Vuilleumier H, Cuttat J F, Blum A L, Chapuis G
Service de chirurgie, CHUV, Lausanne.
Helv Chir Acta. 1994 Apr;60(4):557-67.
Primary adenocarcinoma of the duodenum is a rare lesion and represents 0.35% of all tumors of the gastrointestinal tract. 75% of the primary tumors of the duodenum are adenocarcinomas and 33-45% of the adenocarcinomas of the small bowel arise in the duodenum. The incidence of these tumors has been estimated to be 0.03%. The diagnosis is usually made at a very late stage because the symptoms are often non-specific. The mean diagnostic delay between beginning of symptoms and the diagnosis is of 10 months. Oesogastroduodenoscopy is the diagnostic procedure of choice and upper GI series is still of interest since it permits a topographic analysis of the lesion. Pancreatico-duodenectomy is recognized by a majority of authors as the standard curative procedure, in the absence of regional nodes. Survival after pancreaticoduodenectomy in the absence of local lymph node invasion is 68% at 5 years whereas there is no survivor after 3 years when there is regional invasion of the lymph nodes. Survival rates after palliative excisions are generally of 15 months, after bilio-digestive derivation of 6 months. Radical excision is preferable in as much as it is technically feasible.
十二指肠原发性腺癌是一种罕见病变，占胃肠道所有肿瘤的0.35%。十二指肠原发性肿瘤的75%为腺癌，小肠腺癌的33 - 45%发生于十二指肠。这些肿瘤的发病率估计为0.03%。由于症状往往不具特异性，诊断通常在很晚阶段才做出。症状开始至诊断的平均延迟时间为10个月。食管胃十二指肠镜检查是首选的诊断方法，而上消化道造影仍有意义，因为它能对病变进行地形分析。在无区域淋巴结转移时，胰十二指肠切除术被大多数作者公认为标准的根治性手术。在无局部淋巴结侵犯的情况下，胰十二指肠切除术后5年生存率为68%，而当有区域淋巴结侵犯时，3年后无幸存者。姑息性切除术后的生存率一般为15个月，胆肠转流术后为6个月。只要技术上可行，根治性切除更可取。
