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Zollinger-Ellison-Syndrom

Das gewandelte Verständnis der Chirurgie

Zollinger-Ellison syndrome

The changing role of surgery

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Zusammenfassung

Da die präoperative bildgebende Lokalisation von Gastrinomen nur selten gelingt, sollte nach biochemischer Sicherung eines Zollinger-Ellison-Syndroms (ZES) und Ausschluss einer diffusen Fernmetastasierung beim sporadischen und MEN1-Gastrinom die Indikation zur Operation gestellt werden, um das Auftreten von Lebermetastasen als entscheidende prognostische Determinante zu verhindern. Der erfahrene Chirurg findet mit Hilfe der subtilen Pankreasexploration, des intraoperativen Ultraschalls (IOUS) und der Duodenotomie mehr als 90% der Primärtumoren.

Beim sporadischen Gastrinom erfolgt die Resektion der pankreatischen Gastrinome durch Enukleation bzw. partielle Pankreasresektion mit Lymphadenektomie. Duodenalwandgastrinome werden exzidiert. Die vollständige Resektion dieser Tumoren ist der einzige kurative Ansatz für die betroffenen Patienten. Bei MEN1-Gastrinomen sollte entweder eine milzerhaltende Pankreaslinksresektion mit Enukleation von Tumoren aus dem Pankreaskopf sowie eine Duodenotomie und die Exzision von Duodenalwandgastrinomen oder eine pyloruserhaltende Pankreaskopfresektion erfolgen, wenn die Gastrinquelle durch präoperative SASI-Angiographie in der Pankreaskopfregion regionalisiert wurde.

Abstract

The preoperative localization of gastrinomas often fails despite all modern imaging methods. Therefore, after biochemical confirmation of the diagnosis and exclusion of diffuse metastases, a meticulous surgical exploration including intraoperative ultrasound (IOUS) and duodenal exploration after duodenotomy should be performed. The experienced surgeon will be able to identify more than 90% of the primary tumors. Depending on the localization, excision of the tumor in the duodenal wall or enucleation from the pancreatic head should be performed. If the tumor is localized in the tail of the pancreas, distal pancreatectomy is the treatment of choice. Complete resection of the tumor is the only curative approach for the patients. For MEN-1 gastrinomas a spleen-preserving distal pancreatectomy with enucleation of tumors of the pancreatic head and duodenotomy with excision of duodenal gastrinomas should be performed. If the source of gastrin secretion can be regionalized to the pancreatic head by a preoperative SASI angiography, a pylorus-preserving partial pancreaticoduodenectomy might be the treatment of choice.

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  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg

    V. Fendrich, D. K. Bartsch, P. Langer, A. Zielke & M. Rothmund

  2. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg, Baldingerstraße, 35043 , Marburg

    V. Fendrich

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  1. V. Fendrich
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  2. D. K. Bartsch
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  3. P. Langer
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  4. A. Zielke
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  5. M. Rothmund
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Correspondence to V. Fendrich.

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Fendrich, V., Bartsch, D.K., Langer, P. et al. Zollinger-Ellison-Syndrom. Chirurg 76, 217–226 (2005). https://doi.org/10.1007/s00104-004-0995-5

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