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目的:探讨原发性十二指肠恶性肿瘤的临床特点、诊断方法和预后影响因素。方法:回顾性分析随访资料完整的45例原发性十二指肠恶性肿瘤患者的临床病理资料。结果:腺癌33例(73.3%)为主要的病理类型。主要临床表现为腹痛、上腹部不适、黄疸、消化道出血等。胃十二指肠镜、内镜逆行胰胆管造影(Endoscopic Retrograde Cholangio-Pancreatography,ERCP)、十二指肠低张造影、超声内镜、CT及B超确诊率分别为91.1%(41/45),93.3%(42/45),82.2%(37/45),75.6%(34/45),68.9%(31/45)及26.7%(12/45)。本组45例均行开腹手术,包括根治性手术,胰十二指肠切除术36例;姑息性手术,胃肠吻合术2例、肿瘤局部切除术5例、短路手术2例。根治术和姑息术后5年生存率分别为46.7%和4.4%,两组生存率差异有统计学意义(P<0.05)。对全组45例患者的预后因素进行Cox回归分析的结果显示,手术方式、肿瘤浸润深度和淋巴节转移是影响预后的独立危险因素(均P<0.05)。结论:原发性十二指肠恶性肿瘤缺乏特异性临床表现;胃十二指肠镜、ERCP以及十二指肠低张造影等联合检查可提高诊断率;根治性手术远期疗效较好;淋巴结转移和局部侵犯是肿瘤预后不良的重要影响因素。
Objective: To investigate the clinical features, diagnosis and prognostic factors of primary duodenal malignancies. Methods: The clinicopathological data of 45 patients with primary duodenal malignancies were analyzed retrospectively. Results: Adenocarcinoma in 33 cases (73.3%) as the main pathological type. The main clinical manifestations of abdominal pain, abdominal discomfort, jaundice, gastrointestinal bleeding. The diagnostic rates of endoscopic Retrograde Cholangio-Pancreatography (ERCP), duodenal low contrast radiography, endoscopic ultrasonography, ultrasonography and ultrasonography were 91.1% (41/45) , 93.3% (42/45), 82.2% (37/45), 75.6% (34/45), 68.9% (31/45) and 26.7% (12/45) respectively. The group of 45 patients underwent open surgery, including radical surgery, pancreatoduodenectomy in 36 cases; palliative surgery, gastrointestinal anastomosis in 2 cases, tumor resection in 5 cases, short-circuit surgery in 2 cases. The 5-year survival rates after radical mastectomy and palliative surgery were 46.7% and 4.4%, respectively, with statistically significant difference (P <0.05). Cox regression analysis of prognostic factors in 45 patients showed that surgical modality, tumor invasion depth and lymph node metastasis were independent risk factors for prognosis (all P <0.05). Conclusions: The primary malignant duodenal tumor lacks specific clinical manifestations; the combined examination of gastroduodenoscopy, ERCP and duodenal low contrast imaging can improve the diagnosis rate; the long-term curative effect of radical surgery is better; Lymph node metastasis and local invasion are the important prognostic factors of tumor prognosis.