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[小肠肿瘤——诊断、治疗与预后]

[Tumors of the small intestine--diagnosis, therapy and prognosis].

作者信息

Feil W, Schulz F

出版信息

Langenbecks Arch Chir. 1985;365(1):25-35. doi: 10.1007/BF01261210.

Abstract

Between 1965 and 1983 91 patients suffering from primary tumors of the small intestine underwent surgical treatment. These patients comprise 1.24% of the total number having gastrointestinal tumors in that period. In 33% exact preoperative diagnosis was set. The delay in establishing diagnosis (6.3 months) was due to nonspecific symptoms. The majority of patients underwent operation because of vital indication without former specific investigation. Benign tumors could be resected radically without lethality. Curative resection could be performed in 62.5% and palliative resection in 37.5% of malignant lesions. Surgical lethality was 17.8%. The most common histologic type were the adenocarcinoma at one side and the adenoma at the other. The 5-year-survival-rate for curatively resected patients ranged from 60% for carcinoids, 25% for carcinomas up to 20% for lymphomas. The mean survival rate for patients who underwent curative resection was 44.12 months, for those with palliative treatment 13.37 months. 18 patients, 51.4% of the curatively treated group, are still alive, mean follow-up time being 5 years. Rareness, challenge in diagnosis, surgical procedures, postoperative complications, reoperation frequency and long-term prognosis seen from various points of view are discussed. Our study emphasizes the importance of thorough gastroenterologic investigation of patients with tumor-suspective abdominal symptoms and the eminence of explorative laparotomy as final diagnostic and therapeutic step as well as the postulation for ultimate surgical radicality.

摘要

1965年至1983年间,91例患有小肠原发性肿瘤的患者接受了手术治疗。这些患者占该时期胃肠道肿瘤患者总数的1.24%。33%的患者术前做出了准确诊断。诊断延迟(6.3个月)是由于症状不具有特异性。大多数患者因紧急指征接受手术,此前未进行特异性检查。良性肿瘤可根治性切除,无致死情况。恶性病变中,62.5%可进行根治性切除,37.5%可进行姑息性切除。手术致死率为17.8%。最常见的组织学类型一方面是腺癌,另一方面是腺瘤。根治性切除患者的5年生存率,类癌为60%,癌为25%,淋巴瘤为20%。接受根治性切除患者的平均生存率为44.12个月,接受姑息治疗患者的平均生存率为13.37个月。18例患者(占根治性治疗组的51.4%)仍然存活,平均随访时间为5年。从各个角度讨论了小肠原发性肿瘤的罕见性、诊断挑战、手术操作、术后并发症、再次手术频率和长期预后。我们的研究强调了对有腹部肿瘤可疑症状的患者进行全面胃肠检查的重要性,以及探索性剖腹手术作为最终诊断和治疗步骤的重要性,以及对最终手术根治性的要求。

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