Clinical Analysis Of 16 Cases Of Duodenal Papillary Carcinoma And Literature Review

Aims : To investigate the clinical manifestations,laboratory and imaging examinations,selection of surgical treatment methods,pathological types and histological types of the duodenal papillary carcinoma,choice of postoperative adjuvant chemotherapy and prognosis.Methods: By collecting clinical diagnosis and treatment data from 16 patients with hepatobiliary and pancreatic cancer admitted to the hospital between January 2013 and January 2018 in this hospital,the general conditions of admission,clinical diagnosis,and postoperative pathology of the selected patients were collated.Review,provide clinical reference for the diagnosis,treatment and prognosis of patients with clinically duodenal papillary carcinoma.Results:The clinical manifestations of 16 patients with papillary carcinoma of the duodenum were analgesia,weight loss,abdominal pain,abdominal distension,jaundice and upper gastrointestinal bleeding.The main clinical manifestations were typical fluctuate jaundice and upper gastrointestinal bleeding.In laboratory and radiological examinations,there were 12 patients with elevated bilirubin;9 patients underwent abdominal B-ultrasound,all showed different degree of intrahepatic and extrahepatic bile duct dilatation,suggesting that there were 4 cases of duodenal occupying lesions.(44%);abdominal CT examination in 14 cases,suggesting 12 cases of duodenal papilloma(86%);MRCP examination in 9 cases,suggesting that the common bile duct or duodenal papillary lesions in 7 cases(78%);2 cases of endoscopic ultrasonography,unclear level of duodenal papilla,suggesting duodenal papillary lesions in 2 cases(100%).Of the 16 patients,14 underwent radical pancreatoduodenectomy.One patient underwent local tumor resection.One patient underwent endoscopic examination and histological diagnosis confirmed the family's request for automatic discharge.No surgical treatment was performed.The ratio was94% and the surgical resection rate was 100%.Postoperative pathology reports showed that there were 13 cases(81%)of adenocarcinomas,1 case(6%)of signet-ring cell carcinomas,and 2 cases(13%)of neuroendocrine tumors;According to the degree of tissue differentiation,it was divided into high,medium,low andundifferentiated carcinomas,among which the highest proportion of moderately differentiated carcinomas was 38%(6 cases).Since most of the papillary carcinomas of the duodenum were mainly adenocarcinomas,the duodenal papillary adenocarcinoma was classified into intestinal type 3 cases(4/7)according to histopathological classification according to differentially expressed gene markers by immunohistochemistry.Pancreaticobiliary type 4 cases(3/7).Postoperative follow-up adjuvant chemotherapy for different types of tissue-derived duodenal papillary carcinoma,including 1 patient with duodenal papillary carcinoma originating from bowel type.Postoperative oxaliplatin(100 mg/m2 ivgtt D1)And Stipio(40-60mg/m2 po bid D1-14),three cycles for 1 cycle,total 8 cycles;4 patients received Oxaliplatin(85 mg/m2 ivgtt D1),5-Fu(2.4-3.6 g/m2 ivgtt D1-5)and leucovorin(200mg/m2 ivgtt D1-5),four weeks,for a total of 6 cycles.In the follow-up of 16 patients,14 cases were effectively followed up.The 1-year survival rate was 78.6%(11/14),the 2-year survival rate was 57.1%(8/14),and the 3-year survival rate was 42.9%.(6/14).Conclusions: Fluctuant jaundice and upper gastrointestinal hemorrhage are the main clinical manifestations of duodenal papillary carcinoma.The preoperative imaging examinations are predominantly ERCP,endoscopic,and laboratory examinations.Bilirubin and liver enzymes are generally elevated.The markers CEA and CA19-9are not specific tumor markers of duodenal papillary carcinoma.With the advancement of medical technology,the popularity of ultrasound endoscopy provides a more effective means for the diagnosis of the disease.Pancreatoduodenectomy is the most important surgical treatment for papillary carcinoma of the duodenum.Local resection of the tumor provides a new surgical option for early patients,but strict indications for surgical indications for this procedure are required;After pathological immunohistochemistry will provide chemotherapy strategies in different directions for adjuvant chemotherapy.Early detection and treatment have important value and significance for improving the survival rate of duodenal papillary carcinoma.