内镜黏膜下剥离术在胃异位胰腺治疗中应用.docVIP

内镜黏膜下剥离术在胃异位胰腺治疗中应用【摘要】 目的 探讨内镜黏膜下剥离术(ESD)对于胃异位胰腺的疗效与安全性。方法 经超声内镜检查诊断为胃异位胰腺并要求切除的住院患者，施行全身麻醉状态下ESD操作。Hook刀标记病变范围后，黏膜下注射含肾上腺素、亚甲蓝的甘油果糖注射液，沿标记外侧Flex刀环周切开至黏膜下层，继Hook刀沿黏膜下层剥离直至病变完全切除；切除标本甲醛固定后病理检查。结果 2009年3月至2011年4月，共完成29例胃异位胰腺ESD治疗，其中男13例、女16例，年龄9～61岁，平均46.4岁；共切除病变30个。病变部位：胃窦24例、胃体5例。病灶直径9~17 mm；剥离组织大小(26±12)mm×(21±9)mm。操作时间：30～95 min,平均47 min。一次性切除27例，二次切除2例。术中出血量均少于100 ml；1例术后10 h呕血，经药物治疗痊愈。无术中及术后穿孔。术后随访1~25个月均无瘤体残留与复发。结论 ESD可安全、有效的应用于胃异位胰腺的治疗，并发症发生率低。? 【关键词】 异位胰腺；内镜黏膜下剥离术；临床应用 ?? The application of endoscopic submucosal dissection on gastric ectopic pancreas ZHOU Bing?xi, LI Xiao?fang, WANG Xiu?qi, et al. Department of Gastroenterology, Henan Provincial People?s Hospital, Zhengzhou 450003,China ? 【Abstract】 Objective To evaluate the therapeutic usefulness and safety of endoscopic submucosal dissection (ESD)in patients with gastric ectopic pancreas. Methods All in?patients were underwent endoscopic ultrasonography before endoscopic resection. ESD was performed under general anesthesia. First, the margins of the lesion were marked by Hook knife and submucosal glycerol and fructose injection with a small amount of Epinephrine and Methylene Blue was used to lift the lesion. Then, a circumferential incision into the submucosa around the lesion was performed with Flex knife and submucosal dissection was performed with Hook knife. After removal, the pathologic specimen was mounted and oriented to facilitate histologic examination. Results A total of 30 lesions in 29 patients with gastric ectopic pancreas were treated by ESD from March 2009 to April 2011, which included 13 men and 16 women and ranged in age from 9 to 61 years (mean, 46.4 years). Twenty?four lesions were located at the antrum and five lesions were located at the body of stomach. The lesion size ranged from 9 mm to 17 mm and the stripping tissue size was (26±12)mm× (21±9)mm. The procedure was successfully performed within 30~95 min (mean 47 min)and 27 lesions were removed by one proced