儿童腹部手术中发现异位胰腺的外科处理  

Snrgical trealment of pediatric heterotopic pancreas detected accidentally during laparotomy

作　　者：吴华哲[1] 吴晓娟[2] 冯杰雄[2] 易斌[2] 张光磊[1] 

机构地区：[1]福建医科大学教学医院泉州市儿童医院小儿外科,泉州362000 [2]华中科技大学同济医学院附属同济医院小儿外科,武汉

出　　处：《中华小儿外科杂志》2017年第3期207-210,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨术中偶然发现异位胰腺的外科处理原则。方法回顾性分析2008年1月至2016年1月我院小儿腹部手术中偶然发现的7例异位胰腺患儿的临床资料。其中，男3例，女4例；年龄1d～7岁，平均19个月。术前诊断疾病分别是：先天性胆总管囊肿、环状胰腺、先天性肠闭锁、先天性肥厚性幽门狭窄、先天性巨结肠、先天性肠旋转不良、急性阑尾炎并腹膜炎。经腹开放手术2例，腹腔镜手术5例。异位胰腺位置如下：胃窦部、十二指肠、回肠各1例，空肠3例，回肠梅克尔憩室1例。结果6例异位胰腺行手术切除，包括：病灶部位肠切除肠吻合5例、胃壁部分切除修补术1例；急性阑尾炎并腹膜炎术中发现的异位胰腺未处理。异位胰腺组织均位于黏膜下层，1例部分侵及肌层。本组根据Heinrich分型：Ⅰ型2例，Ⅱ型3例，Ⅲ型1例。手术顺利，术后原有疾病治愈，无并发症出现，分别随访3个月～1年，恢复良好。结论 小儿腹部手术中偶然发现的异位胰腺，综合考虑其发生并发症及手术风险，应尽可能手术切除。Objective To explore the surgical experiences of pediatric heterotopic pancreas （HP） detected incidentally during laparotomy. Methods The clinical data were retrospectively analyzed for 7 surgical cases of HP from January 2008 to January 2016. There were 3 males and 4 females with a diagnostic age of 1 day to 7 years and a mean age of 19 months. Preoperative diagnoses included congenital choledochal cysts, annular pancreas, congenital intestinal atresia, congenital hypertrophic pyloric stenosis, Hirschsprung＇s disease, congenital intestinal malrotation and acute appendicitis plus peritonitis. The locations of HP were stomach （n= 1）, duodenum （n = 1）, jejunum （n = 3）, ileum （n = 1） and ileum plus Meckel＇s diverticulum （n = 1）. Results Six submucosal HP lesions were removed surgically without postoperative complications. The procedures were intestinal resection ＆ anastomosis （n = 5） and gastrorrhaphy （n= 1）. The Heinrich＇s pathological types were Ⅰ （n = 2）; Ⅱ （n = 3） and Ⅲ （n = 1）. All of them recovered well during a follow-up period of 3 months to 1 year. Conclusions In light of the risk of potential late complications, any accidental HP should be excised as much as possible during laparotomy.

关 键 词：异位胰腺 并发症 治疗 

分 类 号：R726.5[医药卫生—儿科]