Hu Ji-Xiong, Miao Xiong-Ying, Zhong De-Wu, Dai Wei-Dong, Liu Wei, Hu Wei
Department of General Surgery, the Second Affiliated Hospital, XiangYa Medical College Central South University, ChangSha, P.R. China.
Hepatogastroenterology. 2006 Nov-Dec;53(72):858-62.
BACKGROUND/AIMS: Our purpose was to review the outcome of the patients with primary duodenal adenocarcinoma and determine factors influencing survival.
Over a 10-year period, 43 patients with this disease were identified. Data were analyzed to assess the outcomes of treatment and predictors of survival.
Patients had symptoms present for an average of 6 months. The most common symptom was obstructive jaundice, observed in 55.8% of the cases. Based on symptomology, primary duodenal adenocarcinoma may be classified into three categories: icteric, obstructive and illusive. The upper gastrointestinal contrast study and esophagogastroduodenoscopy were the most effective diagnostic tests, showing an accuracy of 79.5% and 86.8%, respectively. A curative resection was performed in 28 of the 43 patients (65.1%), a conventional pancreatoduodenectomy in 11, segmental duodenal resection in 16 and gastroduodenectomy in 1. The overall 5-year survival rate was 27%, which was 42 percent after curative resection.
The respectability of the primary lesion was associated with increased survival. An aggressive surgical approach should be pursued. Pancreaticoduodenectomy is usually required for tumors of the first and second portion of the duodenum. Segmental resection may be appropriate for selected patients, especially for cancers of the distal duodenum.
背景/目的：我们的目的是回顾原发性十二指肠腺癌患者的治疗结果，并确定影响生存的因素。
在10年期间，共确定了43例患有这种疾病的患者。对数据进行分析以评估治疗结果和生存预测因素。
患者出现症状的平均时间为6个月。最常见的症状是梗阻性黄疸，见于55.8%的病例。根据症状学，原发性十二指肠腺癌可分为三类：黄疸型、梗阻型和隐匿型。上消化道造影检查和食管胃十二指肠镜检查是最有效的诊断方法，准确率分别为79.5%和86.8%。43例患者中有28例（65.1%）进行了根治性切除，其中11例行传统胰十二指肠切除术，16例行十二指肠节段切除术，1例行胃十二指肠切除术。总体5年生存率为27%，根治性切除术后为42%。
原发性病变的可切除性与生存率提高相关。应采取积极的手术方法。十二指肠第一和第二部分的肿瘤通常需要行胰十二指肠切除术。节段性切除可能适用于特定患者，尤其是十二指肠远端癌。
