内镜黏膜下剥离术治疗小儿胃异位胰腺的应用探讨  

Application of endoscopic submucosal dissection for gastric ectopic pancreas in children

作　　者：张海军 刘海峰[1] 汪星 叶国刚 顾竹珺[1] 冯玉灵 Zhang Haijun;Liu Haifeng;Wang Xing;Gu Zhujun;Ye Guogang;Feng Yuling(Department of Digestive Endoscopy Center,Shanghai Children's Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学医学院附属儿童医院消化内镜中心,上海200062 [2]上海市儿童医院,上海交通大学医学院附属儿童医院普外科,上海200062

出　　处：《中华小儿外科杂志》2022年第9期791-795,共5页Chinese Journal of Pediatric Surgery

基　　金：上海市卫生健康委员会科研课题项目(201840341、20194Y0139)。

摘　　要：目的总结采用内镜黏膜下剥离术(endoscopic mucosal dissection,ESD)治疗胃异位胰腺(ectopic pancreas,EP)经验,评估其可行性、安全性及有效性。方法收集2016年6月至2020年7月上海市儿童医院采用ESD治疗的14例有消化道症状胃EP患儿病例资料,其中男9例,女5例,年龄(9.5±6.5)岁,范围3~16岁。中位身体质量指数为16.4,范围为14.3~22.6。14例胃EP主要临床表现为腹痛(7例)、反酸(6例)、恶心(5例)、呕吐(5例)及嗳气(4例)。所有患儿病变均为单发,病变直径大小范围12~25 mm,平均为15 mm;位置位于胃窦大弯侧12例,幽门2例,其中1例异位胰腺口侧合并溃疡。14例患儿经内镜下诊断明确后,均于全身麻醉下行ESD切除治疗,术中留取病理标本送检。术后定期随访,查看患儿消化道症状改善情况及有无并发症等。结果14例患儿中,13例经ESD完整切除胃EP,1例患儿因黏膜下多次注射后病变无法抬举而未行ESD切除,予保守治疗。手术操作时间38~62 min,平均为42.5 min,封闭创面使用钛夹数量2~6枚,平均为4枚。所有患儿术中及术后均无出血、穿孔发生,术后禁食24~72 h后逐步开放饮食,患儿均好转出院,住院时间4~7 d,平均为5 d。术后病理检查均提示为(异位)胰腺组织。患儿术后随访10个月至4年,保守治疗患儿经内科药物治疗后症状可持续缓解,其余13例患儿营养状况良好,未诉明显腹痛、呕吐、反酸等,胃镜复查显示原病变部位黏膜平坦完整,未见病变复发。结论内镜ESD技术治疗儿童胃异位胰腺可行、安全且有效,值得在儿科临床应用。Objective To summarize therapeutic experiences of endoscopic mucosal dissection(ESD)for gastric ectopic pancreas(EP)and to assess its feasibility,safety and efficacy in children.Methods From June 2016 to July 2020,clinical data were reviewed for 14 children with gastrointestinal symptoms of gastric EP undergoing ESD.There were 9 boys and 5 girls with an average age of(9.5±6.5)(3-16)years.The average body mass index was 16.4(14.3-22.6).Major clinical manifestations included abdominal pain(n=7),acid reflux(n=6),nausea(n=5),vomiting(n=5)and belching(n=4).All of them had a single lesion with an average diameter of 15(12-25)mm.Locations of the lesion were at greater curvature of antrum(n=12)and pylorus(n=2),including heterotopic pancreas with ulceration at rostral side(n=1).After a definite endoscopic diagnosis,ESD resection was performed under general anesthesia and the pathological specimens were collected intraoperatively for examination.Regular postoperative follow-ups was conducted for tracking the improvement of gastrointestinal symptoms and the occurrence of complications.Results One child failed to undergo ESD resection because the lesion could not be lifted after multiple submucosal injections and conservative treatment was offered.The average operative duration was 42.5(38-62)min.The average number of titanium clips for seal wound surface was 4(2-6).None had hemorrhage or perforation during and after operation.Gradually a normal diet resumed after fasting for 24-72 h postoperatively.The average hospitals stay was 5(4-7)days.Postoperative pathological examination revealed heterotopic pancreatic tissue.During a follow-up period of 10 to 48 months,the symptoms of conservative treatment could be relieved continuously after medications.The other 13 children had decent nutritional status and did not complain of obvious abdominal pain,vomiting or acid reflux,etc.Gastroscopy revealed that mucosa at the original lesion site remained flat and intact without recurrence.Conclusions ESD is feasible,safe and effective fo

关 键 词：胃 异位胰腺 儿童 内镜黏膜下剥离术 

分 类 号：R726.5[医药卫生—儿科]