小肠肿瘤课件

LOGOThroughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的诊断中国医学科学院肿瘤医院赵平Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.2比利时鲁汶大学博士北京协和医院大外科副主任教授、主任医师、博士生导师中国医学科学院肿瘤医院院长大外科主任腹部外科主任PET-CT中心主任胰腺癌中心主任中国医院协会肿瘤医院管理分会主任委员北京医学会肿瘤分会主任委员中国老年肿瘤专业委员会主任委员瘤中心Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠的解剖小肠上端始于幽门下端经回盲瓣续接大肠分为十二指肠空肠回肠成人小肠平均长5-7米空肠回肠为腹膜内位器官通过小肠系膜附着于腹后壁活动性很大盘踞在结肠下区迂曲回环形成许多小肠袢部分小肠袢位于骨盆腔中Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的概况原发性小肠肿瘤占胃肠道肿瘤2%-5%原发性小肠恶性肿瘤占胃肠道恶性肿瘤1%小肠肿瘤与原发性小肠恶性肿瘤之比1：4.66Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的概况小肠肿瘤有40余种不同的组织学类型95%以上是腺癌、类癌、间质瘤（GIST）或淋巴瘤小肠腺癌常见于老年人尤为70岁以上的男性所有小肠肿瘤中神经内分泌肿瘤占44%其次是腺癌（33%）淋巴瘤（15%）胃肠道间质瘤（7%）全世界小肠腺癌的年发病率为每百万人口7.3例发达国家的发病率较发展中国家高Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.十二指肠十二指肠长约25-30厘米位于胃幽门与空肠之间呈马蹄铁形状包饶胰头十二指肠分为上部降部横部和升部空肠回肠为腹膜内位器官Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的临床表现小肠腺瘤-腺癌出血贫血肠梗阻小肠平滑肌肉瘤腹痛腹块出血恶心呕吐贫血小肠平滑肌肉瘤三大特征腹块黑便腹痛小肠纤维瘤纤维肉瘤腹痛偶有出血小肠类癌腹痛腹泻恶心呕吐食欲减退消瘦类癌综合征面部潮红腹痛心悸哮喘肢体麻木小肠恶性淋巴瘤腹痛恶心呕吐腹泻便秘食欲减退消瘦贫血Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的临床表现首发症状与原发肿瘤位置相关十二指肠壶腹周围区肿瘤可表现为无痛性黄疸十二指肠梗阻慢性出血症状空回肠恶性肿瘤的表现多为非特异性最常见的症状和体征包括消化道出血、腹痛、肠梗阻（恶心、呕吐）、消瘦、贫血等45%以上的患者有上述表现Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的临床表现小肠癌的症状出现要早得多50%小肠肿瘤患者表现为梗阻或穿孔等急腹症且随肿瘤增大而出现比例增高小肠腺癌与其他恶性类型相比更易出现疼痛和梗阻肉瘤经常表现为急性消化道出血而淋巴瘤更常见的是肠穿孔不同亚型好发部位不同腺癌主要位于十二指肠神经内分泌肿瘤多位于回肠肉瘤和淋巴瘤可发生于小肠全长Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠肿瘤的病理学分类组织来源良性肿瘤恶性肿瘤上皮腺瘤腺癌结缔组织纤维瘤纤维肉瘤平滑肌平滑肌瘤平滑肌肉瘤脂肪脂肪瘤脂肪肉瘤血管血管瘤血管肉瘤淋巴管淋巴管瘤淋巴组织假性淋巴瘤网状细胞肉瘤Hodgkin病神经神经纤维瘤神经纤维肉瘤神经鞘瘤神经鞘肉瘤嗜银细胞类癌Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠恶性肿瘤的形态学表现环形狭窄肠套叠肠出血肠穿孔肠梗阻肠瘘Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.小肠癌缺乏特异性的症状和体征多数病例的诊断延误平均诊断延误时间是8-12个月主要包括漏诊和误诊目前还没有成熟的检查流程小肠癌的诊断Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.：除非出现梗阻症状在小肠肿瘤的诊断中不作为常规使用腹平片可以有效的诊断50-60%的小肠梗阻老年人急腹症要考虑小肠癌的可能腹平片Throughthispublicitycampaign,furtherimprovethesenseofbusinessintegrityoftourismenterprisestohelptourismconsumersandoperatorstosafeguardthelegitimaterightsandinterests,toensurethatourCity'stourismsustainable,healthyandcoordinatedDevelopment.这是一项需要足够时间来进行的全小肠连续对比造影检查适合检查消化道腔内和粘膜的形态异常左图上示空肠癌小肠造影显示肠道狭窄左图下示回肠淋巴肉瘤小肠造影显示肠道粘膜形态的改变全消化道造影Throughthispublicitycampaign,furtherimprovethesenseofbusine