Yan Zhiyu, Zhu Cheng, Wu Xi, Zhu Huijuan, Yuan Tao, Luo Yaping, Feng Yunlu, Wang Qiang, Zhang Shengyu, Xue Huadan, Zheng Zehui, Yang Aiming
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China; Chinese Academy of Medical Science & Peking Union Medical College, Beijing, 100730, China.
Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Pancreatology. 2023 Jan;23(1):98-104. doi: 10.1016/j.pan.2022.12.007. Epub 2022 Dec 13.
BACKGROUND/OBJECTIVES: As the most frequent functional pancreatic neuroendocrine tumor, insulinomas may cause a plethora of symptoms and severe impairment in the living of patients by endogenous hyperinsulinemia and subsequent hypoglycemia. Surgery has been regarded as the first choice although a high risk of complications. Ethanol ablation is a promising non-surgical option that could achieve tumor shrinking in a short-term period. But the impact of symptom control and the long-term efficacy lack sufficient and good-quality evidence.
A total number of 14 endoscopic ultrasonography-guided ethanol ablations were performed in 9 patients between September 2016 and September 2018 in Peking Union Medical College Hospital. The data were collected and prospectively analyzed.
The follow-up duration ranged from 21 to 1567 days in 9 patients, with a median of 994 days. 4 patients were free from relapse during a median follow-up of 1108 days (range: 994-1567 days). In 5 patients who suffered relapses, the median duration with symptom relief after the first ablation was 128 days (range: 13-393 days). If only repeated ablation was taken into consideration, the median duration with symptom relief was 26 days (range: 1-516 days). No complications happened during the procedures. The severe complication rate after the first ablation was 0.0% (0/9), compared to 7.14% (1/14) if each procedure was counted separately. The only severe complication documented was acute pancreatitis which was completely relieved after symptomatic treatment.
For patients who are not suitable for surgical resections, endoscopic ultrasonography-guided ethanol ablation of insulinomas could be an effective and safe alternative to relieve symptoms of hypoglycemia.
背景/目的：胰岛素瘤作为最常见的功能性胰腺神经内分泌肿瘤，可因内源性高胰岛素血症及随后的低血糖导致大量症状，并严重损害患者生活。尽管手术并发症风险高，但一直被视为首选治疗方法。乙醇消融是一种有前景的非手术选择，可在短期内使肿瘤缩小。但症状控制的效果及长期疗效缺乏充分且高质量的证据。
2016年9月至2018年9月间，北京协和医院对9例患者共进行了14次内镜超声引导下乙醇消融术。收集数据并进行前瞻性分析。
9例患者的随访时间为21至1567天，中位数为994天。4例患者在中位随访1108天（范围：994 - 1567天）期间无复发。在5例复发患者中，首次消融后症状缓解的中位持续时间为128天（范围：13 - 393天）。若仅考虑重复消融，症状缓解的中位持续时间为26天（范围：1 - 516天）。手术过程中未发生并发症。首次消融后的严重并发症发生率为0.0%（0/9），若单独计算每次手术，则为7.14%（1/14）。记录到的唯一严重并发症是急性胰腺炎，经对症治疗后完全缓解。
对于不适合手术切除的患者，内镜超声引导下乙醇消融胰岛素瘤可能是缓解低血糖症状的一种有效且安全的替代方法。
