临床研究(Clinical Research)

原发性十二指肠恶性肿瘤的诊治及预后因素分析

Published at: 2017年第26卷第10期

陈斌 1 , 戴正宽 1 , 王春华 2 , 王小农 1 , 何晓 1
1 赣南医学院第一附属医院 肝胆外科,江西 赣州 341000
2 赣南医学院基础学院,江西 赣州 341000
通讯作者 斌 陈 Email: chenb1970829@163.com
DOI: 10.3978/j.issn.1005-6947.2017.10.014
基金:

摘要

目的:探讨原发性十二指肠恶性肿瘤的诊断、外科治疗及影响预后的因素。方法:回顾性分析2008年1月—2015年12月收治88例原发性十二指肠恶性肿瘤患者的临床资料。结果:全组患者中,肿瘤位于球部5例,降部69例,水平部9例,升部5例,其中降部乳头区为62例,占降部89.86%;腺癌56例(63.64%),恶性间质瘤20例(22.73%),类癌6例(6.82%),其他肿瘤6例(6.82%);高分化34例(38.63%),中分化28例(31.82%),低分化19例(21.59%),未分化7例(7.95%)。患者临床表现无特异性,可有腹痛、腹胀、黄疸、呕吐以及上消化道出血等表现。术前十二指肠镜检查诊断正确率为83.54%(66/79),十二指肠低张造影诊断正确率为80.00%(20/25),腹部增强CT检查诊断正确率为47.72%(42/88),B超检查诊断正确率为30.56%(11/36)。行胰十二指肠切除60例,十二指肠节段性切除8例,胃大部分切除术并十二指肠球部肿瘤切除术 5例,姑息性短路手术15例。全组术后总1、3、5年累积生存率分别为81.94%、55.43%、29.32%;胰十二指肠切除术和十二指肠节段性切除术后的1、3、5年累积生存率分别为100%、68.12%、42.04%和100%、61.96%、0;短路手术后患者生存时间均为6~12个月;十二指肠间质瘤患者生存率明显高于十二指肠腺癌患者(χ2=7.237,P=0.007)。单因素分析显示,肿瘤的浸润深度、肿瘤分化程度、淋巴转移情况和手术方式与患者术后生存有关(均P<0.05);多因素回归分析显示,肿瘤的浸润深度、淋巴转移、手术方式是影响患者预后的独立因素(均P<0.05)。结论:原发性十二指肠恶性肿瘤多发生在降部乳头周围区,以腺癌为主。纤维十二指肠镜、十二指肠低张造影是其诊断的主要方法,胰十二指肠切除术是其首选治疗方法。


Analysis of diagnosis, treatment and prognosis of primary malignant duodenal tumors

Abstract

Objective: To investigate the diagnosis, surgical treatment and prognostic factors of primary malignant tumors of the duodenum. Methods: The clinical data of 88 patients with primary malignant duodenal tumors treated during January 2008 to December 2015 were analyzed retrospectively. Results: Of the patients, the tumors in 5 cases located in the duodenal bulb, in 69 cases located in the descending portion, in 9 cases located in the horizontal portion and 5 cases located in the ascending portion, and among them, the tumors in 62 cases located within the duodenal papilla area of descending part, which accounted for 89.86% of those in the descending portion; the tumor types were classified as adenocarcinoma in 56 cases (63.64%), malignant stromal tumor in 20 cases (22.73%), carcinoid tumor in 6 cases (6.82%) and other tumors in 6 cases (6.82%); the histological types were divided into well differentiated in 34 cases (38.63%), moderately differentiated in 28 cases (31.82%), poorly differentiated in 19 cases (21.59%) and undifferentiated in 7 cases (7.95%). Clinical manifestations of the patients included abdominal pain, abdominal distention, jaundice, vomiting and upper gastrointestinal hemorrhage, which showed no specificity. The preoperative correct diagnosis rate by endoscopy, hypotonic duodenograph, ultrasound and CT was 83.54% (66/79), 80.00% (20/25), 30.56% (11/36) and 47.72% (42/88) respectively. Sixty patients underwent pancreaticoduodenectomy, 8 patients received segmental duodenectomy, and 5 cases were subjected to subtotal gastrectomy plus duodenal bulb resection and 15 patients had palliative bypass surgery. The overall 1-, 3-, and 5-year survival rate for the whole group of patients was 82.34%, 54.79%, and 28.98% respectively, and for patients receiving pancreaticoduodenectomy was 100%, 68.12%, 42.04% and for those undergoing segmental duodenectomy was 100%, 61.96% and 0; the postoperative survival time of patients after palliative bypass surgery was 6 to 24 months; the survival rate in patients with duodenal stromal tumors was significantly higher than that in patients with duodenal adenocarcinoma (χ2=7.237, P=0.007). Univariate analysis showed that depth of tumor invasion, tumor differentiation, lymphatic involvement and surgery type were significantly related to the postoperative survival of the patients (all P<0.05); multivariate analysis revealed that depth of tumor invasion, lymphatic involvement and surgery type were independent factors for the prognosis of the patients (all P<0.05). Conclusion: Primary malignant duodenal tumors frequently occur in peripapilla area of descending duodenum and mainly are adenocarcinoma, for which, duodenoscopy and hypotonic duodenograph are the major diagnostic methods, and pancreaticoduodenectomy is the first choice of treatment.


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引用本文: 斌 陈, 正宽 戴, 春华 王, 小农 王, 晓 何. 原发性十二指肠恶性肿瘤的诊治及预后因素分析[J]. 中国普通外科杂志, 2017, 26(10): 1310-1315.
Cite this article as: CHEN Bin, DAI Zhengkuan, WANG Chunhua, WANG Xiaonong, HE Xiao . Analysis of diagnosis, treatment and prognosis of primary malignant duodenal tumors[J]. Chin J Gen Surg, 2017, 26(10): 1310-1315.