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十二指肠乳头肿瘤的临床特点及诊治分析

The clinical characteristics and the diagnosis and treatment of tumors of duodenal papilla

摘要:

目的 探讨十二指肠乳头肿瘤的临床特点、诊断、治疗及预后.方法 回顾性分析2004年4月至2015年4月在浙江大学医学院附属第二医院接受内镜下或外科手术治疗、并经病理确诊的76例十二指肠乳头肿瘤患者的临床资料.男性50例,女性26例;年龄38 ~ 83岁,中位年龄62岁.患者通过超声影像、CT、内镜检查及内镜逆行胰胆管造影(ERCP)获得诊断.76例患者均接受了手术治疗,其中行胰十二指肠切除术61例,行经十二指肠乳头切除+乳头重建6例,行内镜下十二指肠乳头肿瘤切除5例,因不能行根治性手术仅行姑息短路手术4例.采用Kaplan-Meier曲线计算十二指肠乳头癌患者术后生存率.结果 根据术后病理学诊断,良性肿瘤10例,癌前病变8例,恶性肿瘤58例.术后未发生严重并发症,无因术后并发症导致死亡病例.内镜下活检病理结果与术后病理结果对照,符合率为77.6%.术后随访2~120个月,获得随访的53例十二指肠乳头癌患者的l、3、5年生存率分别为73.2%、51.8%、32.1%.结论 超声影像、CT、内镜检查及ERCP可有效诊断十二指肠乳头肿瘤.良性肿瘤及早期恶性肿瘤局部切除及内镜下肿瘤切除安全有效,进展期恶性肿瘤需行胰十二指肠切除术.

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abstracts:

Objective To assess the clinical features,diagnosis,treatment and prognosis of duodenal papilla tumors.Methods The clinical data of 76 patients diagnosed as tumor of duodenal papilla for endoscopic or surgical treatment,in the Second Affiliated Hospital of Zhejiang University,School of Medicine since April 2004 to April 2015 were collected and analyzed retrospectively.There were 50 male and 26 female patients aging from 38 to 83 years with a median age of 62 years.All patients were diagnosed by ultrasound,CT or endoscopic retrograde cholangiopancreatography.All the 76 patients accepted surgical treatment,among which 61 cases accepted pancreaticoduodenectomy,6 cases accepted trans-duodenum papillae resection and reconstruction,5 cases accepted endoscopic duodenal papilla tumor resection and 4 cases accepted palliative operations.Kaplan-Meier method was used to analyze the survival rate.Results Among the 76 cases of patients,the pathological diagnosis included 10 cases of benign tumors,8 cases of precancerous lesions,58 cases of malignant tumor.Death cases were not caused by postoperative complications.Coincidence rate of preoperative biopsy and postoperative pathological diagnosis was 77.6%.Postoperative follow-up was 2 to 120 months,the results showed that the 1,3,5 year survival rates were 73.2%,51.8%,32.1% for 53 patients with duodenal papillary carcinoma.Conclusions Duodenal papilla tumors had varied clinical manifestations,ultrasound,CT and endoscopic examination and ERCP can improve the diagnostic rate of duodenal papilla tumors.For benign tumors and early stage malignant tumors,local excision or endoscopic resection was safe and effective.For advanced malignancies,radical pancreaticoduodenectomy was essential.

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