中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2009年
2期
125-127
,共3页
金仲田%李澍%彭吉润%李英杰%冷希圣
金仲田%李澍%彭吉潤%李英傑%冷希聖
금중전%리주%팽길윤%리영걸%랭희골
十二指肠肿瘤%腺癌%十二指肠镜检查%胰胆管造影术,内窥镜逆行%胰十二指肠切除术
十二指腸腫瘤%腺癌%十二指腸鏡檢查%胰膽管造影術,內窺鏡逆行%胰十二指腸切除術
십이지장종류%선암%십이지장경검사%이담관조영술,내규경역행%이십이지장절제술
Duodenal neoplasms%Adenocarcinoma%Dudenoscopy%Cholangiopancreatography,endoscope retrograde%Pancreaticoduodenectomy
目的 探讨原发性十二指肠癌的诊断和治疗方法 .方法 回顾性分析我院1995-2005年间治疗的原发性十二指肠癌54例的临床资料.结果 本组肿瘤位于球部6例(10%)、降部44例(82%)、水平与升部各2例(4%),其中降部乳头区为38例,占降部86%.病理类型为腺癌50例(92%),黏液腺癌2例(4%),类癌与低分化腺鳞癌各1例(2%).主要临床表现为黄疸、腹痛、消瘦、食欲减退、腹胀、恶心、呕吐、上腹部压痛及腹部包块.经纤维十二指肠镜及ERCP确诊率分别为94%和78%.合并胆囊病变率为37%.行胰十二指肠切除38例,节段性十二指肠切除1例,姑息性手术9例,失去手术时机6例.手术切除率为89%,其中根治性切除率为72%.行胰十二指肠切除患者的3年和5年生存率分别为41%和22%,姑息性手术3～24个月死亡,未行手术者6个月内死亡.结论 原发性十二指肠癌以降部乳头区最多见,以腺癌为主,临床表现特异性差,易合并胆囊病变.纤维十二指肠镜和ERCP是诊断的主要手段,治疗首选胰十二指肠切除术.
目的 探討原髮性十二指腸癌的診斷和治療方法 .方法 迴顧性分析我院1995-2005年間治療的原髮性十二指腸癌54例的臨床資料.結果 本組腫瘤位于毬部6例(10%)、降部44例(82%)、水平與升部各2例(4%),其中降部乳頭區為38例,佔降部86%.病理類型為腺癌50例(92%),黏液腺癌2例(4%),類癌與低分化腺鱗癌各1例(2%).主要臨床錶現為黃疸、腹痛、消瘦、食欲減退、腹脹、噁心、嘔吐、上腹部壓痛及腹部包塊.經纖維十二指腸鏡及ERCP確診率分彆為94%和78%.閤併膽囊病變率為37%.行胰十二指腸切除38例,節段性十二指腸切除1例,姑息性手術9例,失去手術時機6例.手術切除率為89%,其中根治性切除率為72%.行胰十二指腸切除患者的3年和5年生存率分彆為41%和22%,姑息性手術3～24箇月死亡,未行手術者6箇月內死亡.結論 原髮性十二指腸癌以降部乳頭區最多見,以腺癌為主,臨床錶現特異性差,易閤併膽囊病變.纖維十二指腸鏡和ERCP是診斷的主要手段,治療首選胰十二指腸切除術.
목적 탐토원발성십이지장암적진단화치료방법 .방법 회고성분석아원1995-2005년간치료적원발성십이지장암54례적림상자료.결과 본조종류위우구부6례(10%)、강부44례(82%)、수평여승부각2례(4%),기중강부유두구위38례,점강부86%.병리류형위선암50례(92%),점액선암2례(4%),유암여저분화선린암각1례(2%).주요림상표현위황달、복통、소수、식욕감퇴、복창、악심、구토、상복부압통급복부포괴.경섬유십이지장경급ERCP학진솔분별위94%화78%.합병담낭병변솔위37%.행이십이지장절제38례,절단성십이지장절제1례,고식성수술9례,실거수술시궤6례.수술절제솔위89%,기중근치성절제솔위72%.행이십이지장절제환자적3년화5년생존솔분별위41%화22%,고식성수술3～24개월사망,미행수술자6개월내사망.결론 원발성십이지장암이강부유두구최다견,이선암위주,림상표현특이성차,역합병담낭병변.섬유십이지장경화ERCP시진단적주요수단,치료수선이십이지장절제술.
Objective To evaluate the diagnostic procedures and treatment choice of primary malignant tumor of the duodenum.Methods The clinical data of 54 cases with primary malignant tumor of the duodenum at Peking University People's Hospital from 1995 to 2005 were analyzed retrospectively.Resuits Tumors located in the first,second,third and fourth parts in 6 cases(10%),44 cases(82%),2 cases(4%),and 2 cases(4%)respectively,and among them,tumors within papillary area accounted for 86%(38 cases)of all cases.Fifty cases(92%)were of adenocarcinoma,2 cases(4%)of mucinous adenoearcinoma carcinoid and undifferentiated carcinoma for 1 case each(2%)respectively.The main clinical presentations included jaundice,upper abdominal pain,weight loss,abdominal distention,nausea and vomiting.gastrointestinal obstruction and abdominal mass.The accuracy rate of duodenoscopy and ERCP in preoperative diagnosis was 94%,and 78%respectively.Preoperative associated cholecystopathy accounted for 37%.Panceaticoduodenectomy was performed in 38 cases,duodenectonmy in 1 ease,palliative resection of tumor in 9 cases,and tumor was inoperable in 6 cases.Resection rate was 89%,and radical resection rate was 72%.The postoperative 3-and 5-year survival rate was 41%and 22%respectively.Patients after palliative resection died from 3 months to 24 months and all patients who did not undergo a surgery died within 6 months.Conclusions Tumors located in papillary region account for the majority of primary malignant tumors of the duodenum and are mainly of adenocarcinoma.Specific signs on abdominal examination are few.The symptoms of advanced stage are complicated,associated cholecystopathy is relatively frequent.Endoscopy and ERCP examination are the main diagnostic tools.the pancreatoduodenectomy is the first choice of therapy for patients with primary duodenal carcinoma.
