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目的 探讨提高原发性十二指肠肿瘤的诊断率及治疗水平。方法 对近 10年来经手术证实的 14例原发性十二指肠肿瘤 (本组不包括十二指肠乳头肿瘤 )临床表现、手术及病理进行回顾性分析。结果 原发性十二指肠肿瘤恶性肿瘤 12例 ,良性肿瘤 2例 ,良、恶性之比为 1∶6。恶性肿瘤主要为腺癌 ( 8例 ) ,平滑肌肉瘤 ( 3例 ) ,恶性淋巴瘤 1例。上腹隐痛、隐匿性体重下降、大便隐血 (“三隐”症状 )是最常见临床表现。术前纤维或电子十二指肠镜确诊率为 70 % ,上消化道造影为 67% ,CT发现率为 60 % ,全组中行胰十二指肠切除术 5例 ,扩大十二指肠节段切除术 (包括胃十二指肠切除术及十二指肠第 3、4段加空肠上段切除术 ) 6例 ,十二指肠节段切除术 2例 ,1例行旁路手术 ,切除率 93 %。结论 纤维或电子十二指肠镜和上消化道造影是诊断PTD的主要手段 ,恶性肿瘤首选胰十二指肠切除术 ,十二指肠第 3、4段肿瘤未浸润胰腺者可行扩大十二指肠节段切除术。十二指肠良性肿瘤可行节段切除术。
Objective To investigate the diagnosis and treatment of primary duodenal tumors. Methods The clinical manifestations, operation and pathology of 14 cases of primary duodenal tumors confirmed by surgery during the past 10 years (this group excludes duodenal papilla tumors) were retrospectively analyzed. Results There were 12 cases of primary duodenal tumor and 2 cases of benign tumor. The ratio of benign and malignant was 1: 6. Malignant tumors are mainly adenocarcinoma (8 cases), leiomyosarcoma (3 cases) and malignant lymphoma (1 case). Abdominal pain, occult weight loss, fecal occult blood (“three hidden” symptoms) is the most common clinical manifestations. Preoperative diagnosis of fiber or electron duodenoscopy was 70%, upper gastrointestinal angiography was 67%, CT was found in 60%, the whole group of midline pancreatoduodenectomy in 5 cases, to expand the duodenal section Segment resection (including gastroduodenal resection and duodenal third and fourth sections plus upper jejunal resection) in 6 cases, duodenal resection in 2 cases, 1 case of bypass surgery, resection Rate of 93%. Conclusion Fiber or electron duodenoscopy and upper gastrointestinal angiography are the main means of diagnosis of PTD. Malignant tumor is the preferred pancreaticoduodenectomy. Segmental resection of the bowel. Duodenal benign tumor feasible segmentectomy.