异位胰腺的诊断与治疗:附35例病例报告

目的探讨异位胰腺的临床特点、诊断方法及外科处理原则。方法对我院自1996年7月至2006年8月经病理确诊的35例异位胰腺病人的临床特点、影像资料及治疗方法进行回顾性分析。结果本组35例病人中男16例，女19例，年龄18个月至74岁，平均43.5岁。单发33例，多发2例。异位胰腺分布部位：胃13例，十二指肠5例，空肠6例，结肠6例，胆囊、胆总管、后腹膜各1例，回、升结肠并发2例。术前仅6例确诊，8例误诊，21例漏诊。全组均经病理证实，4例内镜下高频电灼或电凝切除，31例手术治疗。随访2.4～8年，无一例出现术后并发症。结论异位胰腺的临床表现无特异性，易漏诊和误诊，内镜超声的临床应用能显著地提高诊断率。异位胰腺一旦出现症状，需早期内镜电凝或电切和手术治疗，以明确诊断及避免出现严重的并发症。无症状者无需治疗但应加强随访。     

异位胰腺的诊断和治疗

目的：探讨异位胰腺的临床特点、诊断及外科处理原则。方法对我院近8年病理确诊的16例异位胰腺患者的资料进行回顾性分析。结果16例中男8例，女8例，年龄1～74岁，平均37．5岁。异位胰腺分布部位：空肠5例，十二指肠4例，胃2例。胆总管2例。胆囊、纵膈和后腹膜各1例。术前仅1例确诊，5例误诊，10例漏诊。均行手术治疗，无一例出现术后并发症。结论异位胰腺的临床表现和检查手段无特异性。易漏诊和误诊；一旦发现，无论有无症状，均以早期手术治疗为宜，以明确诊断及避免出现严重的并发症。     

异位胰腺七例报告

目的: 探讨异位胰腺的临床特点、诊断及外科处理原则。临床资料: 7例异位胰腺患者,其中异位胰腺分布于十二指肠4例、空肠2 例、胃1例。临床表现为腹痛4例、黄疸3例、十二指肠梗阻1例、消化道出血1例;合并胆石 病3例、空肠憩室1例。7例术前均被漏、误诊,均行手术治疗并经病理确诊。结论: 异位胰腺临床表现无特异性,术前诊断困难,易被漏、误诊,一经诊 断,不论有无症状,均以手术治疗为宜,以便明确诊断和防止发生并发症。     

异位胰腺的诊断和治疗（附27例报告）

目的 探讨异位胰腺的临床特点、诊断及治疗方法。方法 回顾性分析我院1975～2003年收治的异位胰腺27例临床资料。结果 年龄在13～67岁之间，平均年龄37.4岁。有临床症状者18例。4例行胃镜下电凝切除；23例剖腹手术切除，其中3例术前确诊。异位胰腺分布部位：胃9例，十二指肠3例，空回肠14例，胆囊1例。结论 异位胰腺无特异临床症状，术前确诊困难。对出现临床症状者，手术切除是首选治疗方法。     

异位胰腺的诊断和治疗(附27例报告)

目的　探讨异位胰腺的临床特点、诊断及治疗方法。方法　回顾性分析我院 1975～2 0 0 3年收治的异位胰腺 2 7例临床资料。结果　年龄在 13～ 6 7岁之间 ,平均年龄 37.4岁。有临床症状者 18例。 4例行胃镜下电凝切除 ;2 3例剖腹手术切除 ,其中 3例术前确诊。异位胰腺分布部位 :胃9例 ,十二指肠 3例 ,空回肠 14例 ,胆囊 1例。结论　异位胰腺无特异临床症状 ,术前确诊困难。对出现临床症状者 ,手术切除是首选治疗方法。     

异位胰腺的外科诊治(附21例报告)

目的探讨异位胰腺的临床诊断与外科处理要点,提高异位胰腺的外科诊治水平。方法回顾性分析1996年1月至2006年2月间我院收治的21例经病理证实的异位胰腺病例资料,对其临床诊断及外科处理进行临床分析,并结合文献讨论。结果21例异位胰腺异位于十二指肠的9例,胃7例,空肠3例,肠系膜2例,均为单发。根据临床表现分型,梗阻型4例,出血型1例,溃疡型1例,肿瘤型3例,憩室型1例,隐匿型11例。分别行胃部分切除术、肠切除术、胰十二指肠切除术、肿块切除。手术后,由异位胰腺引起的临床症状均缓解。结论异位胰腺临床表现复杂多样,并发症多,常易被误诊和漏诊,当症状明显时,应积极手术治疗。     

异位胰腺15例诊治分析

目的 探讨异位胰腺的临床特点、诊断和外科处理。方法 对1990～2001年收治的15例异位胰腺病人的临床表现、诊疗方法进行回顾性总结分析。结果 术前超声内镜定性诊断2例(13％),其余13例术前均被漏诊或误诊。本组15例异位胰腺均行手术切除并经病理诊断确诊。结论 异位胰腺缺乏特异性临床表现,诊断困难。术前超声内镜及组织活检可明确诊断。一经诊断,不论有无症状,均以手术治疗为宜。术前诊断是否明确是手术方式选择的主要依据。手术切除疗效满意。     

胃肠道异位胰腺的诊断和治疗（附13例报告）

目的 探讨异位胰腺的发病概况、临床特点、诊断和治疗方法。方法 回顾分析了我们1985～2002年收治的13例异位胰腺病人的临床资料。结果 本组术前只有2例确诊，其余均误诊；并均手术治疗，术后未发生并发症，无复发。结论 本病因位置多变，临床表现复杂多样，物理检查阳性率低，所以术前诊断困难。本病应手术治疗。     

异位胰腺的诊断与治疗(附21例报告)

目的　探讨异位胰腺的临床诊断与治疗。方法　对 1986～ 1998年收治 2 1例异位胰腺病人的临床表现、影像学检查及手术治疗和病理结果进行回顾性总结分析。结果　本组病例经手术治疗后症状无复发。临床表现和影像学检查对此症定性诊断困难 ,确诊需病理学检查。结论　对于有症状的异位胰腺手术切除疗效满意。而无特殊症状病例需长期随访     

异位胰腺四临床分析

探讨异位胰腺的发病机理、诊断与治疗。结合文献对本院收治的4例异位胰腺进行分析。其中2例在其他腹部手术中发现、1例术前误诊为胆囊腺肌症，1例通过胃镜活检确诊。3例行局部切除，1例行胆囊切除术。认为：异位胰腺的形成原因目前倾向Armstrong学说；术前诊断有一定困难；一旦确诊或在其他腹部手术中发现应手术切除。     

异位胰腺误诊为胃肠间质瘤的临床分析

目的提高对异位胰腺与胃肠问质瘤的鉴别诊断水平。方法回顾性分析2007年1月至2013年6月于上海交通大学医学院附属仁济医院收治的14例术前诊断为胃肠间质瘤而术后病理证实为异位胰腺组织患者的临床资料及随访资料。结果本组病例男9例,女5例,年龄26,69岁。其中8例有上腹隐痛不适症状,2例为肠梗阻表现,4例为体检偶然发现。12例术前影像学检查及内镜检查均提示胃肠间质瘤。所有患者均行手术治疗,其中11例病变发生于胃,l例发生于十二指肠,2例发生于空肠;术后病理证实均为异位胰腺,其中10例以胰腺腺泡和胰腺导管混合存在为主要成分,同时含有平滑肌组织以及少量胃黏膜组织;3例以胰腺腺泡为主;1例以胰腺导管及平滑肌为主。随访时间为（26．5±5．1）月,均无复发和死亡者。结论异位胰腺缺乏特征性的临床表现和有效的术前辅助检查手段,易与胃肠间质瘤混淆。手术切除是治愈异位胰腺的唯一有效手段,而术后病理是鉴别两种疾病最可靠的诊断方法。     

Laparoscopic resection for gastrointestinal stromal tumors in the stomach

Purpose

Gastrointestinal stromal tumors (GISTs) should be surgically resected, even those smaller than 5?cm in size, which is the threshold of clinical malignancy for submucosal tumors (SMTs) in the gastrointestinal tract. This study reviewed the use of laparoscopic surgery for gastric partial resection of GISTs or SMTs that were suspected to be GISTs.

Methods

Eighteen patients underwent laparoscopic partial resection of the stomach for GISTs or SMTs. The tumor location was confirmed by intraluminal endoscopy. One-half of the circumference around the tumor was dissected, and the tumor was turned toward the abdominal cavity. The nonresected part of the tumor and the edge of the incision line was lifted up using forceps, and the incision line was closed using laparoscopic stapling devices.

Results

Two cases were diagnosed as GIST by endoscopic biopsy. Six patients underwent endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNAB) examinations, which diagnosed five GISTs. There were 18 tumors smaller than 5?cm, including 10 GISTs, 4 leiomyomas, 3 schwannomas, and one heterotopic pancreas.

Conclusions

Endoscopic ultrasound-guided FNAB is recommended for definite preoperative diagnosis of histopathologically unknown SMTs to determine the indications for surgery. The laparoscopic approach with the assistance of endoscopy is useful for improving the curability, with minimal invasiveness for the partial resection of GISTs.     

Gastric Obstruction Due to Intramural Pseudocyst Associated with Heterotopic Pancreas

An unusual case of gastric outlet obstruction caused by a gastric intramural pseudocyst associated with heterotopic pancreas is illustrated. Heterotopic pancreas is defined as the presence of aberrant pancreatic tissue that is anatomically and vascularly distinct from the pancreas itself (Liu et al. Am Surg. 78:E141–3, 2012). Heterotopic pancreatic tissue has been reported in many locations along the gastrointestinal tract, identified most commonly in the stomach where it is usually an asymptomatic anatomic curiosity than a source of clinical concern. We encountered an unusual instance in which heterotopic pancreas in the distal stomach was associated with heterotopic pancreatitis and intramural pseudocyst formation that led to gastric obstruction.     

异位胰腺的临床特点及病理特征：附36 例报告

目的：探讨异位胰腺的临床特点、病理特征以及诊断方法。 方法：回顾近2年来收治的36例异位胰腺患者临床资料,分析其临床、病理特点及诊断方法。 结果：全组男19例,女17例,发病以30~49岁发病为多,以胃窦部为高发;36例均表现为反复上腹部不适,其中胃肠镜下诊断为异位胰腺7例,与病理诊断与的吻合率为19.4%。 结论：异位胰腺的发病原因与性别无明显关系,与年龄、浅表性胃炎及糜烂等炎性疾病有关,异位胰腺的确诊需要将临床特点与病理特点相结合。     

内镜黏膜下挖除术治疗胃异位胰腺临床价值研究

目的 探讨内镜黏膜下挖除术（ESE）治疗胃异位胰腺的应用价值。方法 回顾性分析2007年8月至2010年12月复旦大学附属中山医院内镜中心行ESE治疗且经病理证实为胃异位胰腺的60例病人资料,评价ESE治疗的可行性、安全性和必要性。结果 肿瘤位于胃窦部51例（85.0%）,大弯侧34例（56.7%）,23例（38.3%）伴明显脐凹。超声内镜检查 2例（3.3%）位于黏膜肌层,42例（70.0%）位于黏膜下层（有3例与固有肌层关系密切）,16例（26.7%）位于固有肌层。病灶整块挖除率98.3%（59/60）,9例（15%）术中出现动脉性出血,需热活检钳辅助止血或金属夹夹闭止血,术中发生气腹12例（20.0%）,无术中或术后穿孔和不可控性出血而转外科手术病例。中位随访时间17（4～44）个月,未见复发病例。结论 以ESE为基础的内镜外科治疗,不仅满足了胃异位胰腺局部切除的治疗原则,而且还可获得完整病理结果,避免误诊。是一种安全、有效、值得推广的方法。     

Heterotopic pancreas in the stomach (type II according to Heinrich) - literature review and case report

Heterotopic pancreas is a rare congenital disorder characterized by the presence of normal pancreatic tissue located outside the pancreas. The most common locations include the duodenum, stomach, and jejunum. Most cases of heterotopic pancreas are asymptomatic. However, the development of clinical symptoms depends on the size, location and pathological changes similar to those observed in case of the normal pancreas. The Authors presented a case of multiple stomach heterotopic pancreatic lesions in an adult male patient. The atypical clinical presentation including non-specific endoscopic and CT images were responsible for the misdiagnosis before surgery. The patient underwent surgery. The tumor located in the posterior wall of the body of the stomach was excised by wedge resection. The postoperative course proved uneventful. Proper diagnosis was established on the basis of the histopathological examination of the resected tumor: heterotopic pancreas-multiple lesions, type II, according to Heinrich. The presented case report demonstrated that heterotopic pancreas should always be considered in the differential diagnosis of gastric tumors.     

Perforation of the Gastrointestinal Tract Secondary to Ingestion of Foreign Bodies

Introduction Ingesting a foreign body (FB) is not an uncommon occurrence. Most pass through the gastrointestinal (GI) tract uneventfully, and perforation is rare. The aim of this study was to report our experience with ingested FB perforations of the GI tract treated surgically at our institution. Methods A total of 62 consecutive patients who underwent surgery for an ingested FB perforation of the GI tract between 1990 and 2005 were retrospectively reviewed. Three patients with no definite FB demonstrated intraoperatively were included. Results The patients had a median age of 58 years, and 37 (60%) were male. Of the 59 FBs recovered, 55 (93%) were toothpicks and dietary FBs such as fish bones or bone fragments. A definitive preoperative history of FB ingestion was obtained for only two patients, and 36 of 52 patients (69%) wore dentures. Altogether, 18 (29%) perforations occurred in the anus or distal rectum, and 44 perforations were intraabdominal, with the most common abdominal site being the distal ileum (39%). Patients with FB perforations in the stomach, duodenum, and large intestine were significantly more likely to be afebrile (P = 0.043), to have chronic symptoms (> 3 days) (P < 0.001), to have a normal total white blood cell count (P < 0.001), and to be asymptomatic or present with an abdominal mass or abscess (P < 0.001) compared to those with FB perforations in the jejunum and ileum. Conclusions Ingested FB perforation in the adult population is most commonly secondary to unconscious accidental ingestion and is frequently caused by dietary FBs especially fish bones. A preoperative history of FB ingestion is thus rarely obtained, although wearing dentures is a common risk factor. FB perforations of the stomach, duodenum, and large intestine tend to present with a longer, more innocuous clinical picture than perforations in the jejunum or ileum.