CAJ | 학술논문

目的探讨原发性十二指肠肿瘤的诊断和术式选择.方法回顾性分析中国医科大学附属第一医院2001-2007年间124例原发性十二指肠肿瘤患者的临床资料,其中良性肿瘤10例,恶性肿瘤114例.结果本组原发性十二指肠肿瘤常见的临床表现有上腹痛、黄疸、体重下降以及纳差等.肿瘤位于十二指肠球部9例(7.3%),降部107例(86.3%),水平部7例(5.7%),升部1例(0.8%).术前纤维内镜确诊率为90.5%,ERCP确诊率为94.1%,超声内镜确诊率为100%,胃肠气钡双重造影发现率为78.6%,MRI发现率为80.5%,CT发现率为75.7%,B超发现率为40.6%.10例原发性十二指肠良性肿瘤中5例行肿瘤局部切除术,2例行标准胰十二指肠切除术,1例行十二指肠节段切除术,2例未手术,5年生存率为100%;114例原发性十二指肠恶性肿瘤中47例行标准胰十二指肠切除术,3例行保留幽门的胰十二指肠切除术,5年生存率为35.8%;6例行局部肿瘤切除术,12例行十二指肠节段切除术,5年生存率为16.7%;22例行旁路手术,均死于术后5～16个月;2例行支架介入术,2例行经皮肝胆道穿刺引流术,死于术后3～11个月;其余未手术,死于术后1～11个月.结论原发性十二指肠肿瘤缺乏特异性临床表现,经内镜、超声内镜以及ERCP等联合检查可提高术前诊断率.对良性肿瘤可行局部肿瘤切除术或十二指肠节段切除术,对恶性肿瘤首选胰十二指肠切除术,对晚期肿瘤患者可采用旁路手术以提高生存率及生存质量.
목적 탐토원발성십이지장종류적진단화술식선택.방법 회고성분석중국의과대학부속제일의원2001-2007년간124례원발성십이지장종류환자적림상자료,기중량성종류10례,악성종류114례.결과 본조원발성십이지장종류상견적림상표현유상복통、황달、체중하강이급납차등.종류위우십이지장구부9례(7.3%),강부107례(86.3%),수평부7례(5.7%),승부1례(0.8%).술전섬유내경학진솔위90.5%,ERCP학진솔위94.1%,초성내경학진솔위100%,위장기패쌍중조영발현솔위78.6%,MRI발현솔위80.5%,CT발현솔위75.7%,B초발현솔위40.6%.10례원발성십이지장량성종류중5례행종류국부절제술,2례행표준이십이지장절제술,1례행십이지장절단절제술,2례미수술,5년생존솔위100%;114례원발성십이지장악성종류중47례행표준이십이지장절제술,3례행보류유문적이십이지장절제술,5년생존솔위35.8%;6례행국부종류절제술,12례행십이지장절단절제술,5년생존솔위16.7%;22례행방로수술,균사우술후5～16개월;2례행지가개입술,2례행경피간담도천자인류술,사우술후3～11개월;기여미수술,사우술후1～11개월.결론 원발성십이지장종류결핍특이성림상표현,경내경、초성내경이급ERCP등연합검사가제고술전진단솔.대량성종류가행국부종류절제술혹십이지장절단절제술,대악성종류수선이십이지장절제술,대만기종류환자가채용방로수술이제고생존솔급생존질량.
Objective To investigate the diagnosis and therapeutic methods of primary tumors of the duedenum(PTD). Methods Clinical data of 124 patients with primary duodenal tumors who were hospitalized in the First Affiliated Hospital of China Medical University from 2001 to 2007 were analyzed retrospectively. Of all the tumors,10 cases were of benign tumors and 114 cases were malignant tumors. Diagnosis was established on endoscopy and radiography. Results Common clinical manifestations included upper abdominal pain, jaundice, weight loss and poor appetite. Lesion located in the superior portion of the duodenum in 9 cases, in the descending portion in 107 cases, in the horizontal portion in 7 cases, and in the ascending portion in 1 case. The correct preoperative diagnostic rate by endoscopy was 90.5%, by ERCP was 94.1%, by ultra-endoscopy was 100%, by air barium double radiography was 78.6%, by MRI was 80.5%, and by BUS was 40.6%. Among the 10 benign PTD cases, 5 cases underwent simple tumor resection, 2 cases underwent standard pancreaticoduedenectomy, 1 case received segmental duodenectomy and 2 cases didn't receive operation, the 5-year survival rate was 100%. Among the 114 malignant PTD cases, 47 cases underwent standard pancreaticoduodenectomy, 3 cases received pylorus preserving pancreaticoduodenectomy, 3 cases underwent pancreaticeduodenectomy in other hospitals, with the 5-year survival rate of 35.8%. Six cases underwent simple tumor resection, and 12 case received segmental duodenectomy, with the 5-year survival rate of 16.7%. Twenty-two cases treated by bypass operation died in 5-16 months after operation. 2 cases treated by stent-intervention, and 2 cases by PTCD (percutancous transhepatic cholangiodrainage) died in 3-11 months. Those not treated surgically died in 1-11 months. Conclusions Patients with PTD usually lack specific clinical manifestations, but combination of endoscopy, ultra-endoscopy, ERCP and other eximinations can improve the preoperative positive diagnosis rate. simple tumor resection and segmental duodenectomy are curable for PBTDs (primary benign tumors of the duodenum), while for PMTDs (primary malignant tumors of duodenum), pancreaticoduodenectomy should be done, and bypass operation is suitable for late-stage patients to improve survival rate and life-quality.