异位胰腺的临床、CT表现特点及其误诊分析  

Clinical and CT Features and Misdiagnosis of Ectopic Pancreas

作　　者：孟婷 阮志兵 徐茂丽 夏小梅 MENG Ting;YUAN Zhibing;XU Maoli(School of Medical Imaging,Guizhou Medical University,Guiyang,Guizhou Province 550004,P.R.China)

机构地区：[1]贵州医科大学医学影像学院,贵阳550004

出　　处：《临床放射学杂志》2023年第11期1774-1779,共6页Journal of Clinical Radiology

基　　金：贵州省卫生健康委科学技术基金项目(gzwjkj2020-1-179);贵州医科大学附属医院国家自然科学基金培育计划项目(gyfynsfc-2021-39)资助。

摘　　要：目的分析异位胰腺(EP)的临床特点、CT表现及误诊原因,提高对本病的认识及诊断准确率。方法回顾性分析117例经病理证实的EP患者临床与45例患者CT资料。结果(1)临床表现:最常见症状为腹胀、腹痛(64.6%),少数可出现腹部不适、反酸、嗳气、恶心、呕吐、黄疸、黑便等症状,小儿易并发肠套叠及肠梗阻,16.7%无症状。(2)发生部位:117例中胃60例(51.3%),十二指肠26例(22.2%),空回肠19例(16.2%),食管、肠系膜、胆管各2例,食管憩室、回肠及回盲部憩室、结肠、胆囊各1例,1例同时发生于胆管及十二指肠。(3)CT表现:45例共47个病灶,43例单发,45个病灶边界清楚;实性45个,囊性2个;多数(82.9%)表现为椭圆形或扁平状、类圆形,少数表现为不规则形、局部胃壁/肠壁增厚;73.9%为腔内生长,21.7%为腔内外同时生长,4.4%为腔外生长。6个病灶可见导管征,3个病灶可见脐凹征。病灶长径/短径为1.00~2.28,平均值为(1.52±0.41),大部分(92.7%)病灶长径<3 cm。CT平扫为均匀等密度,增强呈持续性强化,37/41个病灶门静脉期及延迟期病灶强化程度类似或高于原位胰腺;EP CT平扫、动脉期CT值与原位胰腺同期相比较,差异有统计学意义(P<0.05),门静脉期及延迟期两者CT值比较差异无统计学意义。EP与同期相原位胰腺CT平扫、动脉期、门静脉期、延迟期CT值均呈显著相关(r=0.600、0.502、0.697、0.792,P<0.05)。47个病灶中,4个正确诊断,30个误诊,3个漏诊,10个诊断不明。结论EP患者CT表现具有一定的特征性,综合其好发部位、生长方式、长径/短径值、密度与强化方式、导管征、脐凹征有助于本病的诊断。临床表现无特异性、认识不足、检查前准备不充分是其漏诊/误诊的主要原因。Objective To analyze the clinical features,CT features and causes of misdiagnosis of ectopic pancreas(EP),and to improve the understanding and diagnostic accuracy.Methods The clinical data of 117 EP patients and CT data of 45 EP patients were retrospectively analyzed.Results(1)Clinical manifestations:The most common symptoms were abdominal distension and abdominal pain(64.6%),and a few of them had abdominal discomfort,acid regurgitation,belching,nausea,vomiting,jaundice,melena and other symptoms.Intussusception and intestinal obstruction were easy to occur in children,and 16.7%had no symptoms.(2)Location:Among 117 cases,60 cases(51.3%)occurred in stomach,26 cases(22.2%)in duodenum,19 cases(16.2%)in empty ileum,2 cases in esophagus,2 cases in mesentery,2 cases in bile duct,1 case of esophageal diverticulum,1 case of ileum and ileocecal diverticulum,1 case of colon and 1 case of gallbladder,and 1 case of bile duct and duodenum simultaneously.(3)CT features:47 lesions were found in 45 patients,43 were single lesions,and 45 lesions had clear boundary.45 were solid and 2 were cystic.Most of them(82.9%)showed oval or flat shape and round shape,while a few showed irregular shape and local gastric wall/intestinal wall thickening.73.9%were intraluminal growth,21.7%were both intraluminal and extraluminal growth,and 4.4%were extraluminal growth.Catheter sign was observed in 6 lesions and umbilical concave sign in 3 lesions.The long diameter/short diameter of the lesions ranged from 1.00-2.28,with an average of(1.52±0.41),and(92.7%)the length diameter of the lesions was less than 3cm.The EP on CT plain scan was uniform and isodense,and the enhancement degree of portal phase and delayed phase(37/41)was similar or higher than that of the original pancreas.There were significant differences in the CT values between the two groups(P<0.05).There was no significant difference in the CT values between the two groups in portal phase and delayed phase.EP was significantly correlated with CT values of simultaneous in-situ pancreatic

关 键 词：异位胰腺 临床特点 体层摄影术 X线计算机 CT特征 误诊分析 

分 类 号：R576[医药卫生—消化系统] R816.5[医药卫生—内科学]