A Clinical Analysis of Ectopic Pancreas-Case Analysis

異位性胰臟之臨床分析

周華康(Hwa-Kung Chou) ； 趙有誠(You-Chen Chao) ； 許重得(Chung-Te Hsu) ； 唐鴻舜(Hung-Shang Tang) ； 葉淳(Chun Yeh) ； 劉耀基(Yao-Chi Liu) ； 季大為(Da-Wei Chi) ； 江蓉華(Jung-Hwa Chiang)

《Journal of Medical Sciences》 16卷3期 (1995/12) Pp. 203-210

摘要

三軍總醫院在過去12年間共有12例經開刀病理切片證實的異位性胰臟。發生部位在胃有7例，十二指腸球部1例，十二指腸第二部分1例，空腸2例，腸繫膜1例。其中男性7名，女性5名。發生年齡自出生3天到71歲，平均36歲。9例是接受上腸胃道內視鏡檢查發現，其中4例發現黏膜下腫瘤合併臍狀凹陷特徵，5例只發現黏膜下腫瘤但無臍狀凹陷特徵。另外3例是接受其他腹部手術而意外發現。有臍狀凹陷特徵的4例，術前正確診斷率為75％，但無此特徵的5例，無論使用上腸胃道鋇劑檢查或內視鏡超音波均無法與其他黏膜下腫瘤鑑別診斷，術前正確診斷率為0％。內視鏡超音波只能鑑別黏膜下腫瘤或胃外壓迫，但黏膜下腫瘤中，腺肌瘤、類癌及神經纖維瘤的超音波圖相與異位性胰臟相似，因此不能完全正確診斷。由本分析顯示，凡是異位性胰臟具有臍狀凹陷特徵者，較易於術前由內視鏡像得到正確診斷，而無此特徵者無論內視鏡，上腸胃道鋇劑檢查或內視鏡超音波均無法在術前完全確定診斷。時常想到異位性胰臟之診斷同時熟悉其內視鏡及鋇劑攝影之特徵或可減少不必要之外科手術至最低。

關鍵字

異位性胰臟

並列摘要

In the past 12 years, 12 patients with histologically proven ectopic pancreas were detected in the Tri-Service General Hospital. Distribution of the ectopic pancreatic tissue were 7 in the stomach, 1 in duodenal bulb, 1 in the 2nd portion of duodenum, 2 in the jejunum and 1 in the mesentery. There were seven males and five females. Their ages ranged from 3 days to 71 years old with a mean age of 36.1 years. Preoperative upper gastrointestinal (UGI) panendoscopy were performed in 9 cases. Characteristic central umbilicated submucosal lesion were found in 4 cases, while the other 5 cases presented with a submucosal tumor without central umbilication. The remaining three patients were incidentally found during laparotomy. Although endoscopic ultrasonography may differentiate submucosal tumor from external compression, it cannot differentiate the nature of various submucosa tumors, such as adenomyoma, carcinoid, neurofibroma and ectopic pancreas. Our analysis showed that ectopic pancreas might be correctly diagnosed preoperatively by UGI panendoscopic study when it presented with a characteristic central umbilication. On the other hand, if the lesion presented without central umbilication, definite preoperative diagnosis may be difficult.

並列關鍵字

ectopic pancreas