[从钡餐检查到胶囊内镜检查以及从开放手术到腹腔镜手术治疗小肠肿瘤]

Târcoveanu E, Georgescu St, Vasilescu A, Dănilă N, Lupaşcu C, Dimofte G, Neacşu C N, Moldovanu R

Clinica I Chirurgie "I. Tănăsescu - Vl. Buţureanu", Universitatea de Medicină si Farmacie "Gr. T. Popa" Iaşi, România.

Chirurgia (Bucur). 2011 Jul-Aug;106(4):451-64.

INTRODUCTION

Tumors of the small bowel are rare and present with nonspecific symptoms. That causes a significant delay in diagnosis and consequently a worse outcome for the patient.

METHODS

In a retro-prospective study we evaluated a series of 63 patients with small bowel tumors operated in the First Surgical Clinic Iaşi, during 1992-2010: 18 duodenal tumors, 26 jejunum tumors and 19 ileum tumors. There were 18 (28.6%) cases with benign tumors and 45 (71.4%) cases with malignant tumors (41 primary tumors and 4 secondary tumors). We discuss problems related to diagnosis, treatment and prognosis of these tumors in the presence of new explorations (capsule endoscopy, enteroscopy) and minimally invasive approach.

RESULTS

Duodenal tumors were malignant in 14 cases (11 adenocarcinomas, 3 malignant GIST tumors) and benign in 4 cases (adenoma, lipoma, GIST tumor, schwannoma) which led to stenosis in 5 cases, upper gastrointestinal bleeding in 3 cases. Positive diagnostic was confirmed with barium meal and endoscopy. The jejunal and ileal tumors were mostly malignant 31 cases (13 carcinomas, 10 lymphomas, 2 malignant GIST and one sarcoma) with only 14 cases of benign tumors (5 GIST). Their tendency was to present as emergencies: 17 obstructions and 5 peritonitis. Modem imagistic proved useful as diagnostic tool: capsule endoscopy, CT-scan and enteroscopy. The benign tumors benefited from local resection (5 cases) and segmental enterectomy (12 cases), while malignant tumors were managed using Whiple's procedures (10 cases), duodenal-jejunal resections (1 case), segmental enterectomy (29 cases), ileocolectomy (2 cases) and three bypasses. Laparoscopic approach was performed in 8 cases.

CONCLUSIONS

The incidence of small bowel tumors remains low. For diagnosis, CT-scan, enteroscopy and capsule endoscopy are very useful; unfortunately the last method is not practicable in emergency. Surgery is the best choice plus chemotherapy for some malignant tumors. Laparoscopic approach is feasible in selected cases.

引言

小肠肿瘤较为罕见，症状不具特异性，这导致诊断出现显著延迟，进而使患者预后更差。

方法

在一项回顾性前瞻性研究中，我们评估了1992年至2010年期间在雅西第一外科诊所接受手术的63例小肠肿瘤患者：18例十二指肠肿瘤、26例空肠肿瘤和19例回肠肿瘤。其中有18例（28.6%）为良性肿瘤，45例（71.4%）为恶性肿瘤（41例原发性肿瘤和4例继发性肿瘤）。我们讨论了在有新的检查方法（胶囊内镜、小肠镜）和微创方法的情况下，这些肿瘤的诊断、治疗和预后相关问题。

结果

十二指肠肿瘤中14例为恶性（11例腺癌、3例恶性胃肠道间质瘤），4例为良性（腺瘤、脂肪瘤、胃肠道间质瘤、神经鞘瘤），其中5例导致狭窄，3例出现上消化道出血。通过钡餐和内镜检查确诊。空肠和回肠肿瘤大多为恶性，共31例（13例癌、10例淋巴瘤、2例恶性胃肠道间质瘤和1例肉瘤），仅有14例良性肿瘤（5例胃肠道间质瘤）。它们往往表现为急症：17例肠梗阻和5例腹膜炎。现代影像学检查被证明是有用的诊断工具：胶囊内镜、CT扫描和小肠镜。良性肿瘤采用局部切除（5例）和节段性肠切除（12例），而恶性肿瘤则采用惠普尔手术（10例）、十二指肠空肠切除术（1例）、节段性肠切除（29例）、回盲部切除术（2例）和三次旁路手术。8例采用了腹腔镜手术方法。