Overview
Periportal carcinoma is a general term for carcinomas that grow in the periportal area, the duodenal papilla, the lower end of the common bile duct, and the medial wall of the duodenum. The common feature is that obstruction of the common bile duct and main pancreatic duct can be caused when the cancer is small. The course of the disease progresses slowly, jaundice appears early, the surgical resection rate is about 60%, and the five-year survival rate is 40%-60%.
Etiology
The cause of the disease is unknown.
Symptoms
Painless jaundice with progressive exacerbation often occurs at an early stage, and occasionally fluctuates due to necrosis of the cancerous tumor and recanalization of the bile ducts. Prolonged cholestasis may lead to biliary cirrhosis and enlarged gallbladder. If combined with biliary tract infection, there may be high fever, chills and even toxic shock. Abdominal pain is usually not heavy, sometimes radiating to the back. Digestive tract dysfunction, clay-colored stools, fecal occult blood may be positive, generalized itching, poor appetite, diarrhea, emaciation. Pay special attention to the presence of the following conditions:
1. persistent and progressive epigastric fullness and vague pain for several months over 41 years of age;
2. persistent and progressively worsening epigastric and mid-abdominal pain that radiates to the low back, is worse at night and lighter at day, is worse in the lying position, and is relieved by lying on the side, curling up, or sitting in a forward position;
3. progressive wasting;
4. progressive obstructive jaundice;
5. sudden onset of diabetes mellitus or pancreatitis in always healthy middle-aged or elderly people, or aggravation of existing diabetes mellitus without obvious triggers;
6. unilateral testicular pain, unilateral lower limb edema;
7. Sudden appearance of various neuropsychiatric symptoms.
Examination
1. Laboratory tests should be performed to measure serum total bilirubin, 1-minute bilirubin, ALP, LDH and its isoenzymes, γ-GT, 5-NT, amylase, CA19-9, blood glucose and urinary glucose, and monoclonal antibody against pancreatic cancer cells (Du-PAN-2), pancreatic embryonic antigen (POA), CEA, serum ferritin, pancreatic cancer-related antigen (PCAA), etc. 2. 2. B-mode ultrasonography, if necessary, under ultrasound guidance, percutaneous fine-needle aspiration cytology is performed. Fiberoptic duodenoscopy can be used to observe the lesions in the descending papillary part of duodenum and the abdomen of the pot, and biopsy or pancreatic duct intubation can be used to take pancreatic fluid and send it to the relevant examination, and intubation contrast can also be used to understand the scope of lesion involvement.4. Imaging examination can be performed on chest and abdominal plain film, to observe the left diaphragm with or without elevation, the left thoracic cavity with or without accumulation of fluids, and pancreas with or without calcification; pancreas and bile duct retrograde imaging; CT and MRI examination can be performed, as well as CT and MRI examination. MRI, CT-guided fine-needle aspiration cytology can also be performed. If necessary, retroperitoneal insufflation angiography (for suspected pancreatic tail or pancreatic body cancer); selective or super-selective peritoneal arteriography, percutaneous transhepatic cholangiography (PTC).
Diagnosis
The combination of clinical symptoms and relevant examinations may help in the diagnosis.
Differential diagnosis
Clinical manifestations of periampullary carcinoma are often atypical and should be differentiated from pancreatic cancer. Attention should also be paid to differentiate it from various diseases, such as chronic gastric disease, gallbladder disease, jaundiced hepatitis, chronic pancreatitis, diabetes mellitus, unilateral deep vein thrombosis of the lower limbs and neuropsychiatric disease, etc. In highly suspected cases, the diagnosis should be made by combining clinical symptoms and relevant examinations. For highly suspected cases, early caesarean section should be sought, and treatment should not be delayed by waiting for special examination.
Treatment
1. Give easily digestible food according to the nursing routine of digestive system diseases.
2. If there is no distant metastasis, strive for early surgical treatment, perform Whipple operation or PPPD (Pancreaticoduodenectomy with Pylorus Preservation), and improve the survival rate with radiotherapy and chemotherapy during or after the operation. Patients without surgical conditions can actively adopt high-dose local irradiation and radioisotope local implantation irradiation, etc., with chemotherapy; or endoscopic biliary drainage, percutaneous transhepatic biliary drainage, peritoneal arterial chemotherapeutic drug perfusion and other therapies.
3. Supportive and symptomatic treatment, infusion of fluids, oral administration of various digestive enzymes, supplementation of vitamins (A, D, K, etc.) and other nutrients. For severe pain, painkillers should be given, and for itchy skin, cholestyramine should be used (not to be used in case of complete bile duct obstruction), or topical menthol-camphor glycerite lotion should be used. For those with high blood sugar, ordinary insulin should be used in moderation.