论文部分内容阅读
目的:探讨十二指肠间质瘤的临床特征、外科治疗方法及效果。方法:回顾分析复旦大学附属中山医院1995—2006年间收治的30例十二指肠间质瘤患者的临床资料。结果:肿瘤最常见于十二指肠降部60%(18/30),其次为水平部20%(6/ 30),球部10%(3/30),升部10%(3/30)。肿瘤以恶性多见,占76.7%(23/30),交界性13.3(4/30),良性10%(3/30)。细胞类型以梭形细胞型多见,占73.3%(22/30),混合型次之,占23.3%(7/30),上皮细胞型少见,占3.3%(1/30)。临床表现无特异性,以黑便多见,占40%(12/30),其次为腹痛30%(10/30)、饱胀13.3%(7/30)、贫血20%(6/30)。诊断方法的选择依次为上消化道钡餐造影、胃镜、内镜超声及CT。30例患者均获得手术治疗,15例行胰十二指肠切除术,其中13例为降部肿瘤,2例为横部肿瘤,术后病理检查均无淋巴结转移;5例降部和2例球部肿瘤行肿瘤及十二指肠壁局部切除术,4例水平部和3例升部肿瘤行十二指肠节段切除术,另有1例球部肿瘤行远端胃大部切除术。术后随访15个月～9年,其中24例获得完整随访,1年生存率、3年生存率分别为100%和87.5%。结论:十二指肠间质瘤以恶性者多见,其局部侵袭性不如消化道癌,淋巴结转移少见,术前诊断主要依据上腹部增强CT、胃肠道钡剂造影、胃镜以及内镜超声检查,其手术方式的选择更多取决于肿瘤的部位和大小。
Objective: To investigate the clinical features, surgical treatment and efficacy of duodenal stromal tumors. Methods: The clinical data of 30 patients with duodenal stromal tumors admitted to Zhongshan Hospital Affiliated to Fudan University from 1995 to 2006 were retrospectively analyzed. Results: The most common tumor was duodenal descending 60% (18/30), followed by horizontal 20% (6/30), ball 10% (3/30), ascending 10% (3/30 ). Malignant tumors more common, accounting for 76.7% (23/30), borderline 13.3 (4/30), benign 10% (3/30). Most of the cell types were spindle cell type, accounting for 73.3% (22/30), mixed type followed by 23.3% (7/30), and epithelial cell type rare, accounting for 3.3% (1/30). Clinical manifestations of non-specific to black will be more common, accounting for 40% (12/30), followed by abdominal pain 30% (10/30), fullness 13.3% (7/30), anemia 20% (6/30) . The choice of diagnostic methods followed by upper gastrointestinal barium meal angiography, endoscopy, endoscopic ultrasonography and CT. Thirty patients were surgically treated and 15 patients underwent pancreatoduodenectomy. Among them, 13 were descending tumors and 2 were transverse tumors. There were no lymph node metastases in the pathological examination after operation. Five patients had descending and 2 patients Ball tumor and duodenal resection of the tumor, 4 cases of horizontal and 3 cases of ascending tumor line segment resection of the duodenum, and another case of ball tumor distal gastrectomy . The patients were followed up for 15 months to 9 years. Twenty-four of them were followed up completely. The 1-year survival rate and 3-year survival rate were 100% and 87.5% respectively. Conclusions: Duodenal stromal tumors are more common in patients with malignant tumors. Their local invasiveness is not as good as that of digestive tract cancer and lymph node metastasis. The preoperative diagnosis is mainly based on the findings of upper abdominal CT, gastrointestinal barium, gastroscopy and endoscopic ultrasonography Check, the choice of surgical approach depends more on tumor location and size.