CAJ | 학술논문

目的总结十二指肠脂肪瘤的临床特点,探讨有效的术前诊断方法与恰当的治疗方案.方法回顾性分析浙江大学医学院附属第一医院2000年6月至2008年12月间8例十二指肠脂肪瘤患者的临床表现、实验室检查结果、内镜下表现、影像学特点及病理组织学结果 .结果 8例中反复黑便者4例,上腹不适、反酸或呃逆者3例,无症状者1例.血脂及血清肿瘤标志物测定均未见明显异常.胃镜检查发现病灶6例(球部2例,降部4例,其中2例首次检查时漏诊).CT发现十二指肠肠壁局部增厚6例,局部肠腔变窄4例,肠腔内低密度病灶3例,CT值平均-85 HU,增强后病灶均匀强化.超声内镜下表现为起源于黏膜下层的密集高回声区,圆形或椭圆形,边界清楚,内部回声均匀.内镜活检结果均为黏膜慢性炎症,外科手术或内镜下切除术后病理结果均为十二指肠脂肪瘤.行胰十二指肠切除术1例,十二指肠肿瘤切除术3例,内镜下行圈套摘除术4例,无出血、穿孔等相关并发症发生.结论十二指肠脂肪瘤好发于降部,临床表现无特异性,内镜与影像学检查是发现病灶的主要手段,内镜超声具有重要的诊断与鉴别诊断价值,除肿瘤局部切除术或局部肠段切除术外,对有适应证者可在内镜下行圈套摘除术.
목적 총결십이지장지방류적림상특점,탐토유효적술전진단방법 여흡당적치료방안.방법 회고성분석절강대학의학원부속제일의원2000년6월지2008년12월간8례십이지장지방류환자적림상표현、실험실검사결과 、내경하표현、영상학특점급병리조직학결과 .결과 8례중반복흑편자4례,상복불괄、반산혹애역자3례,무증상자1례.혈지급혈청종류표지물측정균미견명현이상.위경검사발현병조6례(구부2례,강부4례,기중2례수차검사시루진).CT발현십이지장장벽국부증후6례,국부장강변착4례,장강내저밀도병조3례,CT치평균-85 HU,증강후병조균균강화.초성내경하표현위기원우점막하층적밀집고회성구,원형혹타원형,변계청초,내부회성균균.내경활검결과 균위점막만성염증,외과수술혹내경하절제술후병리결과 균위십이지장지방류.행이십이지장절제술1례,십이지장종류절제술3례,내경하행권투적제술4례,무출혈、천공등상관병발증발생.결론 십이지장지방류호발우강부,림상표현무특이성,내경여영상학검사시발현병조적주요수단,내경초성구유중요적진단여감별진단개치,제종류국부절제술혹국부장단절제술외,대유괄응증자가재내경하행권투적제술.
Objective To summarize the clinical features of the duodenal lipomas in order to explore effective diagnostic methods and appropriate treatment preoperatively. Methods The clinical features, laboratory results, endoscopic appearance, radiological and pathological data of 8 cases of duodenal lipoma were retrospectively analyzed. Results Four patients suffered with repeated melena, 3 cases with epigastric discomfort, sour regurgitation or hiccup, while 1 patient without any symptoms. Liver functions, serum lipids and tumor markers were normal in all patients. Six patients had been detected lesions by gastroscopy (2 cases missed diagnosed in the first examination) , these lesions were appeared in duodenal bulb (2 cases) or descendant duodenum (4 cases). Abdominal CT examination revealed partial duodenal wall thickening (6 cases) , partial enteric cavity narrowing (4 cases) , or low-density lesions in enteric cavity (3 cases) with CT value of -85 HU and evenly intensified when enhanced. EUS showed intensive hyperechoic lesions from submucosa, with homogeneous echo and clear margin. Biopsy under endoscopy in all patients showed chronic inflammation of mucosa, while the pathologic diagnosis was lipoma after surgical excision or endoscopic resection. Pancreaticoduodenectomy performed in 1 patient, duodenal tumorectomy in 3 patients and endoscopic resection with snare in 4 patients. Conclusion Common site of duodenal lipoma is descending part, and the clinical manifestations are non-specific. Imaging and endoscopic examination are the mainly methods to detect the lesion, while EUS is significantly valuable in diagnosing and differential diagnosing. It can be treated by partial tumorectomy or endoscopic trap resection.