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Objective To investigate the diagnosis and therapeutic methods of primary tumors of duodenum(PTD).Methods Clinical data of 86 patients with primary duodenal tumors who were hospitalized in the First Affiliated Hospital of China Medical University during 26 years were analyzed retrospectively.Of all the tumors,18 cases were benign tumors and 68 cases were malignant tumors.Results The clinical(manifestations) were symptoms of bile duct obstruction,GI and nonspecific symptoms,and signs included(fever),anemia and weight loss.The correct preoperative diagnostic rate by auxiliary examinations were:(duodenal) endoscopy 92%,air barium double radiography 89%,MRCP 85%,BUS 33%,CT 51%,MRI 75%,and duodenal endoscopy combined with air barium double radiography were 95%.Tumors were mostly located in the descending portion of duodenum(71 cases).Eighteen cases of benign PTDs were resected(completely) with a 5-year survival of 92.3%.Among the 68 maligant PTD cases,35 cases underwent(pancreatoduodenectomy),and 8 cases received segmental duodenectomy,with a resection rate of 63.2% and the 5-year survival rate of 31.0%.The remaining 25 cases,in which the tumors were unresectable,were treated by bypass operations,the 5-year survival rate was 0%.Conclusions Patients with PTD usually lack specific symptoms and signs,but combination of endoscopy,GI air barium double radiography and other(examinations) can improve the preoperative positive diagnostic rate.Segmental duodenectomy and simple tumor resection are curable for primary benign tumors of duodenum;while for primary malignant tumors of(duodenum),the therapy of choice should be pancreatoduodenectomy.
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ObjectiveTo study the diagnosis and treatment of primary duodenal papilla neoplasm(PDPN). MethodsThe clinical data of 64 patients with PDPN were analysed retrospectively. Results Among 38 cases received deodunscopy, PDPN were found in 32 cases (84.2%). Tumors were found in 49 of 51 cases received ERCP. There were 2 cases of benign tumor and 62 of maligancies in this series. 4 of 46 cases survived 4 years after Whipple operation,and 4 of 11 cases underwent lacal resection of PDPN suvived 4～6 years. ConclusionsTEndoscopy and ERCP are main methods for the diagnosis of PDPN; It is essential to use the rationale operation to improve the results of surgical treatment.
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Objective To investigate the clinical manifestations, histopathological patterns, and methods of diagnosis and treatment of primary malignant duodenal tumors. Methods The data of 82 patients with primary malignant duodenal tumors confirmed by pathology and admitted to our hospital over a 10-year period were analyzed retrospectively. Results Tumor location:Tumors were located in the peripapilla region in 64 cases, at the descending portion of the duodenum in 11 cases, at other regions of the duodenum in 7 cases. The common presenting symptoms and signs were abdominal pain in 57 cases, jaundice 53 cases, and gastrointestinal bleeding in 41 cases. In these patients, radical resection of tumor was performed in 36 cases, palliative resection of tumor in 31cases,and operative intervention was not done in 15 cases.The 5-year survival rate of followed-up patients in this group was 2.4%. Conclusions The common presenting symptoms and signs of patients with primary malignant duodenal tumors were abdominal pain, jaundice and GI bleeding, but these patients usually lack specific symptoms and signs. The chief pathologic type is adenocarcinoma and the predisposed site of occurrence is the duodenal papillary region and the descending duodenum . CT, B ultrasonography and gastroduodenoscopy are the chief measures for the diagnosis of primary duodenal malignant tumors, and surgical resection is the main modality of treatment of this disease. The prognosis of primary duodenal malignant tumors is very poor.
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Objective To investigate the diagnosis and treatment of patients with benign tumor of duodenum(BTD). Methods Clinico-pathological data of 24 patients with BTD treated by surgery in our department in recent 21 years were analyzed retrospectively. Among the 24 cases, 18 cases underwent local resection, 4 segmental duodenectomy, 1 subtotal gastrectomy and 1 pylorus-preserving pancreatoduodenectomy. Results Abdominal pain, digestive tract hemorrhage and duodenal obstruction were the common clinical manifestations of BTD. The correct diagnostic rates of air barium double contrast radiography and duodenoscopy were 82.4% and 93.3% respectively. The result of surgical treatment was satisfactory, except 1 patient who died of acute myocardial infarction 6 days after the operation. Of the 24 patients, the pathological examination showed as follows 8 had a villous adenoma, 6 gastrointestinal stromal tumor, 5 Brunner′s gland adenoma, 2 leiomyoma, 2 multiple adenomas in familial adenomatous polyposis, 1 hemangioma. Conclusions Air barium double contrast radiography and duodenoscopy are mainsteps for the diagnosis of BTD. The best treatment is surgical resection.
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Objective To study the diagnosis and treatment of duodenal papilla tumor (DPT). Methods Analyses were made on the clinical data of 22 patients with DPT proved by operation and pathology from 1977 to 1999. Results There were 17 patients with duodenal papillary carcinoma, 5 with duodenal papilloma in this series. Discomfort of the upper abdomen (16 cases) and jaundice (22 cases) were the main symptoms. Barium meal examination, BUS, CT and ERCP were very useful in the diagnosis of DPT. In this series, 19 of 22 patients received pancreaticoduodenctomy, and 3 received local reseciton, the resection rate was 100%. 15 patients (88.2%) were followed up, the 5 years survival rate was 73.3%, 7 years survival rate was 46.7%. Conclusions Duodenoscope and ERCP are credible methods for diagnosis of this disease, resection is the main way of treatment.
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Objective To investigate the clinicopathological characteristics, diagnosis and treatment of primary duodenal malignant tumors (PDMTs). Methods The clinical data of 47 PDMTs confirmed by pathology were retrospectively analyzed. Results Pathological types were adenocarcinoma in 42 cases, leiomyosarcoma in 4, and carcinoid in 1.The most common location of the tumor was the descending portion (35), especially the peri-papillary region (28) of the duodenum. The most common symptoms and signs were abdominal pain, jaundice, upper gastrointestinal hemorrhage, obstruction ,and weight loss. The main diagnostic modalities were gastroduodenoscopy, GI barium meal, ERCP, ultrasound (US) and CT. US together with ERCP was the most useful in improving the diagnosis of peripapilla tumors in the duodenum. Panceraticoduodenectomy and some palliative procedures were performed for 25 and 20 cases, respectively.Surgical mortality and postoperative morbidity were 2.2% (1/45) and 20% (9/45),retrospectively. The 3-year and 5-year survival for those adenocarcinoma without distant metastasis undergoing pancreaticoduodenectomy were 50% and 32%. No long survival was found after the palliative operation. Conclusions Adenocarcinoma is the most common pathological type of PDMTs.No specific symptoms were shown in the early stage of PDMTs, US, CT and ERCP are the main diagnostic procedures. Radical pancraticoduodenectomy can prolong survival time and should be attempted for those without systemic dissemination.Palliative operations should be considered for tumors in advanced stage.
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Objective To investigate early diagnosis and treatment of tumor of duodenal papilla.Methods Their clinical data of 64 cases of tumor of duodenal papilla confirmed by operation and pathology were analyzed retrospectively.They included 60 cases of carcinoma of duodenal papilla and 4 cases of adenoma.Results The main clinical symptoms were jaundice(42 cases),digestive tract symptoms(35 cases),recurrent cholangitis(7 cases) and hemorrhage of upper digestive tract(1 case).The diagnosis rate accuracy of ERCP,Fiberoptic duodenoendoscopy,MRCP,BUS and CT were 100%,97.3%,82.4%,82.8% and 76.1% respectively.Fifly-five cases underwent pancreatoduodenectomy,5 cases received local resection,and the remaining 4 cases were treated by palliative surgery.The surgical complication rate was 16.1% and the surgical mortality rate was 3.6%.The 1-year,3-year and 5-year survival rate of pancreatoduodenectomy were 67.4%,40.6% and 36.3%.Conclusions Jaundice and abdommal pain are the main symptoms of tumor of duodenal papilla.Fiberoptic duodenoendoscopy and ERCP are most effective methods for diagnosis of tumor of duodenal papilla.It is essential to early select radical resection operation so as to improve the results of surgical treatment.
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Objective To improve the diagnosis and treatment of primary duodenal malignant (neoplasms)(PDMN).Methods The clinical data of 19 patients with primary malignant neoplasms of the (duodenum) were anayzed retrospectively.Results The clinical manifestations were jaudice in 9 cases, upper abdominal pain in 7 cases, gastrointestinal hemorrhage in 6 cases,abdominal mass in 3 cases,and vomitting in 1 case. Diagnostic procedure and detection rate: The detection rate of PDMN by duodenoscopy was 83.3%(15/18), by hypotonic duodenography was 82.3%(14/17), 77.8%(7/9) by CT, and 1 case by MRI.16 cases (underwent) surgery with resection rate of 68.8 %(11/16).Pancreaticoduodenectomy was (performed) in 9 (cases), simple tumor resection and regional lymphadenectomy in 1 case,resection of duodenal bulb plus partial gastrectomy in 1 case,and gastroenterostomy or choledochojejunostomy in 5 cases.The radical resection rate was 62.5%(10/16).The postoperative 1-,3-,and 5-year survival rate in radical (resection) (patients) was 90.0%(9/10),40.0%(4/10) and 30.0%(3/10),respectively.In those with (gastroenterostomy) or (choledochojejunostomy), the survival time was 6~15 months. Conclusions (Duodenoscopy) and hypotonic (duodenography) are ideal tools for the diagnosis of all locations of PDMN.(Pancreaticoduodenectomy) might result in prolonged survival of patients with PDMN.