Treatment of Zollinger-Ellison syndrome with exploratory laparotomy, proximal gastric vagotomy, and H2-receptor antagonists. A prospective study.
Treatment of Zollinger-Ellison syndrome with exploratory laparotomy, proximal gastric vagotomy, and H2-receptor antagonists. A prospective study.
复制标题
采用剖腹探查术、近端胃迷走神经切断术和 H2 受体拮抗剂治疗 Zollinger-Ellison 综合征。
DOI：
10.1016/0016-5085(85)90337-3
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发表时间：
1985
期刊：
影响因子：
29.4
通讯作者：
Fordtran,JS
中科院分区：
文献类型：
--
作者：
Richardson,CT;Peters,MN;Feldman,M;McClelland,RN;Walsh,JH;Cooper,KA;Willeford,G;Dickerman,RM;Fordtran,JS
对22例Zollinger-Ellison综合征患者采用内外科相结合的方法进行治疗。患者最初使用西咪替丁或雷尼替丁治疗。开腹手术切除了容易切除的肿瘤，并进行了近端胃迷走神经切开术。发现肿瘤9例(41%)，其中6例肿瘤全部切除。所有可见肿瘤切除患者术后6wk空腹血清胃泌素浓度和静脉注射促胰液素的胃泌素反应均正常，术后6wk~5年有4例患者空腹血清胃泌素浓度和静脉注射促胰液素反应正常。迷走神经切断术后，每个患者的胃酸分泌减少，即使没有发现肿瘤或完全切除也是如此。因此，切断迷走神经降低了对内源性高胃泌素血症的酸性分泌反应。此外，切断迷走神经可增强H2受体拮抗剂对胃酸分泌的抑制作用。随访时间为6周至6年(中位数为2年)。除1例患者外，所有患者的西咪替丁或雷尼替丁的剂量均较术前减少。两名患者没有服用抗分泌药物。只有3名患者偶尔出现溃疡病症状。所有患者均未出现出血、穿孔或梗阻等并发症。所有患者都进行了内窥镜检查，以评估活动性溃疡的发生率，并发现1例患者有溃疡。基于这些结果，我们认为这种内外科结合的方法是治疗Zollinger-Ellison综合征的有效方法。
Twenty-two patients with Zollinger-Ellison syndrome were managed by a combined medical and surgical approach. Patients were treated initially with cimetidine or ranitidine. A laparotomy was performed to remove easily resectable tumors and to carry out a proximal gastric vagotomy. Tumors were found in 9 patients (41%) and all visible tumors were removed from 6 of the 9 patients. Fasting serum gastrin concentrations and serum gastrin responses to intravenous secretin were normal 6 wk after surgery in each of the patients from whom all visible tumors were resected and are normal in 4 patients, 6 wk to 5 yr after surgery. Acid secretion was reduced after vagotomy in each patient, even when tumors were not found or completely resected. Thus, vagotomy decreased the acid secretory response to endogenous hypergastrinemia. In addition, vagotomy augmented the inhibitory effect of H2-receptor antagonists on acid secretion. Follow-up has ranged from 6 wk to 6 yr (median, 2 yr). Dosages of cimetidine or ranitidine have been reduced, compared with preoperative amounts, in all but 1 patient. Two patients are taking no antisecretory drugs. Only 3 patients have had occasional symptoms of ulcer disease. Complications such as bleeding, perforation, or obstruction have not occurred in any patient. Endoscopy was performed in all patients to estimate the point prevalence of active ulcers and an ulcer was found in 1 patient. Based on these results, it is our opinion that this combined medical and surgical approach is an effective treatment for patients with Zollinger-Ellison syndrome.