CAJ | 학술논문

目的探讨上消化道异位胰腺的临床、胃镜、内镜超声（EUS）表现及治疗价值。方法分析该院经病理证实的35例上消化道异位胰腺患者的临床资料，总结其临床症状，胃镜、内镜超声表现及内镜下治疗效果。结果35例患者中临床上有症状者30例，上腹痛18例，腹胀5例，嗳气4例，黑便3例；病灶位于胃窦23例，胃体3例，胃底3例，胃角2例，胃窦体交界2例，十二指肠球部2例。内镜下表现为隆起性病变，直径0．5～2．0cm，20例中央有脐样凹陷，项端可见导管开口，内镜超声下，病变位于黏膜下层28例，累及黏膜层2例，黏膜肌层4例，固有肌层1例，表现为中等回声4例，低回声24例，混合回声7例，其中10例可见管状结构样回声。20例行内镜下黏膜切除术（EM R），15例行内镜下套扎联合高频电切除术，术中出血3例，未见穿孔等其他并发症。结论上消化道异位胰腺临床表现无特异性，胃镜联合内镜超声对其诊断，并指导内镜下治疗有重要价值。内镜下EM R术及套扎联合高频电切除术是治疗上消化道异位胰腺的一种安全、有效的治疗手段。
목적탐토상소화도이위이선적림상、위경、내경초성（EUS）표현급치료개치。방법분석해원경병리증실적35례상소화도이위이선환자적림상자료，총결기림상증상，위경、내경초성표현급내경하치료효과。결과35례환자중림상상유증상자30례，상복통18례，복창5례，애기4례，흑편3례；병조위우위두23례，위체3례，위저3례，위각2례，위두체교계2례，십이지장구부2례。내경하표현위륭기성병변，직경0．5～2．0cm，20례중앙유제양요함，항단가견도관개구，내경초성하，병변위우점막하층28례，루급점막층2례，점막기층4례，고유기층1례，표현위중등회성4례，저회성24례，혼합회성7례，기중10례가견관상결구양회성。20례행내경하점막절제술（EM R），15례행내경하투찰연합고빈전절제술，술중출혈3례，미견천공등기타병발증。결론상소화도이위이선림상표현무특이성，위경연합내경초성대기진단，병지도내경하치료유중요개치。내경하EM R술급투찰연합고빈전절제술시치료상소화도이위이선적일충안전、유효적치료수단。
Objective To explore the cinical ,endoscopic and endoscopic ultrasonography (EUS) manifestations of upper gastro-intestinal heterotopic pancreas(HP) and the treatment value .Methods The clinical data in 35 cases of upper gastrointestinal HP confirmed by pathology in our hospital were retrospectively analyzed for summarizing its clinical symptoms ,endoscopic and EUS manifestations and the treatment effect under endoscopy .Results Among all the 35 cases ,the cinlincal symptoms were in 30 cases , upper abdominal pain in 18 cases ,abdominal distension in 5 cases ,belching in 4 cases ,melena in 3 cases ,the lesion was located in gastric antrum in 23 cases ,in gastric body in 3 cases ,in gastric fundus in 3 cases ,in gastric angle in 2 cases ,in the junction of gastric antrum and corpus ventriculi in 2 cases ,in durodenal bulb in 2 cases ,most HP were represented by protuberant lesions under endos-copy ,the diameter of the lesions ranged 0 .5-2 .0 cm .20 cases were centrally umbilicated hollow with ducts opening on the top of the protuberant lesion .Under EUS ,the lesions involved submucosa in 28 cases ,mucosa in 2 cases ,muscularis mucosae in 4 cases , and muscularis propria in 1 case .4 cases appeared as the midium echo ,24 cases as hypoecho and 7 cases as mixed echo ,among them ,the tubular structure echo within the lesions were found in 10 cases .20 cases were treated by endoscopic mucosal resection (EMR) ,15 cases were performed the ligation combined with the high frequency electroresection .Intraoperative bleeding occurred in 3 cases and no other complicntions such as perforation occurred .Conclusion The clinical manifestations of upper gastrointestinal HP have no specificity .Gastroendoscopy combimed with EUS has the important value in the diagnosis and endoscopis therapy .En-doscopic EMR and ligation combined with the high frequency electroresection are the safe and effective means for treating upper gastrointestinal HP .