Shen Zhihong, Yu Jianhua, Tang Haijun, Lu Baochun
Department of Hepatobiliary Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing University, Shaoxing 312000, China.
Comb Chem High Throughput Screen. 2019;22(4):280-286. doi: 10.2174/1386207322666190411112412.
Patients with pancreatic adenocarcinoma may develop into duodenal obstruction during the course of their disease. The diagnosis of obstruction can be generally achieved by means of imaging technologies.
We reported a rare case of pancreatic tumor with duodenal obstruction accompanied by obstructive symptoms, which was finally confirmed by laparotomy. A 68-year-old man was admitted to our department with a 3-day medical history of upper abdominal pain, nausea and vomiting. The diagnosis of duodenal obstruction was established by means of various imagings including computed tomography (CT) scan, gastroscopy and upper gastrointestinal imaging. Upper gastrointestinal imaging and magnetic resonance imaging (MRI) showed extrinsic tumor mass was noted at the second and third portion of the duodenum accompanied by duodenal obstruction and dilatation, respectively. Laparotomy confirmed a tumor mass arising from the head and uncinate process of pancreas, which had invaded the second and third portions of the duodenum and caused closed loop obstruction. A pancreaticoduodenectomy (Whipple procedure) was performed followed by therapeutic trade-off according to intraoperative exploration. Postoperative histopathology revealed pancreatic tumor only infiltrated duodenal wall, while resection margins of pancreas, common bile duct and duodenum were all negative. The patient was cured and discharged home 12 days after surgery.
The present case indicated radical operation in our study appeared to be the first choice treatment for patients with malignant duodenal obstruction.
胰腺腺癌患者在病程中可能会发展为十二指肠梗阻。梗阻的诊断通常可通过影像学技术实现。
我们报告了一例罕见的胰腺肿瘤伴十二指肠梗阻并伴有梗阻症状的病例，最终通过剖腹手术得以确诊。一名68岁男性因上腹部疼痛、恶心和呕吐3天病史入住我科。通过包括计算机断层扫描（CT）、胃镜和上消化道造影等各种影像学检查确诊为十二指肠梗阻。上消化道造影和磁共振成像（MRI）显示十二指肠第二和第三段有外在肿瘤肿块，分别伴有十二指肠梗阻和扩张。剖腹手术证实肿瘤肿块起源于胰头和钩突，侵犯了十二指肠第二和第三段并导致闭环梗阻。进行了胰十二指肠切除术（惠普尔手术），并根据术中探查进行了治疗权衡。术后组织病理学显示胰腺肿瘤仅浸润十二指肠壁，而胰腺、胆总管和十二指肠的切缘均为阴性。患者术后12天治愈出院。
本病例表明，在我们的研究中，根治性手术似乎是恶性十二指肠梗阻患者的首选治疗方法。
