内镜黏膜下挖除术治疗胃异位胰腺临床价值研究

Endoscopic submucosal exavation for the treatment of gastric heterotopic pancreas

目的探讨内镜黏膜下挖除术(ESE)治疗胃异位胰腺的应用价值。方法回顾性分析2007年8月至2010年12月复旦大学附属中山医院内镜中心行ESE治疗且经病理证实为胃异位胰腺的60例病人资料,评价ESE治疗的可行性、安全性和必要性。结果肿瘤位于胃窦部51例(85.0%),大弯侧34例(56.7%),23例(38.3%)伴明显脐凹。超声内镜检查2例(3.3%)位于黏膜肌层,42例(70.0%)位于黏膜下层(有3例与固有肌层关系密切),16例(26.7%)位于固有肌层。病灶整块挖除率98.3%(59/60),9例(15%)术中出现动脉性出血,需热活检钳辅助止血或金属夹夹闭止血,术中发生气腹12例(20.0%),无术中或术后穿孔和不可控性出血而转外科手术病例。中位随访时间17(4～44)个月,未见复发病例。结论以ESE为基础的内镜外科治疗,不仅满足了胃异位胰腺局部切除的治疗原则,而且还可获得完整病理结果,避免误诊。是一种安全、有效、值得推广的方法。

Objective To evaluate endoscopic submucosal exavation（ESE） in the treatment of heterotopic pancreas in stomach. Methods The clinical data of 60 cases of gastric heterotopic pancreas diagnosed by pathology between August 2007 and December 2010 in Endoscopy Center, Zhongshan Hospital of Fudan University were analyzed retrospectively. The cases were all treated with ESE, and the effects and safety were evaluated. Results Heterotopic pancreas were most commonly found in gastric antrum （51/60, 85% ） and greater gastric curvature （34/60, 56.7%）. Twenty-three cases （38.3%）were found a hollow in the top. EUS found that 2 cases （3.3%）were originated from muscular layer of mucosa, 42 cases （70%）from submucosa layer, 16 cases （26.7%） from muscle propria. En-bloc resection rate was 98.3%（59/60）. During ESE, arterial hemorrhage happened in 9 cases （15%）, which could be controlled by electric coagulation forceps or metal clips. Pneumoperitoneum was found in 12 cases （20%）. There was no patient converted to surgery due to complications. During a median follow-up of 17 （4-44） months, no recurrence was found. Conclusion ESE is a method not only to get the exact pathologic diagnosis but also to meet with principle of the local resection for heterotopic pancreas. It is safe, effective and worthy of spreading.