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目的:探讨原发性十二指肠乳头、降部、水平部良恶性肿瘤的诊断和手术方式选择,提高诊治水平和疗效.方法:对2001-09/2005-10收治的8例原发性十二指肠乳头、降部、水平部肿瘤的诊断和手术方式进行回顾性分析.术前行B超、CT、十二指肠低张造影、十二指肠镜检查,发现乳头肿瘤3例,降部肿瘤2例,水平部肿瘤3例.结果:确诊原发性十二指肠乳头管状腺瘤及间质瘤并行肿瘤局部切除术各1例,中高分化腺癌行胰十二指肠切除术1例;原发性十二指肠降部中及低分化腺癌行胰十二指肠切除术各1例;原发性十二指肠水平部间质瘤行局部肠段切除术2例,中高分化腺癌行胰十二指肠切除术1例.所有病例术后恢复良好,无手术并发症.随访时间29.1±19.7(3-51)mo,均健康生存.结论:对于原发性十二指肠乳头和降部良性肿瘤,以CT结合十二指肠镜检查和局部肿瘤切除为主要诊断手段和术式选择;对于原发性十二指肠水平部良性肿瘤,首选十二指肠低张造影检查和局部肠段切除治疗;对于原发性十二指肠乳头、降部或水平部恶性肿瘤,均应首选胰十二指肠切除术.
Objective: To investigate the diagnosis and surgical methods of benign and malignant tumors of the primary duodenal papilla, descending and horizontal duodenum, and to improve the diagnosis and treatment level and efficacy. Methods: 8 cases admitted to the hospital from September 2001 to October 2005 were included. The diagnosis and surgical methods of the duodenal papilla, descending and horizontal tumors were retrospectively analyzed. B-ultrasonography, CT, duodenal angiography, and duodenoscopy were performed before operation and 3 cases of papillary tumors were found. 2 cases of descending tumors and 3 cases of horizontal tumors. Results: Definitive diagnosis of primary duodenal papillary tubular adenoma and stromal tumor. Local tumor resection in 1 case each, moderately well-differentiated adenocarcinoma in the pancreatic duodenum. One patient underwent resection; one patient underwent pancreaticoduodenectomy in primary duodenal descending and poorly differentiated adenocarcinoma; local intestinal resection was performed in primary duodenal stromal tumor. Two patients with moderately-differentiated adenocarcinoma underwent pancreaticoduodenectomy in one case. All cases recovered well after surgery without complications. The follow-up time was 29.1±19.7 (3-51) months, and both were healthy. Conclusion: For the original Duodenal papilla and benign neoplasm with CT and duodenaloscopy and local tumor resection as main diagnostic tools and surgical procedures For primary benign duodenal tumors, duodenal angiography and local bowel resection are preferred; for primary duodenal papillary, descending or horizontal malignancies, Preferred pancreaticoduodenectomy.