摘要
目的:分析异位胰腺的临床特征、超声内镜特征、病理学特征以及影像学(增强CT)特征等。方法:回顾性收集2012年1月至2019年7月在武汉大学中南医院确诊为异位胰腺的68例患者的病历资料,包括临床表现、内镜下表现、超声内镜表现、病理学特点、增强CT表现以及治疗方法等。结果:(1)异位胰腺发病率无明显性别差异,所有年龄段都可以发病,但多见于中老年人群为主,异位胰腺临床上一般常合并有胃十二指肠炎慢性炎症、糜烂、溃疡和息肉等病变,临床表现以消化道无特异性症状为主;发病部位以胃窦、十二指肠球部和近端空肠等上消化道为主。(2)98.5%以单发(67例)的胃、十二指肠炎及近端空肠黏膜下病变为主,表面中央顶端呈典型"脐样凹陷征"并"导管征"者不多见(15例,22.1%)。(3)Gaspar-Fuentes分类以Ⅰ型为主(59例,86.8%)。(4)异位胰腺的超声内镜回声特点与组织病理成分及并发症有关,EUS多数呈混杂欠均匀回声(22例,43.1%,均属于Gaspar-Fuentes分类Ⅰ型)和低回声(21例,41.2%,其中Ⅰ型19例,Ⅲ型2例)为主。(5)CT增强特点也与其病理组织成分及其比例、血供、并发症等密切相关;腺泡为主者CT呈明显强化,成分类似正常胰腺者强化程度类似于正常胰腺,导管为主者轻度强化,导管扩张或囊变者不强化。(6)治疗:行内镜下治疗者57例,外科治疗者11例。结论:异位胰腺仅凭胃肠镜和超声内镜诊断率并不高,多数等到组织病理报告尚能确诊(极少数鉴别困难者尚需免疫组织化学鉴别)。其超声回声与组织病理成分密切相关,导管扩张囊性变等会影响其在超声内镜下回声特点。当发现不明原因的胃肠道黏膜糜烂、溃疡、消化道出血、贫血等疾病合并局限性胃肠壁增厚、向腔内凸起的黏膜下隆起性病变时也要考虑异位胰腺或者异位胰腺并发症的可能性。内镜下黏膜剥离切除术(EMR)、内镜黏膜下
Objective:To retrospective analyze the general clinical characteristics of heterotopic pancreas,as well as their echo characteristics of endoscopic ultrasonography(EUS), histopathological features,CT enhancement features, diagnosis and treatment methods, etc.Methods:A total of 68 patients finally diagnosed with heterotopic pancreas in Zhongnan Hospital of Wuhan University from January2012 to July 2019 were studied.Results:(1) There was no significant gender difference in the incidence rate of heterotopic/ectopic pancreas(EP), and ectopic pancreas were often combined with superficial gastritis, erosive gastritis, duodenal erosive ulcer, polyp like formation, etc, most commonly occurred in the upper gastrointestinal tract(especially distributed in antrum, duodenal and proximal jejunum).The major clinical manifestations were nonspecific, mainly including abdominal pain, abdominal distention, acid regurgitation, hiccup and gastroitestinal hemorrhage, and mostly occured in middle and old aged people.(2) 98.5% of the cases were presented as single upper gastrointestinal submucosal lesions(67 cases).The typical "central dimpling sign" and "catheter sign" on the top of the central surface were rare(15 cases, 22.1%).(3) In pathology, Gaspar Fuentes type Ⅰ was the most common.(4) The EUS characteristics of ectopic pancreas were closely related to histopathological composition and complications.Most of them showed mixed echogenicity(22 cases, 43.1%)and hypoechoic submucosal lesions(21 cases, 41.2%).(5) CT enhancement features were also closely related to the pathological tissue composition and ectopic pancreas’ proportion, blood supply, complications, etc.(6) 57 cases were treated by gastrointestinal endoscopy, and 11 cases underwent surgical treatment.Conclusion:The diagnosis rate of heterotopic pancreas by the means of gastrointestinal endoscopy and EUS is not high enough, and final diagnosis can be confirmed by histopathological biopsy after resection(or even by immunohistochemical staining when necessory).The possib
作者
克热木·如孜
李瑾
肖书渊
刘欢
赵秋
KEREMU Ruzi;LI Jin;XIAO Shuyuan;LIU Huan;ZHAO Qiu(Dept,of Gastroenterology,Zhongnan Hospital of Wuhan University\Hubei Clinical Research Center of Intestinal Diseases,Hubei Key Lab of Intestinal&Colorectal Diseases;Dept.of Pathology,Zhongnan Hospital of Wuhan University&Center of Pathology and Molecular Diagnosis,Wuhan University,Wuhan 430071,China)
出处
《武汉大学学报（医学版）》
CAS
2021年第4期652-656,677,共6页
Medical Journal of Wuhan University
关键词
异位胰腺
内镜特点
超声内镜特点
CT特点
组织病理
Heterotopic Pancreas
Endoscopic Characteristics
Endoscopic Ultrasonography Features
CT Features
Histopathology
