超声内镜对胃内异位胰腺与间叶源性肿瘤的诊断比较

The endoscopic ultrasonography(EUS) in ectopic pancreas and mesenchymal tumors in the stomach

目的通过比较胃内异位胰腺与间叶源性肿瘤的内镜及超声内镜特征,以评价超声内镜对胃内异位胰腺的诊断价值。方法回顾性分析2005年1月～2009年11月行超声内镜检查的599例胃内隆起性病变患者,将病理确诊的异位胰腺与间叶源性肿瘤(GIMT)的内镜及超声内镜特征进行回顾性比较分析。结果①经病理确诊的异位胰腺共计18例,GIMT58例。超声内镜诊断异位胰腺的敏感性、特异性、阳性预测值及阴性预测值分别为66.7%、84.44%、63.16%和86.36%。②异位胰腺发生部位主要为胃窦部,有16例;胃体大弯侧及后壁各1例。大体形态上表现为黏膜下隆起伴中央脐样开口8例,单纯黏膜下隆起10例。直径4～60mm,平均5.14mm。③超声内镜声像学提示异位胰腺表现为中等回声7例,低回声11例,无高回声病变。12例病变内部可见特征性的不规则管状或小囊性无回声。边界清晰规则的5例,欠规则的13例。13例起源于黏膜下层,2例起源于固有肌层;3例病变跨层次分布;无起源于黏膜肌层及浆膜层的病变。④胃异位胰腺与GIMT比较,在患者年龄、胃内生长部位、表面黏膜情况、起源层次、病变边缘、内部回声高低及内部有无灶性无回声区方面差异有显著性。异位胰腺相对年轻,病变较小,好发于胃窦,表面可有凹陷性开口,但不占多数;多起源于第3层胃壁,病变边缘多不光滑;与周围黏膜下层及固有肌层回声比较,内部回声多介于两者之间,且有2/3病变内部有灶性无回声区。结论超声内镜是诊断胃内异位胰腺的有效方法,但敏感性不高;超声内镜在一定程度上能鉴别异位胰腺与间叶源性肿瘤。

[ Objective ] To evaluate the value of endoscopic uhrasonography （EUS） in ectopic pancreas and the characteristics between gastric ectopic pancreases and mesenchymal tumors. [ Methods ] Retrospective analysis the endoscopic and EUS features in 18 ectopic pancreases. All patients （n=76） were diagnosed pathologically as having gastric ectopie Pancreas （n=18） or mesenchymal tumors （n=58） between 2005 and 2009. The EUS images of the pa- tients were retrospectively reviewed, including the lesion location, size, growth pattern, layer of origin, presence or absence of layer disruption, margin, and internal echo pattern. These EUS imaging findings were compared for ec- topic pancreases and mesenchymal tumors. [Results] Compared with mesenchymal tumors, ectopic pancreases showed a significant difference in the lesion location, growth pattern, layer of origin, presence of layer disruption, margin, and internal echo （P 〈0.05）. Ectopic pancreases mainly located in the antrum and showed inner growth pat- tern. It often originated from the third layer of the gastric wall and showed heterogeneous hypoechogenicity with focalanechoicity inside. There was no statistical difference in the lesion size and presence of focal anechoic portion. [ Coneltmion ] Careful assessment of the EUS maybe a useful aid in the differentiation of ectopic pancreases from mesenchymal tumors in the stomach.