胃肠道异位胰腺的诊断与治疗

目的 探讨胃肠道异位胰腺的临床特点、诊断及外科处理原则。方法 对我院近20年收治的经术后病理确诊的18例胃肠道异位胰腺患者进行了外科治疗，并对其临床症状、诊断方法、病变部位分布及治疗措施进行了回顾性分析。结果 本组18例患者表现为反复上腹部疼痛不适9例，消化道出血7例，腹部包块1例，无明显症状1例。异位胰腺分布部位：胃7例，十二指肠5例，空肠3例，回肠3例，其中美克尔憩室内2例。术前误诊11例，漏诊6例，仅1例确诊。全部患者均行手术治疗，无1例出现术后井发症，随访1～10年异位胰腺无复发，临床疗效满意。结论胃肠道异位胰腺缺乏特征性的临床表现和有效的检查手段，易漏诊和误诊；一旦发现，均应早期手术治疗，以明确诊断及避免出现严重的并发症。

Diagnosis and Treatment of Heterotopic Pancreas in Gastroenterology Tract: a Report of 18 Cases

Objective To explore the clinical features, misdiagnosis reason and treatment ruler of heterotopic pancreas in gastroenterological tract. Methods A total of 18 postoperative histologically confirmed cases of heterotopic pancreas in gastroenterological tract were treated in our department from Aug. 1984 to Aug. 2004. We retrospectively analyzed their major clinical symptoms, diagnostic procedure, type of operation and pathological change bites. Results Among all the patients, 9 patients had epigastric pain, 7 massive digestive hemorrhage, 1 stomach mass, another 1 no definite symptom. Pathological change bites located in stomach in 7 cases, in duodenum in 5 cases, in jejunum in 3 cases, in ileum in 3 cases which include 2 cases locating in Meckel diverticulum. Eleven patients were misdiagnosed to other disease, 6 had not been diagnosed,and only one case was definite diagnosed before operation. All patients were treated by surgical operation. Follow up from 1 year to 10 years, clinical symptom had not episode, no operative complication had been found, and satisfactory clinical effect had been gained in these patients of this group. Conclusions Heterotopic pancreas in gastroenterological tract was difficult to diagnose for dificiency special clinical symptom and effective examination methods. Cases of heterotopic pancreas in gastroenterological tract with symptoms should be surgically managed as soon as possible so as to get difinite diagnosis and avoid severious complication.