【摘要】 目的探讨超声内镜(EUS)检查对胃异位胰腺的诊治价值。方法回顾分析我院2004年5月～2010年5月36例EUS诊断为胃异位胰腺患者的临床表现及超声内镜(EUS)的影像特征。将EUS的诊断结果与内镜或手术切除的组织病理诊断结果进行比较,分析治疗后随访3个月至1年状况。结果异位胰腺好发于胃(29/36,80.5%),尤其是大弯侧(19/36,52.7%),内镜下主要表现为隆起性病变,中央见脐样凹陷(25/36,69.4%);其EUS主要特征为病变主要位于黏膜和黏膜下层(32/36,88.8%)的偏高或网格样混杂回声占位,内部回声不均匀(27/36,75%),7例(7/36,19.4%)出现特征性管状结构样回声,29例(29/36,80.6%)边界清晰,27例(27/36,75%)病变边缘不规则。有12例(12/36,33.3%)患者在行异位胰腺切除术后,相应的症状消失。结论胃镜结合超声内镜检查是判断胃异位胰腺范围及指导治疗的重要手段。对于局限于黏膜层、黏膜浅层及黏膜下层的直径小于15 mm的病变,内镜下治疗是最佳选择,特别是透明帽辅助法黏膜切除。累及固有肌层时,最好手术治疗。对有上腹痛和不适的患者,建议内镜治疗。更多还原

【Abstract】 Objective To evaluate endoscopic ultrasonography(EUS) as used in the diagnosis and treatment of gastric heterotopic pancreas.Methods Data from 36 patients with pathologically confirmed heterotopic pancreas were retrospectively studied.These patients received diagnosis and treatment in our hospital during the time from May 2004 to May 2010.Clinical manifestations and EUS images were documented,and appropriate endoscopic resection or surgery procedures were performed.Follow-up was done for periods between 3 months and 1 year.Results Gastric heterotopic pancreas was frequently found in the antrum(29/36,80.5%),with its greater curvature being a high risk site(19/36,52.7%).In 25 cases(69.4%),the lesions were found by endoscopy to have umbilicate pits with an opening in the center.It was further confirmed by EUS that in a great majority of the cases(32/36,88.8%) the lesions originated from the mucosa/submucosa with hyper-echo or mixed echo.Most cases had a clear outline(29/36,80.6%),but in many being irregular(27/36,75%).In 7 cases(19.4%),the lesions were characterized by a tube-like echo in the center.Results from the follow-up suggested that in 12 patients(33.3%) their clinical symptoms disappeared after the treatment.Conclusion Endoscopy,together with EUS,is a useful tool for properly diagnosing heterotopic pancreas in the stomach.Endoscopic mucosal resection(EMR),and especially Cap-EMR,is desirable for cases without the muscularis propria involved and lesion diameter below 15 mm.Surgery is preferred for cases with the muscularis propria involved.For those who have abdominal pain or discomfort,endoscopic treatment is recommended.更多还原