The role of surgery in the Zollinger-Ellison syndrome.
The role of surgery in the Zollinger-Ellison syndrome.
复制标题
手术在佐林格-埃里森综合征中的作用。
DOI：
10.1097/00000658-198305000-00014
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发表时间：
1983
影响因子：
9
通讯作者：
TownsendJr,CM
中科院分区：
文献类型：
--
作者：
Thompson,JC;Lewis,BG;Wiener,I;TownsendJr,CM
当Zollinger-Ellison综合征首次被发现时，全胃切除术被认为是治疗该综合征分泌表现的最有效方法。然而，最近人们对利用h2受体拮抗剂进行医学治疗产生了极大的热情。在过去的12年中，作者在德克萨斯大学医学分院治疗了27例Zollinger-Ellison综合征患者，并对全胃切除术的结果感到满意，27例患者中有23例接受了全胃切除术（1例患者拒绝手术，3例患者接受了较小的胃手术）。23例患者行全胃切除术并Roux-en-Y食管空肠吻合术。无手术死亡病例。在17例患者中发现原发肿瘤，其中7例也有转移性肿瘤。9例患者未发现肿瘤。9名患者死亡；所有患者5年精算生存率为75%，10年生存率为52%。27例患者中有11例有多发内分泌肿瘤I型综合征。在18名幸存者中，只有3人的血清胃泌素水平正常，而且这3人都患有胰腺外胃泌素瘤，1人在胰周淋巴结，1人在肝脏，1人在附在胃上的囊性肿瘤。营养结果良好，术后平均体重减轻14.7%（平均随访时间45个月）。作者认为全胃切除术治疗佐林格-埃利森综合征的高分泌问题是安全可靠的。结果与长期医疗管理的结果比较好，后者的成功取决于对一生中反复挑战的一系列有利反应。图片
When the Zollinger-Ellison syndrome was first identified, total gastrectomy was proposed as the most effective treatment for the secretory manifestations of the syndrome. Recently, however, great enthusiasm has developed for medical treatment by means of H2-receptor antagonists. The authors have cared for 27 patients with the Zollinger-Ellison syndrome at The University of Texas Medical Branch in the past 12 years and have been pleased with the results of total gastrectomy, which was performed in 23 of the 27 patients (one patient refused operation and three patients had lesser gastric operations). Twenty-three patients underwent total gastrectomy with Roux-en-Y esophagojejunostomy. There were no operative deaths. Primary tumors were found in 17 patients, seven of whom also had metastatic tumors. No tumors were found in nine patients. Nine patients are dead; the actuarial survival rate for all patients was 75% at 5 years and 52% at 10 years. Eleven of the 27 patients had the multiple endocrine neoplasia I syndrome. Of the 18 survivors, only three have normal serum gastrin levels, and all three had extrapancreatic gastrinomas, one in peripancreatic lymph nodes, one in the liver, and one in a cystic tumor attached to the stomach. Nutritional results were good to excellent, with a mean postoperative weight loss of 14.7% (mean follow-up period was 45 months). The authors conclude that treatment of the hypersecretory problems of the Zollinger-Ellison syndrome by total gastrectomy is safe and dependable. Results compare well with those of long-term medical management, whose success is dependent upon serial favorable responses to a lifetime of repeated challenges. Images