Pezet D, Rotman N, Slim K, Boudet M J, Chipponi J, Fagniez P L
Department of Digestive Surgery, Hôtel-Dieu, Clermont-Ferrand, France.
J Am Coll Surg. 1995 May;180(5):541-4.
We evaluated villous tumors of the duodenum in regard to preoperative diagnosis of malignancy and the choice of treatment.
From January 1974 to October 1992, forty-seven patients with a benign or malignant tumor arising from the duodenal mucosa were studied. Forty-two patients underwent a macroscopically complete resection of the tumor. Nineteen tumors were malignant.
Preoperative endoscopic biopsy results had a 52 percent sensitivity and 100 percent specificity for the diagnosis of malignancy. For the 42 patients who underwent complete resection, jaundice was predictive of malignancy (p < 0.01), whereas tumor size was not (p < 0.2). The five-year survival rate of this group was 69.5 percent (confidence interval: 50 to 84). The recurrence rate was higher (p < 0.01) and the survival rate shorter (p < 0.001) for patients who underwent ampullectomy (n = 8) compared with patients treated by limited resection (n = 20) or pancreatoduodenectomy (n = 14).
Preoperative diagnosis of malignancy is difficult for villous tumors of the duodenum. For tumors located near the papilla, it seems that pancreatoduodenectomy is the best treatment.
我们对十二指肠绒毛状肿瘤的恶性肿瘤术前诊断及治疗选择进行了评估。
1974年1月至1992年10月，对47例源于十二指肠黏膜的良性或恶性肿瘤患者进行了研究。42例患者肿瘤在宏观上实现了完整切除。其中19个肿瘤为恶性。
术前内镜活检结果对恶性肿瘤诊断的敏感性为52%，特异性为100%。对于42例行完整切除的患者，黄疸可预测恶性肿瘤（p < 0.01），而肿瘤大小则不能（p < 0.2）。该组患者的五年生存率为69.5%（置信区间：50%至84%）。与接受有限切除（n = 20）或胰十二指肠切除术（n = 14）的患者相比，接受壶腹切除术（n = 8）的患者复发率更高（p < 0.01），生存率更低（p < 0.001）。
十二指肠绒毛状肿瘤的恶性肿瘤术前诊断较为困难。对于位于乳头附近的肿瘤，胰十二指肠切除术似乎是最佳治疗方法。
