| Objective:Clinical characteristics of primary tumor of the duodenum(PTD)and effective diagnostic methods and therapeutic measures are discussed and researched in this paper,which may provide theoretical basis for clinical diagnosis and treatment of PTD.Method:A retrospective analysis on clinical data of 50 PTD patients admitted into China-Japan Union Hospital of Jilin University during January 2012 and January 2016 was conducted,including general data,admitting diagnosis,clinical manifestations,endoscopic examination results,imageological examination results,laboratory examination results,pathological examination results,therapeutic methods and prognosis.Result:This group is composed of 26 male patients and 24 female patients,so the male-female ratio is about 1.08: 1.As for these patients,their ages range from 33 to 82(58.88±10.57)years old and courses of disease range from one day to two years.There are 7 cases of benign tumor and 43 cases of malignant tumor.As for patients in this group,admitting diagnoses include 18 cases of obstructive jaundice(36%),14 cases of malignant tumor & space-occupying lesion of duodenum(28%),4 cases of gastrointestinal bleeding(8%),4 cases of space-occupying lesion at the end of common bile duct(8%),2 cases of cholangiectasis(4%),1 case of duodenal ulcer(2%),2 cases of abdomen mass(4%),2 cases ofabdominal pain to be examined(4%),1 case of space-occupying lesion of liver,1 case of hepatic cyst and 1 case of pancreatic head carcinoma,for which accuracy rate of diagnosis at the time of admission is 28%.Clinical manifestations of this group lack specificity,the most important clinical manifestations including 13 cases of skin and sclera yellowing(26%),6cases of abdominal pain(12%),4 cases of nausea & vomit(8%),3 cases of abdominal distention(6%),3 cases of lacking in strength(6%),3 cases of abdominal pain with skin & sclera yellowing(6%),2 cases of epigastric discomfort(4%),2 cases of melena(4%),2 cases of abdominal pain with fever(4%),2 cases of fever(4%),2 cases of abdominal pain with abdominal distention(4%),1 case of abdominal mass(2%),1 case of melena with fever(2%),1 case of haematemesis with hematochezia(2%),1 case of nausea & vomit with abdominal distention(2%),1 case of abdominal pain and abdominal distention with skin & sclera yellowing(2%),1 case of skin & sclera yellowing with diarrhea(2%),1 case of abdominal pain with diarrhea(2%)and 1 case of urgency of urination &dysuria(2%).Detection rates of pre-operation B-ultrasonic examination,CT,stomach & duodenum endoscopy,ERCP,EUS,MRCP are 47.5%,92.5%,92.1%,100%,100%,84.2% respectively.Serum Tumor Marker Examination were examined in 37 cases: 16 cases of CA199 increase(43.2%),5 cases of CA242 increase(13.5%),2 cases of CA724 increase(5.4%)and 3 cases of CEA increase(8.1%).In this group,locations of disease occurrence include 28 cases of disease occurrence at the papilla(56%),15 cases of disease occurrence at the descending part(other than papilla)(30%),3 cases of disease occurrence at the intersection between the descending part and horizontal part(6%),2 cases of disease occurrence at the horizontal part(4%)and 2 cases of disease occurrence at the duodenal bulb(4%).Method of Operation: 32 cases ofpancreaticoduodenectomy,7 cases of local tumor resection,1 case of segmental duodenectomy and 10 cases of bypass operations,for which resecting rate is 80%.Pathological Results: 37 cases of adenocarcinoma(74%),3 cases of highly malignant potential stromal tumor(6%),2 cases of low malignant potential stromal tumor(4%),4 cases of tubulovillous adenoma(8%),2 cases of neuroendocrine carcinoma(4%),1 cases of neuroendocrine tumor(2%)and 1 case of hamartoma(2%).Clinical follow-up or telephone follow-up for the 50 PTD patients in this group was conducted by June 2016,during which follow-up of 50 patients was completed and 3 patients were under the circumstance of loss of follow-up.Follow-up duration ranges from 3 months to 52 months and median follow-up duration is 15 months,and follow-up rate is 94%(47/50).After operation,there were 4 cases of local recurrence and 7cases of metastasis(including 4 cases of liver metastasis,1 case of liver metastasis with pulmonary metastasis,1 case of liver metastasis with renal metastasis and 1 case of brain metastasis),for which interval of recurrence ranges from 3 months to 41 months and average inverval of recurrence is 17 months.10 patients died(9 patients died from local tumor recurrence or tumor metastasis and 1 patient died from undetermined cause as stated by the patient's family member).Conclusion:1.PTD lacks specific clinical manifestations,so it is difficult to realize early diagnosis.It is more likely that PTD occurs at the descending part,for which occurrence of the disease at the papilla is most common.2.Endoscopy and CT examinations serve as the main examination methods.3.Patients with PTD should actively accept surgical treatment.Asfor PBTD,local tumor resection and segmental duodenectomy can be performed.As for PMTD,pancreaticoduodenectomy should be the first choice. |
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