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目的 探讨原发性十二指肠癌(PDC)的诊断、外科治疗及预后影响因素.方法 回顾性分析2008年1月至2015年12月收治的56例PDC患者的临床资料.结果 肿瘤位于球部3例、降部44例、水平部6例、升部3例,其中降部乳头区40例,占全部肿瘤的71.4％.病理类型高分化腺癌22例(22/56,39.3％),中分化腺癌16例(16/56,28.6％),低分化腺癌12例(12/56,21.4％),未分化腺癌6例(7/56,10.7％).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84.0％ (42/50)、十二指肠低张造影诊断正确率为81.3％(13/16)、腹部增强CT检查诊断正确率为48.2％(27/56)、B超检查诊断正确率为30.4％(7/23).行胰十二指肠切除40例,十二指肠节段性切除5例,胃大部分切除术并十二指肠球部肿瘤切除术3例,姑息性短路手术8例.本组患者术后总体1、3、5年累积生存率分别为82.6％、56.7％、30.1％.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％、68.8％、42.2％和100％、61.8％、0.短路手术后患者生存时间6～12个月.单因素分析显示:肿瘤浸润深度、肿瘤分化程度、淋巴转移情况和根治手术对十二指肠癌术后生存率有影响(P＜0.05);多因素回归分析显示肿瘤浸润深度、淋巴结转移、根治手术是影响十二指肠癌患者预后的独立因素(P＜0.05).结论 PDC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诊断原发性十二指肠癌的主要方法.胰十二指肠切除术是PDC患者的首选治疗方法.

Objective To study the diagnosis,surgical treatment and prognosis of patients with primary duodenal carcinoma.Methods The clinical data of 56 patients with primary duodenal carcinoma treated between 2008 to 2015 were retrospectively analyzed.Results The number of patients with tumors located in the first,second,third and fourth parts of duodenum were 3,44,6,and 3 patients respectively.Tumors which were within the papillary region accounted for 71.4％ (40 patients).Twenty-two patients (22/56,39.3％) had well differentiated adenocarcinoma,16 patients (16/56,28.6％) had moderately differentiated adenocarcinoma and 6 patients (7/56,10.7％) had undifferentiated carcinoma.The clinical manifestations were not specific,which included abdominal pain,abdominal distention,jaundice,bowel obstruction or bleeding.The correct rates of diagnosis made by endoscopy,duodenography,ultrasound and CT were 84.0％,81.3％,30.4％ and 48.2％ respectively.Forty patients underwent pancreaticoduodenectomy,5 segmental duodenectomy,9 bypass operation,and 3 subtotal gastrectomy and duodenal bulb tumor resection.The 1-,3-,and 5-year survival rates of all the patients were 82.6％,56.7％ and 30.1％ respectively.The-1,3-,and 5-year survival rates of the patients who underwent pancreaticoduodenectomy and segmental duodenectomy were 100％,68.8％,42.2％ and 100％,61.8％,0 respectively.All the patients who underwent palliative resection died 6 to 24 months after surgery.Univariate analysis revealed the operation types.,depth of tumor invasion,lymphatic invasion,and tumor differentiation correlated with prognosis.Multivariate analysis showed only the operative types,depth of tumor invasion and lymphatic invasion to be independent prognostic factors.Conclusions Tumors located in the papillary region accounted for the majority of primary malignant tumors of the duodenum and they were mainly adenocarcinomas.Duodenography and endoscopy were the major methods used in the diagnosis of primary duodenal carcinoma.Pancreaticoduodeneetomy was the best therapy for primary duodenal carcinoma.