36例异位胰腺患者诊治分析

Diagnosis and treatment of 36 patients with ectopic esophageal cancer

目的探讨异位胰腺的好发部位、临床表现和诊治方式。方法回顾性选取2007年1月至2019年12月间中国医学科学院肿瘤医院收治的36例异位胰腺患者的临床病理资料,分析异位胰腺的好发部位、临床表现和诊治方式。结果患者男18例,女18例,年龄20~68岁,平均46.5岁;占位直径1.8~8cm,平均2.45cm。24例(66.7%)患者无临床症状,是因体检或其他疾病检查发现。占位部位:胃28例(77.8%)(包括胃窦14例、胃体10例、胃角2例和胃底2例),十二指肠5例(13.9%),空肠2例(5.6%),其他1例(2.8%)。超声内镜层次:黏膜层15例(41.7%),黏膜下层21例(58.3%),其中侵犯固有肌层16例(44.4%)。手术方式:内镜下肿物剥离术12例(33.3%),胃肠部分切除术16例(44.4%),远端胃大部切除术6例(16.7%),远端胃大部+D2根治术1例(2.8%),胰十二指肠切除术1例(2.8%)。结论异位胰腺好发于胃窦,多位于黏膜下层和固有肌层,易误诊为胃肠间质瘤,少数可误诊为恶性肿瘤,对出现临床症状者,首选内镜下治疗或手术切除。

Objective To investigate the location,clinical manifestation,diagnosis and treatment of ectopic esophageal cancer. Methods The clinicopathological data of 36 patients with ectopic pancreas admitted to Cancer Hospital,Chinese Academy of Medical Sciences were retrospectively analyzed from January 2007 to December 2019. the Location,clinical manifestation,diagnosis and treatment of ectopic pancreas were analyzed. Results Among the participants,18 were male and 18 were female. The average age was 46. 5( 20 to 68) years. The diameter of space-occupying lesions was 1. 8 to 8 cm( average 2. 45 cm).Twenty-four patients( 66. 7%) did not have clinical symptoms and the lesions were discovered by physical examination or detection for other diseases. Ectopic pancreas occurred in stomach in 28 patients( 77. 8%)including antrum( 14 patients),gastric body( 10 patients),gastric horn( 2 patients),gastric fundus( 2 patients),duodenum( 5 patients,13. 9%),jejunum( 2 patients,5. 6%),other( 1 patient,2. 8%).Pathology and endoscopic ultrasonography showed that the lesions originated from the mucosa( 15 patients,41. 7%),submucosa( 21 patients,58. 3%) and muscularis propria( 16 patients,44. 4%). Among them,12 patients( 33. 3%) underwent endoscopic tumor dissection,16 patients( 44. 4%) underwent partial gastrectomy or small bowel resection,6 patients( 16. 7%) underwent distal subtotal gastrectomy,1 patient( 2. 8%) underwent distal subtotal gastrectomy and D2 lymph node dissection,and 1 patient( 2. 8%)underwent pancreaticoduodenectomy above the duodenal papilla. Conclusion Ectopic pancreas often occurs in gastric antrum,mostly located in submucosa and muscularis propria. It is easy to be misdiagnosed as gastrointestinal stromal tumors. In rare cases,it can be misdiagnosed as malignant tumors. Endoscopic or surgical resection is the first choice of treatment for treating ectopic esophageal cancer with clinical symptoms.