病例:患者,女,60岁,因上腹痛半年于2002年10月10口入院。入院前4个月曾因上腹痛在外院行胃镜检查,诊断为“十二指肠球部糜烂”,按胃病治疗无效,腹痛逐渐加重,出现乏力、纳差、恶心、呕吐、解黑便、消瘦(3个月体重下降6kg)和大便秘结。查体:浅表淋巴结无肿大,皮肤巩膜无黄染,心肺无异常,腹软,未及包块,上腹压痛(+),肝脾肋下未及。血常规:血红蛋白100g/L,粪便隐血试验(++),肝、肾功能正常,胸片无明显异常,腹部B超检查示上腹部、腹主动脉前方有实质性低回声结节(为肿大的淋巴结),电子胃镜检查示十二指肠球部后壁见一约2.0cm×2.0cm的不规则隆起物,呈分叶状改变,组织较脆,触之易出血,球部变形,病理活检示低分化腺癌。 讨论:原发性十二指肠癌(不包括壶腹周围癌)是一种 Case: Patient, female, 60 years old, admitted to hospital on October 10, 2002 due to upper abdominal pain for half a year. 4 months prior to admission due to upper abdominal pain in the outer hospital gastroscopy, diagnosed as “duodenal bulb erosion”, according to stomach treatment ineffective, abdominal pain gradually aggravated, fatigue, anorexia, nausea, vomiting, melena, Weight loss (3 months weight loss 6kg) and constipation. Physical examination: superficial lymph nodes without swelling, skin sclera no yellow dye, no abnormal heart and lung, abdominal soft, not mass, abdominal tenderness (+), liver and spleen ribs and not yet. Blood: hemoglobin 100g / L, fecal occult blood test (++), liver and kidney function was normal, no significant abnormal chest X-ray examination of the abdomen on the abdomen, abdominal aorta with substantial hypoechoic nodules Large lymph nodes), electronic gastroscopy showed the rear wall of the duodenal bulb see an irregular bulge about 2.0cm × 2.0cm, showed lobulated changes, the organization is more brittle, easy to touch the bleeding, deformation of the ball, Biopsy showed poorly differentiated adenocarcinoma. Discussion: Primary duodenal cancer (excluding periampullary cancer) is one type