胃肠道异位胰腺的诊断与治疗(附18例报告)

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例胃肠道异位胰腺病人进行了外科治疗，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分析。结果本组18例病人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。全部病人均行手术治疗，无一例出现术后并发症，随访1～10年无复发，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 gastrointestinal tract: a report of 18 cases

Objective To investigate the clinical features, misdiagnosis reasons and management principles of heterotopic pancreas in gastrointestinal tract. Methods The clinical data of 18 cases of histologically confirmed heterotopic pancreas in gastrointestinal tract after operation treated in our hospital from August 1984 to August 2004 were retrospectively analyzed. Results Of the 18 patients, 9 had epigastric pain, 7 massive digestive hemorrhage, 1 stomach mass and 1 no definite symptoms. The heterotopic pancreas was located in the stomach in 7 patients, in the duodenum in 5, in the jejunum in 3 and in ileum in 3. For the 3 patients with the heterotopic pancreas in the ileum, 2 had it in the Meckel diverticulum. Before operation, 11 patients were misdiagnosed, 6 were not diagnosed and only 1 was definitely diagnosed. All the 18 patients were surgically treated. The follow-up for 1-10 years showed that there was no recurrence and clinical outcome was good. Conclusions Heterotopic pancreas in the gastrointestinal tract is difficult to diagnosis due to lack of special symptoms and effective examining methods. The patients with the heterotopic pancreas in the gastrointestinal tract should be surgically managed as soon as possible to get definite diagnosis and avoid serious complications.