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目的了解十二指肠球部溃疡并存胃癌的发病情况及临床特点。方法无选择地收集国内文献近年来公开报道的十二指肠球部溃疡并存胃癌163例,加上本院5例共168例,所有病例均经内镜或(和)手术病理证实。结果十二指肠球部溃疡并存胃癌占同期镜检人数的0.11%(102/92982),占十二指肠球部溃疡的0.65%(139/21243),占胃癌的2.9%(86/2951),占复合性溃疡的3.0%(23/779),男女之比为3.0∶1,中位年龄49~63岁,平均56.4岁,病程2个月~40年不等,常见症状有腹痛、呕血及黑便、纳差、消瘦等。病灶近一半位于胃窦及角切部,Borrmann分型以Ⅱ型及Ⅲ型为主(占79.3%),病理以管状腺癌多见(占61.7%),其次为低分化腺癌(占19.2%)及印戒细胞癌(10.0%)。结论十二指肠球部溃疡并存胃癌临床无特异性症状,故胃镜检查发现十二指肠球部溃疡后,切不可忽视对胃部的全面观察,并应常规活检,发现胃部癌肿后,仍应尽可能进入十二指肠,以发现是否有共存病变,为选择手术方式及进一步治疗提供依据。
Objective To understand the incidence of gastric cancer with duodenal ulcer and clinical features. Methods We collected 163 cases of duodenal ulcer complicated with gastric cancer in our country in recent years, plus 168 cases of 5 cases in our hospital. All cases were confirmed by endoscopy and / or surgical pathology. Results Gastric cancer of duodenal ulcer was 0.11% (102/92982), accounting for 0.65% (139/21243) of duodenal ulcer and 2.9% of gastric cancer (86/2951 ), Accounting for 3.0% (23/779) of composite ulcer. The ratio of male to female was 3.0: 1. The median age ranged from 49 to 63 years (average 56.4 years). The course of disease ranged from 2 months to 40 years. Common symptoms were abdominal pain, Hematemesis and melena, anorexia, weight loss and so on. Nearly half of the lesions were located in the antrum and the angle cut. The Borrmann type was predominantly type II and type III (79.3%), with tubular adenocarcinoma (61.7%), followed by poorly differentiated adenocarcinoma (19.2% ) And signet ring cell carcinoma (10.0%). Conclusion duodenal ulcer coexistence gastric cancer clinical non-specific symptoms, so gastroscopy found duodenal ulcer, must not be ignored on the full observation of the stomach, and routine biopsy should be found after gastric cancer , Should still enter the duodenum as far as possible, in order to find out whether there is coexistence of lesions, to provide the basis for the selection of surgical methods and further treatment.