异位胰腺的超声内镜特征和内镜治疗作用

Endoscopic ultrasonography features and endoscopic excavation for heterotopic pancreas

目的 探讨异位胰腺超声内镜(endoscopic ultrasonography,EUS)的特征和内镜黏膜下肿物切除术对异位胰腺的治疗作用。方法 选取2012年10月至2018年9月哈尔滨医科大学附属第二医院收治的黏膜下肿物患者,经EUS检查后行内镜黏膜下肿物切除术,病理诊断为异位胰腺者。观察其EUS下的特征,并对患者进行追踪随访。结果 本研究共纳入31例患者,17例( 54.84%)病变位于胃窦,6例(19.35%)位于胃体,5例(16.13%)位于十二指肠,2例(6.45%)位于胃底,1例(3.23%)位于食管;4例(12.90%)表面有中央凹陷;24例(77.42%)呈低回声;14例(45.16%)起源于黏膜下层,8例(25.81%)起源于固有肌层,7例(22.58%)起源于黏膜肌层,2例(6.45%)累及多层;18例(58.06%)内部回声均匀;26例(83.87%)边界清晰。17例(54.84%)患者行内镜固有肌层剥离术(endoscopic mucosal dissection, EMD),14例(45.16%)行内镜黏膜下剥离术(endoscopic submucosal dissection ,ESD),均一次性切除,术后随访均无瘤体残留及复发。结论 异位胰腺好发于胃窦,胃体、十二指肠为次,以低回声为主,内部回声多均匀,边界大多清晰,多起源于黏膜肌层、黏膜下层、固有肌层。内镜黏膜下肿物切除术可以为异位胰腺提供病理诊断的标本,同时也是一种安全有效的治疗手段。

Objective To describe the endoscopic ultrasonography(EUS) features of heterotopic pancreas and evaluate the value of endoscopic excavation for heterotopic pancreas.Methods Patients with heterotopic pancreas who received EUS and endoscopic excavation were collected from Oct. 2012 to Sep. 2018. EUS features, endoscopic resection and follow-up were evaluated in all the patients.Results Thirty-one patients were enrolled in the present study. Seventeen lesions(54.84%) were located in the antrum, 6 lesions(19.35%) were located in gastric body, 5 lesions(16.13%) were located in duodenum, 2 lesions(6.45%) were located in gastric fundus, and 1 lesion(3.23%) was located in esophagus. Four lesions(12.90%) showed central dimpling on the surface. Twenty-four lesions(77.42%) showed hypoechoic echogenicity. Fourteen lesions(45.16%) were located in submucosa, 8 lesions(25.81%) were located in muscularis propria, 7 lesions(22.58%) were located in muscularis mucosa and 2 lesions(6.45%) involved two or more sonographic layers. Eighteen lesions(58.06%) were homogeneous. The borders were distinct in 26 lesions(83.87%). Seventeen patients(54.84%) underwent endoscopic mucosal dissection(EMD). Fourteen patients(45.16%) underwent endoscopic submucosal dissection(ESD). Complete endoscopic excavation was performed in all patients with no complications occurring in any patients. No recurrence or metastases was found in all patients during the follow-up period.Conclusion The most common location of heterotopic pancreas is antrum of stomach, gastric body and duodenum are followed. EUS homogeneous hypoechogenecity was predominant. The borders were distinct in most lesions. Muscularis mucosa, submucosa, muscularis propria were the most frequently involved layers. Endoscopic excavation appears to be a safe and feasible procedure for accurate histopathologic evaluation and curative treatment for heterotopic pancreas.