原发性十二指肠癌102例临床特点探析.docVIP

原发性十二指肠癌102例临床特点探析 　【摘要】 目的 探讨原发性十二指肠癌的临床特点。 方法 回顾性分析1996年5月至2005年5月我院经内镜活组织检查或术后病理检查证实的102例原发性十二指肠癌的临床资料。结果 40-60岁为十二指肠癌的高发年龄。黄疸、上腹疼痛、 腹胀、 消瘦，为本组四大主要临床表现;十二指肠镜、十二指肠气钡双重造影、ＣＴ、Ｂ超的确诊率分别为93.8% 、75% 、56%、30%。CA50阳性率81.8% ，CA19-9阳性率73.8% ，二者联合检测阳性率 89.7%;术前总误诊率为24.6%;胰十二指肠切除术76例(83%)，3年生存率仅为31.5 %。 结论 ①原发性十二指肠癌具有症状不典型、误诊率高及预后差等特点；②十二指肠镜、十二指肠气钡双重造影、ＣＴ联合应用可提高诊断准确率；③CA50、CA19-9联合检测有助诊断。 【关键词】 十二指肠癌 诊断 手术 　　【Abstract】 Objective To investigate the clinical characteristics of primary duodenal carcinoma . Methods Clinical data of 102 patients with primary duodenal carcinoma confirmed pathologically or by operation from May, 1996 to May,2005 were analyzed retrospectively. Results The age of most patients was from 40 to 60 years old. Jaundice, abdominal pain,abdomen bulge and weight loss were common manifestations. Duoenoscope,hypotonic duodenography ,computed tomographic scan and B-ultrasound’s definite diagnosis rates were 93.8%,75%,56% and 30% respectively .CA50 and CA19-9’s masculine rates were 81.8% and 73.8% ,their combinative masculine rate was 89.7 % . Total error diagnosis rate was 24.6 %. 76(83%) cases underwent pancreatoduodenectomy and their 3- year’s survival rate was only 31.5 %. Conclusions ①Primary duodenal carcinoma has its characteristic of no characteristic manifestations, high rate of error diagnosis and bad prognosis ;②Using duoenoscope, hypotonic duodenography and computed tomographic scan combinatively can help to achieve a high definite diagnosis rate;③Combined test of CA50 and CA19-9 is useful for the diagnosis . 　　【Key words】 Duodenal carcinoma Diagnosis Operation 　　原发性十二指肠癌临床比较少见 ,在其发生、诊断及治疗等诸多方面尚缺乏统一认识，因此，对其临床特点的研究显得尤为重要。作者试图通过回顾分析本院1996年5月至2005年5月共收治的102例十二指肠癌患者的临床资料，对其临床特点进行探讨。 　　1 资料与方法 　　1.1 一般资料 本组男72例,女30例 ;男女比为2.4∶1 ;年龄30～84(平均56.7)岁;其中58例发生于40～60岁(56.9%);本组病例不包括乏特壶腹、胰头及总胆管下段的癌，所有病例均经内镜活组检查或术后病理诊断证实。 　　1.2 方法 临床特点分析采用回顾性研究分析。 　　2 结果 　　2.1 临床表现 黄疸74例(73%),上腹疼痛65例(64%),腹胀50例(49%),消瘦36例(35.3%),发热23例(22.5%),乏力20例(19.6%),呕吐19例(18.6%),呕血和/或便血17例(16.7