内镜黏膜下剥离术在胃异位胰腺治疗中应用

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1、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

2、个。病变部位：胃窦24例、胃体5例。病灶直径9~17mm；剥离组织大小(26±12)mm×(21±9)mm。操作时间：30～95min,平均47min。一次性切除27例，二次切除2例。术中出血量均少于100ml；1例术后10h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��Theapplicationofendoscopicsubmucosaldissectionong

3、astricectopicpancreas11ZHOUBing�xi,LIXiao�fang,WANGXiu�qi,etal.DepartmentofGastroenterology,HenanProvincialPeople�sHospital,Zhengzhou450003,China�【Abstract】ObjectiveToevaluatethetherapeuticusefulnessandsafetyofendoscopicsubmucosaldissection(ESD)inpatientswithg

4、astricectopicpancreas.MethodsAllin�patientswereunderwentendoscopicultrasonographybeforeendoscopicresection.ESDwasperformedundergeneralanesthesia.First,themarginsofthelesionweremarkedbyHookknifeandsubmucosalglycerolandfructoseinjectionwithasmallamountofEpinephr

5、ineandMethyleneBluewasusedtoliftthelesion.Then,acircumferentialincisionintothesubmucosaaroundthelesionwasperformedwithFlexknifeandsubmucosaldissectionwasperformedwithHookknife.Afterremoval,thepathologicspecimenwasmountedandorientedtofacilitatehistologicexamina

6、tion.ResultsAtotalof30lesionsin29patientswithgastricectopic11pancreasweretreatedbyESDfromMarch2009toApril2011,whichincluded13menand16womenandrangedinagefrom9to61years(mean,46.4years).Twenty�fourlesionswerelocatedattheantrumandfivelesionswerelocatedatthebodyofs

7、tomach.Thelesionsizerangedfrom9mmto17mmandthestrippingtissuesizewas(26±12)mm×(21±9)mm.Theprocedurewassuccessfullyperformedwithin30~95min(mean47min)and27lesionswereremovedbyoneprocedureand2lesionswereremovedbyquadricresection.Mildbleedingoccurredinonepatientatt

8、enhoursafterESD,whichwasmanagedbyprotonpumpinhibitors.Noperforationorseverehemorrhageoccurred.Thepatientswerefollowedupfor1to25months,andnotumorresidueorrecurrencewasobserved.Concl