Qin Shan-Yu, Lu Xiu-Ping, Jiang Hai-Xing
Department of Gastroenterology (SQ, XL, HJ), First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
Medicine (Baltimore). 2014 Sep;93(14):e85. doi: 10.1097/MD.0000000000000085.
Surgical resection is a standard treatment for insulinomas; however, it is associated with a high risk of complications and limited to specific suitable candidates. In recent years, endoscopic ultrasound (EUS)-guided ethanol ablation of insulinomas has emerged as a new therapeutic option, especially for elderly patients and candidates unfit for surgery. We aimed to evaluate the feasibility and safety of this technique for insulinomas. Four patients diagnosed with insulinomas based on EUS-fine-needle aspiration and immunohistochemistry results underwent EUS-guided 95% ethanol ablation. A comprehensive literature review was performed to understand the current status of the feasibility, safety, and effects of EUS-guided ethanol ablation of insulinomas. EUS-guided ethanol ablation of insulinomas was successfully completed in all the 4 patients. There were no perioperative or postoperative complications. The patients were discharged at 3 days after the procedure. No recurrence of hypoglycemia or tumors was noted during follow-up (range, 3-6 months). Literature review showed 8 patients with insulinomas who underwent EUS-guided ethanol ablation. All the procedures were successful, with no need for further surgical treatment. Among these reviewed cases, 6 patients had no post-procedural complications, while other 2 patients showed a mild increase in the serum levels of lipase and/or pancreatic enzymes within 48 h post-procedure; furthermore, 1 of these 2 patients presented at a later date with medically controllable hematoma and ulceration. During follow-up, 6 patients remained asymptomatic and normoglycemic, while the 2 patients who presented post-procedural complications developed occasional mild confusion. EUS-guided ethanol ablation of insulinomas is an effective and safe modality, with an acceptable level of post-procedural complications. However, the long-term effects of this new therapeutic option need to be validated in a large randomized controlled trial with longer follow-up.
手术切除是胰岛素瘤的标准治疗方法；然而，它与高并发症风险相关，且仅限于特定合适的患者。近年来，内镜超声（EUS）引导下乙醇消融胰岛素瘤已成为一种新的治疗选择，尤其适用于老年患者和不适合手术的患者。我们旨在评估该技术治疗胰岛素瘤的可行性和安全性。4例根据EUS细针穿刺和免疫组化结果诊断为胰岛素瘤的患者接受了EUS引导下95%乙醇消融。进行了全面的文献综述以了解EUS引导下乙醇消融胰岛素瘤的可行性、安全性及效果的现状。所有4例患者均成功完成了EUS引导下乙醇消融胰岛素瘤。围手术期及术后均无并发症。患者在术后3天出院。随访期间（3 - 6个月）未发现低血糖或肿瘤复发。文献综述显示有8例胰岛素瘤患者接受了EUS引导下乙醇消融。所有手术均成功，无需进一步手术治疗。在这些回顾的病例中，6例患者术后无并发症，而另外2例患者在术后48小时内血清脂肪酶和/或胰酶水平轻度升高；此外，这2例患者中有1例后来出现了可通过药物控制的血肿和溃疡。随访期间，6例患者无症状且血糖正常，而2例出现术后并发症的患者偶尔出现轻度意识模糊。EUS引导下乙醇消融胰岛素瘤是一种有效且安全的方式，术后并发症水平可接受。然而，这种新治疗选择的长期效果需要在一项随访时间更长的大型随机对照试验中得到验证。
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