen in our hospital from 1998 to 2008. Re, suits： 33 cases of adenocarcinoma （73.3 %） as the main pathological types. The main clinical manifestations were abdominal pain, upper abdominal discomfort, jaundice, gastrointestinal bleeding.The correct diagnosis rate for Gastric duodenoscopy 91.1%（41/45）, for ERCP 93.3 % （42/45）, for duodenography 82.2 %（37/45）, for EUS 75.6 % （34/45）, for ultrasound examination 68.9 %（31/45）, for CT 26.7 % （12/45）, respectively. All of the 45 patients received surgery including radical surgery： pancreaticoduodenectomy （36 patients）; palliative surgery： gastrointestinal anastomosis （2 patients）, local tumor resection （5 patients）, short-circuit operation （2 patients）. The 5 year survival rate of radical surgery and palliative were 46.7 %and 4.4 % respectively. There was a significant diference between the two groups（P〈0.05 ）. The multivariate analysis showed that surgical procedure, depth of invasion and lymph node metastasis were independent prognostic risk factors （P 〈0.05）. Conclusions： Primary malignant tumor of the duodenum lack of specific clinical manifestations; Gastric duodenoscopy, ERCP and angiography, hypotonic duodenum of the joint inspection may improve the rate of diagnosis. Radical resection have better long-term effect. Lymph node metastasis and local invasion were important adverse prognostic factors.