Recent advances in the localization and surgical management of duodenal gastrinomas.
Recent advances in the localization and surgical management of duodenal gastrinomas.
复制标题
十二指肠胃泌素瘤的定位和手术治疗的最新进展。
DOI：
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发表时间：
1994
期刊：
影响因子：
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通讯作者：
Modlin Im
中科院分区：
文献类型：
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作者：
Lawton Gp;Modlin Im
十二指肠胃泌素瘤现在更多地被认为是Zollinger-Ellison综合征患者高胃泌素血症的来源。十二指肠胃泌素瘤的细胞谱系可能不同于胰腺胃泌素瘤，这是它们临床行为不同的原因。试图定位粘膜下肿瘤是困难的，而且受到其体积小的限制。术中内窥镜透照、选择性动脉内注射促胰液素、十二指肠切开加粘膜外翻是目前最敏感和可靠的定位方法。超声内窥镜检查和生长抑素核素扫描进一步提高了这些肿瘤术前定位的准确性。目前基于治愈率和生存数据的信息要求对散发性或与1型多发性内分泌肿瘤相关的患者进行主要手术治疗。因此，广泛局部切除十二指肠胃泌素瘤，切除所有肿瘤淋巴组织和酸抑制药物治疗(质子泵抑制)可能产生80%至90%的5年存活率。同样，在表现为1型多发性内分泌肿瘤的胰腺和十二指肠胃泌素瘤患者中，附加的胰腺病变摘除加或不加胰腺远端切除可使治愈率达到67%至100%。
Duodenal gastrinomas are now more frequently recognized as the source of hypergastrinemia in patients with Zollinger-Ellison syndrome. The cell lineage of duodenal gastrinomas may differ from that of pancreatic gastrinomas, which accounts for variations in their clinical behavior. Attempts to localize the submucosal tumors are difficult and are limited by their small size. Intraoperative endoscopic transillumination, selective intra-arterial secretin injection, and duodenotomy with mucosal eversion are currently the most sensitive and reliable methods of localization. Endoscopic ultrasonography and somatostatin scintigraphy further enhance the accuracy of preoperative localization of these tumors. Current information based on cure rates and survival data mandates a primary surgical approach in patients with either the sporadic or the multiple endocrine neoplasia type 1-associated form of the disease. Thus, wide local resection of duodenal gastrinomas with removal of all tumor-bearing lymphatic tissue and acid inhibitory pharmacotherapy (proton pump inhibition) may yield 5-year survival rates of 80% to 90%. Similarly, in patients with pancreatic and duodenal gastrinomas as a manifestation of multiple endocrine neoplasia type 1, the additional enucleation of pancreatic lesions with or without distal pancreatectomy has resulted in cure rates of 67% to 100%.