本文關鍵詞：異位胰腺臨床特征及其超聲內鏡檢查診斷價值分析　出處：《浙江大學》2015年碩士論文　論文類型：學位論文

  更多相關文章： 異位胰腺 臨床表現(xiàn) 超聲內鏡 病理 診斷

【摘要】：目的： 探討異位胰腺臨床特征、超聲內鏡表現(xiàn)及其與病理特征聯(lián)系,旨在提高對異位胰腺的認識。 方法： 回顧性分析2000.12.01至2014.11.30在浙江大學醫(yī)學院附屬第二醫(yī)院獲得病理確診的異位胰腺99例,分析病人年齡、性別、臨床表現(xiàn)、病灶位置、發(fā)現(xiàn)方式等特征。其中25例行超聲內鏡檢查,內鏡觀察病灶部位、外形、表面粘膜、頂端凹陷、中央腺管開口及周邊黏膜橋；超聲觀察病灶大小、起源層、累及層、邊界、內部回聲特點、無回聲管狀結構；并分析異位胰腺聲像圖表現(xiàn)與病理特征的關系。 結果： 1、男性68例,女性31例；年齡分布在11-81歲,平均年齡52.5歲。異位胰腺可位于多種組織器官,75.8%異位胰腺位于胃、十二指腸,位于消化道管壁內達86.9%。7%異位胰腺直接引起如出血、梗阻等癥狀,與病灶部位、病理改變有明顯相關性,其中1例發(fā)生癌變(1.0%)。 2、異位胰腺超聲內鏡均表現(xiàn)為小于3cm的廣基底粘膜下腫塊,好發(fā)于胃竇部(60.0%),表面黏膜光整(84.0%)；超聲圖像可見邊界清楚(72.0%)、不均勻(68.0%)、低回聲(80.0%)病灶,可位于第2層(8.0%)、3層(32.0%)、4層(20.0%)或同時累及多層(40.0%),多數(shù)位于粘膜下層；部分可見病灶后方固有肌層增厚(16.0%)。典型病灶可見頂端凹陷伴有腺管開口(8.0%)或病灶內部見小而規(guī)則無回聲管狀或囊狀結構(12.0%),為異位胰腺特征性表現(xiàn)。異位胰腺超聲表現(xiàn)與病理組成具有密切聯(lián)系。異位胰腺組織邊界不規(guī)則、胰腺小葉結節(jié)樣結構明顯,則超聲內鏡見病灶邊界不清。異位胰腺以腺泡細胞為主超聲內鏡表現(xiàn)為低回聲病灶,而以導管組織或脂肪細胞為主則表現(xiàn)為高回聲病灶。病灶內部無回聲管狀或囊狀結構為擴張導管。 結論： 異位胰腺好發(fā)于胃及十二指腸,胃部異位胰腺多見于胃竇尤其大彎側。多數(shù)異位胰腺無特異臨床表現(xiàn),7%可出現(xiàn)相關性癥狀如消化道出血、梗阻等。1%異位胰腺發(fā)生癌變,提示臨床對診斷異位胰腺仍需要隨訪觀察。 超聲內鏡對異位胰腺具有較大診斷價值,超聲內鏡檢查發(fā)現(xiàn)病灶頂端凹陷伴腺管開口或病灶內部見小而規(guī)則的管狀或囊狀無回聲區(qū)易診斷異位胰腺。異位胰腺的超聲表現(xiàn)與病理特征間具有密切的聯(lián)系。異位胰腺易與間質瘤混淆,鑒別診斷為臨床難點。
[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.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R576

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本文編號：1399106