Mee A S, Ismail S, Bornman P C, Marks I N
Q J Med. 1983 Spring;52(206):256-67.
Nine patients with the Zollinger-Ellison syndrome seen at a single referral centre between 1976 and 1981 are presented to highlight changes in the recognition, diagnosis and management of the condition. Less well recognized manifestations such as diarrhoea and features of the multiple endocrine neoplasia (MEN) type I syndrome are described, and the simplification of the pre-operative diagnosis by the use of both the serum gastrin estimation and the secretin provocation test considered. The problem of tumour localization is discussed with special reference to the newer techniques such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and CAT scanning, and the value of arteriography confirmed. The striking advances in management during the past few years are stressed with special reference to the role of the H2-receptor blocking drugs. Despite their profound inhibitory effect on both acid secretion and symptoms, all patients with the exception of those with proven metastases or the MEN type I syndrome underwent laparotomy to exclude a resectable lesion. If no resectable lesion was found truncal vagotomy was performed to facilitate acid secretory control post-operatively and H2-receptor blocking drugs continued in a dose necessary to maintain basal acid secretion under 5 mmol/hr.
本文介绍了1976年至1981年间在单一转诊中心就诊的9例佐林格-埃利森综合征患者，以突出该疾病在识别、诊断和治疗方面的变化。文中描述了一些较难识别的表现，如腹泻和I型多发性内分泌肿瘤（MEN）综合征的特征，并探讨了通过血清胃泌素测定和促胰液素激发试验简化术前诊断的方法。文中特别提及超声、内镜逆行胰胆管造影（ERCP）和计算机断层扫描（CAT）等新技术，讨论了肿瘤定位问题，并证实了动脉造影的价值。文中强调了过去几年在治疗方面取得的显著进展，特别提及了H2受体阻断药物的作用。尽管这些药物对胃酸分泌和症状有显著抑制作用，但除了已证实有转移或患有I型MEN综合征的患者外，所有患者均接受了剖腹手术以排除可切除病变。如果未发现可切除病变，则进行迷走神经干切断术以利于术后控制胃酸分泌，并继续使用H2受体阻断药物，剂量以维持基础胃酸分泌低于5 mmol/小时为宜。
