[精品][经典]内镜黏膜下剥离术在胃异位胰腺治疗中的应用.doc

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1、［经典］内镜黏膜下剥离术在胃异位胰腺治疗中的应用内镜黏膜下剥离术在胃异位胰腺治疗中的应用【摘耍】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

2、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9〜17mm；剥离组织大小(26+12)mmX(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。术后随访广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。❷【关键词】异位胰腺；内镜黏膜下剥离术；临床应用Theapplicationofendoscopicsubmucosaldissectionongas

3、tricectopicpancreasZHOUBing❷xi,LTXiao^fang,WANGXiu❷qi,etal.DepartmentofGastroenterology,HenanProvincialPeople❷sHospitai,Zhengzhou450003,China【Abstract】ObjectiveToevaluatethetherapeuticusefulnessandsafetyofendoscopicsubmucosaldissection(ESD)inpatientswithgastricectopicpanc

4、reas・MethodsAllin-patientswereunderwentendoscopicultrasonographybeforeendoscopicresection.ESDwasperformedundergeneralanesthesia・First,themarginsofthelesionweremarkedbyHookknifeandsubmucosalglycerolandfructoseinjectionwithasmallamountofEpinephrineandMethyleneBluewasusedtol

5、iftthelesion.Then,acircumferentialincisionintothesubmucosaaroundthelesionwasperformedwithFlexknifeandsubmucosaldissectionwasperformedwithHookknife・Afterremoval,thepathologicspecimenwasmountedandorientedtofacilitatehistologicexamination.ResultsAtotalof30lesionsin29patients

6、withgastricectopicpancreasweretreatedbyESDfromMarch2009toApril2011,whichineluded13menand16womenandrangedinagefrom9to61years(mean,46.4years).Twenty❷fourlesionswerelocatedattheantrumandfivelesionswerelocatedatthebodyofstomach.Thelesionsizerangedfrom9mmto17mmandthestrippingt

7、issuesizewas(26±12)minX(21±9)mm.Theprocedurewassuccessfullyperformedwithin30、95min(mean47min)and27lesionswereremovedbyoneprocedureand2lesionswereremovedbyquadricresection.M订dbleedingoccurredinonepatientattenhoursafterESD,whichwasmanagedbyprotonpumpinhibitors・Noperforation

8、orseverehemorrhageoccurred・Thepatientswerefollowedupfor1to25months,andnotumorresidueorrecurrence