CAJ | 학술논문

目的探讨内镜黏膜下剥离术(ESD)和内镜隧道技术(STER)在胃异位胰腺诊断及治疗中的临床价值.方法 2009年10月至2013年3月胃镜疑诊为胃异位胰腺并强烈要求内镜切除的患者40例住院接受ESD或STER,切除标本行病理学检查明确诊断,随访观察治疗效果和安全性.结果术后病理确诊胃异位胰腺25例,其中位于胃窦20例,胃底体交界3例,胃体2例；胰腺组织成团块状20例,散在分布状5例；25例中21例施行ESD术,4例行STER术,完整切除率88％ (22/25),余3例剥离后有少许组织残留.术后迟发性出血1例(4％),予多枚钛铗止血成功无需另加手术,无术中及术后穿孔.术后随访1 ～30个月未见复发.结论 ESD能完整大块的切除病变组织,不仅能提供标本获得准确的病理学诊断,同时起到微创治疗的作用,是胃异位胰腺有效且安全的诊治手段,内镜隧道剥离切除术可能为胃异位胰腺的诊治提供一种新的方法.
목적 탐토내경점막하박리술(ESD)화내경수도기술(STER)재위이위이선진단급치료중적림상개치.방법 2009년10월지2013년3월위경의진위위이위이선병강렬요구내경절제적환자40례주원접수ESD혹STER,절제표본행병이학검사명학진단,수방관찰치료효과화안전성.결과 술후병리학진위이위이선25례,기중위우위두20례,위저체교계3례,위체2례；이선조직성단괴상20례,산재분포상5례；25례중21례시행ESD술,4례행STER술,완정절제솔88％ (22/25),여3례박리후유소허조직잔류.술후지발성출혈1례(4％),여다매태협지혈성공무수령가수술,무술중급술후천공.술후수방1 ～30개월미견복발.결론 ESD능완정대괴적절제병변조직,불부능제공표본획득준학적병이학진단,동시기도미창치료적작용,시위이위이선유효차안전적진치수단,내경수도박리절제술가능위위이위이선적진치제공일충신적방법.
Objective To investigate endoscopic submucosal dissection (ESD) and submucosal tunneling endoscopic resection (STER) for the diagnosis and therapy of gastric ectopic pancreas.Methods The patients who diagnosed with gastric ectopic pancreas by gastroscope and demanded endoscopic resection received ESD or STER in hospital,the lesions were definitely diagnosed by pathology,and the therapeutic effect and safety were followed-up.Results A total of 40 patients received ESD or STER from October 2009 to March 2013,25 gastric ectopic pancreases were definitely diagnosed by pathology.Of the 25 patients,20 lesions were located at the antrum,3 fundus-body of stomach,2 body of stomach; 20 pancreatic tissue were crumby,5 were diffused distribution 5 cases.Of the 25 cases,21 patients received ESD,4 received STER,88％ (22/25) lesions were completely resected.Three lesions had a little tissue residual after resection,1 (4％) patient developed a massive delay-bleeding which was stopped with hemoclips.None perforation occurred during operation and postoperation.No recurrence was observed in patients followed up 1 to 30 months.Conclusion ESD could resect the whole lesion to offer an accurate pathology diagnose,meanwhile good for treatment,ESD is an effective and relatively safe method for gastric ectopic pancreas,STER may be a new approach for gastric ectopic pancreas.