异位胰腺临床特征及其超声内镜检查诊断价值分析

发布时间：2018-01-08 23:23

本文关键词：异位胰腺临床特征及其超声内镜检查诊断价值分析　出处：《浙江大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的：探讨异位胰腺临床特征、超声内镜表现及其与病理特征联系,旨在提高对异位胰腺的认识。方法：回顾性分析2000.12.01至2014.11.30在浙江大学医学院附属第二医院获得病理确诊的异位胰腺99例,分析病人年龄、性别、临床表现、病灶位置、发现方式等特征。其中25例行超声内镜检查,内镜观察病灶部位、外形、表面粘膜、顶端凹陷、中央腺管开口及周边黏膜桥；超声观察病灶大小、起源层、累及层、边界、内部回声特点、无回声管状结构；并分析异位胰腺声像图表现与病理特征的关系。结果： 1、男性68例,女性31例；年龄分布在11-81岁,平均年龄52.5岁。异位胰腺可位于多种组织器官,75.8%异位胰腺位于胃、十二指肠,位于消化道管壁内达86.9%。7%异位胰腺直接引起如出血、梗阻等症状,与病灶部位、病理改变有明显相关性,其中1例发生癌变(1.0%)。 2、异位胰腺超声内镜均表现为小于3cm的广基底粘膜下肿块,好发于胃窦部(60.0%),表面黏膜光整(84.0%)；超声图像可见边界清楚(72.0%)、不均匀(68.0%)、低回声(80.0%)病灶,可位于第2层(8.0%)、3层(32.0%)、4层(20.0%)或同时累及多层(40.0%),多数位于粘膜下层；部分可见病灶后方固有肌层增厚(16.0%)。典型病灶可见顶端凹陷伴有腺管开口(8.0%)或病灶内部见小而规则无回声管状或囊状结构(12.0%),为异位胰腺特征性表现。异位胰腺超声表现与病理组成具有密切联系。异位胰腺组织边界不规则、胰腺小叶结节样结构明显,则超声内镜见病灶边界不清。异位胰腺以腺泡细胞为主超声内镜表现为低回声病灶,而以导管组织或脂肪细胞为主则表现为高回声病灶。病灶内部无回声管状或囊状结构为扩张导管。结论：异位胰腺好发于胃及十二指肠,胃部异位胰腺多见于胃窦尤其大弯侧。多数异位胰腺无特异临床表现,7%可出现相关性症状如消化道出血、梗阻等。1%异位胰腺发生癌变,提示临床对诊断异位胰腺仍需要随访观察。超声内镜对异位胰腺具有较大诊断价值,超声内镜检查发现病灶顶端凹陷伴腺管开口或病灶内部见小而规则的管状或囊状无回声区易诊断异位胰腺。异位胰腺的超声表现与病理特征间具有密切的联系。异位胰腺易与间质瘤混淆,鉴别诊断为临床难点。
[Abstract]:Objective: To explore the clinical features, endoscopic features and pathological features of ectopic pancreas in order to improve the understanding of ectopic pancreas. Methods: The age and sex of 99 patients with ectopic pancreas confirmed pathologically in the second affiliated Hospital of Zhejiang University Medical College from January 1 to November 30, 2010 were analyzed retrospectively. Among them 25 cases were examined by endoscopy the location of lesion appearance surface mucous membrane apical depression central glandular duct orifice and surrounding mucosal bridge were observed. The size of the lesion, the origin layer, the involved layer, the boundary, the characteristics of the internal echo, and the non-echoic tubular structure were observed by ultrasound. The relationship between the ultrasonographic features of ectopic pancreas and pathological features was analyzed. Results: (1) 68 males and 31 females; The age distribution ranged from 11 to 81 years with an average age of 52.5 years. Ectopic pancreas could be located in various tissues and organs 75.8% of which were located in stomach and duodenum. The ectopic pancreas was directly caused by hemorrhage and obstruction in 86.9% of the alimentary canal wall, which was significantly correlated with the location and pathological changes of the lesion, in which 1 case had carcinogenesis 1.0%. 2Endoscopic findings of ectopic pancreas were less than 3 cm wide basal submucous mass, which occurred in the antrum of the stomach, and 84.0% of the surface mucous membrane. Ultrasound images showed a clear boundary of 72.0%, uneven 68.0%, hypoechoic (80.0%) lesions, which could be located on the second layer (8.0 / 3) and at 32.0 / 3). The fourth layer (20. 0) or multiple layers (40. 0%), most of them were located in the submucous layer. Partial thickening of the posterior lamina propria muscularis was seen in some lesions. Typical lesions could be seen with an apical concave accompanied by an opening of the glandular duct (8.0) or with a small, irregular echoic tubular or cystic structure within the lesion (. 12.0). The ultrasound findings of ectopic pancreas were closely related to the pathological composition. The boundary of ectopic pancreas tissue was irregular and the nodular structure of pancreatic lobule was obvious. Ectopic pancreas was characterized by acinar cells as hypoechoic lesions. The hyperechoic lesions were mainly found in ductal tissues or adipocytes, and there were no echoic tubular or cystic structures in the lesions. Conclusion: Ectopic pancreas occurred in the stomach and duodenum, and the ectopic pancreas in the gastric antrum, especially in the great curved side. Most of the ectopic pancreas had no specific clinical manifestation. 7% of the ectopic pancreas had associated symptoms such as gastrointestinal hemorrhage. Obstruction. 1% of ectopic pancreas carcinogenesis, suggesting that clinical diagnosis of ectopic pancreas still need to follow up observation. Endoscopic ultrasonography has great diagnostic value in ectopic pancreas. Endoscopic examination revealed that the small and regular tubular or cystic anechoic region was easy to diagnose the ectopic pancreas. The ultrasonographic features of the ectopic pancreas were closely related to the pathological features. Ectopic pancreas is easily confused with stromal tumors. Differential diagnosis is difficult in clinic.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R576

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