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目的探讨十二指肠乳头部肿瘤的早期诊断及治疗水平。方法回顾性分析收治的64例经手术及病理证实为十二指肠乳头部肿瘤患者的临床资料,包括十二指肠乳头部癌60例,腺瘤4例。结果主要临床表现为黄疸(42例),消化道症状(35例),反复发作的胆管炎(7例)及上消化道出血(1例)。术前ERCP,十二指肠镜,MRCP,BUS,CT检查阳性率分别为100%,97.3%,82.4%,82.8%,76.1%。55例行胰十二指肠切除术,5例行十二指肠乳头局部切除术,4例行姑息性胆肠吻合术。手术并发症发生率16.5%,手术病死率3.6%。行胰十二指肠切除术的癌患者术后1,3,5年生存率为67.4%,40.6%,36.3%。结论黄疸和腹痛是十二指肠乳头部肿瘤的主要症状;十二指肠镜和ER-CP是诊断十二指肠乳头肿瘤最有效的检查方法;早期选择根治性切除手术是治疗的关键。
Objective To investigate the early diagnosis and treatment of duodenal papillary tumors. Methods The clinical data of 64 patients with duodenal papillary carcinoma confirmed by operation and pathology including 64 cases of duodenal papillary carcinoma and 4 cases of adenoma were retrospectively analyzed. Results The main clinical manifestations were jaundice (42 cases), gastrointestinal symptoms (35 cases), recurrent cholangitis (7 cases) and upper gastrointestinal bleeding (1 case). The positive rates of preoperative ERCP, duodenoscopy, MRCP, BUS and CT were 100%, 97.3%, 82.4%, 82.8% and 76.1% respectively. Fifty-five patients underwent pancreatoduodenectomy, 5 underwent partial duodenal papilla resection, and 4 underwent palliative cholangioenterostomy. The incidence of surgical complications was 16.5% and the operative mortality was 3.6%. The 1, 3, 5-year survival rates of patients with pancreaticoduodenectomy were 67.4%, 40.6% and 36.3%, respectively. Conclusions Jaundice and abdominal pain are the main symptoms of duodenal papillary tumors. Duodenoscopy and ER-CP are the most effective methods for the diagnosis of duodenal papillary tumors. The early choice of radical resection is the key to treatment.