Meko J B, Norton J A
Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Curr Opin Gen Surg. 1994:186-94.
Pancreatic endocrine tumors are rare, yet can cause significant morbidity due to excessive secretion of hormones. Octreotide is effective in reducing the plasma concentrations of many of these hormones. The availability of potent H2-receptor antagonists and omeprazole has altered the emphasis in patients with Zollinger-Ellison syndrome away from total gastrectomy and towards resection of the gastrinoma for potential cure. Fifty percent of insulinomas and gastrinomas are not evident on preoperative imaging studies, despite their sophistication. Calcium angiography, endoscopic ultrasonography, isotope-labeled octreotide scanning, and injection of methylene blue during secretin angiography are recent imaging modalities that have shown promise in the localization of these tumors. Intraoperative ultrasound has emerged as the best method for operative detection of insulinomas. Duodenotomy and intraoperative endoscopic transillumination are especially important in the surgical management of Zollinger-Ellison syndrome because 30% to 40% of gastrinomas are located in the duodenum. The management of patients with multiple endocrine neoplasia type 1 and Zollinger-Ellison syndrome continues to be controversial. Some advocate an aggressive surgical approach, whereas others have had little success in rendering patients eugastrinemic.
胰腺内分泌肿瘤较为罕见，但因其激素分泌过多可导致严重的发病率。奥曲肽可有效降低许多此类激素的血浆浓度。强效H2受体拮抗剂和奥美拉唑的出现，使卓-艾综合征患者的治疗重点从全胃切除术转向胃泌素瘤切除术以实现潜在治愈。尽管术前影像学检查手段先进，但仍有50%的胰岛素瘤和胃泌素瘤在检查中未显影。钙血管造影、内镜超声检查、同位素标记奥曲肽扫描以及在促胰液素血管造影期间注射亚甲蓝是近年来显示出在这些肿瘤定位方面有前景的影像学方法。术中超声已成为手术检测胰岛素瘤的最佳方法。十二指肠切开术和术中内镜透照在卓-艾综合征的外科治疗中尤为重要，因为30%至40%的胃泌素瘤位于十二指肠。1型多发性内分泌腺瘤病和卓-艾综合征患者的治疗仍存在争议。一些人主张积极的手术方法，而另一些人在使患者胃泌素水平正常化方面收效甚微。
