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目的 总结原发性十二指肠恶性肿瘤常见临床表现、病理学特征及诊断手段 ,探讨腺癌发生的机制。方法 回顾性分析 1978～ 1998年我院收治并经病理学证实的 47例原发性十二指肠恶性肿瘤。结果 患者平均发病年龄 5 4 6岁 (2 0～ 84岁 ) ,男女之比 1 94∶1,中位病程 10 6d(7～6 40d)。病理学类型为腺癌 42例 ,平滑肌肉瘤 4例 ,类癌 1例。好发于十二指肠降部 (35例 ,75 % ) ,尤其是乳头区 (2 8例 )。常见临床表现依次为上腹疼痛 (6 8% ) ,黄疸 (6 0 % ) ,消化道出血 (47% ) ,呕吐(45 % ) ,体重减轻 (32 % ) ,乳头区以外肿瘤常有呕吐、消化道出血 ,平滑肌肉瘤多有腹块。诊断手段主要有纤维胃镜、胃肠钡餐、B型超声、CT和内窥镜逆行胰胆管造影 (ERCP) ,纤维胃镜对球部肿瘤确诊率高 ,B型超声和ERCP联合检查可提高十二指肠乳头区肿瘤检出率 ,胃肠钡餐对其它部位肿瘤有帮助。结论 原发性十二指肠恶性肿瘤以腺癌为主 ,好发于十二指肠降段 ,早期临床表现无特异性 ,可根据症状选择系列或联合应用诊断手段 ;十二指肠腺癌与血型无关。
Objective To summarize the common clinical manifestations, pathological features, and diagnostic methods of primary duodenal malignancies and explore the mechanism of adenocarcinoma. Methods Retrospective analysis of 47 patients with primary duodenal malignancies treated in our hospital from 1978 to 1998 and confirmed by pathology. RESULTS: The average age of onset of the disease was 546 years (range, 20-84 years). The ratio of males and females was 1 94:1. The median course of illness was 10 6 days (7 to 6 40 days). The pathological types were adenocarcinoma in 42 cases, leiomyosarcoma in 4 cases, and carcinoid in 1 case. Occur in the descending duodenum (35 cases, 75%), especially in the nipple area (28 cases). Common clinical manifestations were epigastric pain (6 8%), jaundice (60%), gastrointestinal bleeding (47%), vomiting (45 %), weight loss (32%), and often vomiting outside the nipple area. Gastrointestinal bleeding, leiomyosarcoma and abdominal mass. The diagnostic methods include fiberoptic gastroscopy, gastrointestinal barium meal, B-mode ultrasound, CT, and endoscopic retrograde cholangiopancreatography (ERCP). Fiberoptic gastroscopy has a high diagnostic rate for bulbous tumors, and B-ultrasound and ERCP combined examinations can improve the twelve-finger. The detection rate of intestinal papillary area tumors, gastrointestinal barium meal is helpful for other parts of the tumor. Conclusion Adenocarcinoma is predominant in primary duodenal malignancies. It occurs in descending segments of duodenum. The early clinical manifestations are not specific. Diagnostic or serial diagnostic methods can be used according to the symptoms. Duodenal adenocarcinoma Has nothing to do with blood type.