胰岛素瘤术中定位诊断的体会

本院1987～1992年间共手术治疗胰岛素瘤13例,通过仔细探查胰腺,借助术中B超进行定位诊断,全部病例均获得一次性手术治愈。结果表明:术中应用B超检查可以精确定位胰岛素瘤,从而避免盲目性胰腺切除,简化了手术方式,提高手术治愈率及减少手术并发症。     

腹腔镜下胰岛素瘤切除13例

【摘要】 目的 探讨完全腹腔镜下胰岛素瘤手术切除的可行性、安全性。方法 我科2008年1月~2012年9月住院的对13例胰岛素瘤患者行完全腹腔镜下肿瘤切除的临床资料进行回顾性分析,并总结其主要技术环节。结果 13例患者在腹腔镜超声指导下成功实施镜下胰岛素瘤切除术,其中行单纯肿瘤切除术7例,胰体尾+脾切除4例,保留脾脏胰体尾切除术2例,过程顺利,血糖监测提示手术效果满意,术后胰漏3例,保守治疗痊愈,术后无严重腹腔感染和大出血发生。随访无复发。结论 腹腔镜下行胰岛素瘤切除安全、微创、可行,尤其是结合腹腔镜术中超声可有助于胰岛素瘤的的准确定位及选择合适的手术方式。     

胰岛素瘤围手术期的护理

胰岛素瘤是一种少见的内分泌疾病,临床表现主要是神经、精神方面的症状。一旦诊断明确,须及早行手术治疗。本文总结了32例胰岛素瘤围手术期的护理,介绍了胰岛素瘤的手术方法,重点阐述了术前护理特点、术后病情观察及护理。     

胰岛素瘤的诊断与治疗

目的 总结胰岛素瘤的临床特点和诊治经验,并讨论其诊治方法.方法 回顾性分析了1997年1月至2012年1月间收治的32例胰岛素瘤的临床表现和辅助检查等特点,并结合文献讨论胰岛素瘤诊治的有关问题.结果 32例患者均有Whipple三联征,术前B超、CT、数字减影血管造影（DSA）定性诊断的准确率分别为28.1％ （9/32）、64.0％ （16/25）、90.0％ （9/10）,术中B超为100％ （9/9）.肿瘤局部摘除术20例,胰体尾切除术7例（加做脾切除3例）,胰尾切除术4例,原发性肝癌并胰腺部分切除术1例.结论 准确的术前定位及定性检查有助于术中选择合理的手术方式,术中超声是胰岛素瘤最有效的定位诊断方法.胰岛素瘤一经确诊,须尽快手术治疗.行肿瘤摘除术是治疗良性胰岛素瘤的最佳方式,能够降低术后并发症发生率.     

胰岛素瘤的诊断与治疗

目的 探讨胰岛素瘤的诊断治疗经验.方法 对本院2008年3月至2012年12月收治的10例胰岛素瘤资料进行回顾性研究.其中男2例,女8例;年龄11 ～ 52岁,平均（32±15）岁.通过对患者进行定性、定位检查确诊,并进行手术干预和随访观察.结果 7例为单纯性胰岛素瘤,3例为多发性内分泌肿瘤-1型（MEN-1）相关的胰岛素瘤;9例为良性肿瘤,1例为交界性肿瘤.10例均有典型的Whipp1e三联征.肿瘤直径＜2 cm者占79.5％.手术切除肿瘤16个,其中12.5％位于胰头部,6.25％位于胰颈部,25％位于胰体部,56.25％位于胰尾部.术前定位检查发现的胰岛素瘤敏感性：经腹超声检查30.5％,多排螺旋增强CT 68.9％,薄层CT灌注扫描79.5％.术中定位诊断方法的敏感性：术中多普勒超声检查100％.81.25％的病例可行肿瘤的局部摘除术.随访6个月～5年,10例病情稳定,血糖均在正常范围之内.结论 手术切除是胰岛素瘤的最佳治疗方式.薄层CT多期动态增强扫描是目前胰岛素瘤术前定位诊断的首选方法,术中多普勒超声显著提高手术切除率.加强对胰岛素瘤的认识,早期诊断并合理积极的手术治疗,能够改善患者生活质量.     

恶性胰岛素瘤的诊断和治疗(附9例报道)

总结恶性胰岛素瘤的诊治经验，并对照良性胰岛素瘤分析其临床特点。方法回顾性分析我院15年来收治的9例恶性胰岛素瘤临床资料。结果恶性胰岛素瘤患者多有严重的低血糖表现，手术和介入化疗是主要的治疗手段。结论综合治疗能改善恶性胰岛素瘤患者的预后。     

胰岛素瘤的定位诊断与治疗(附38例报告)

目的正确评价胰岛素瘤的各种定位诊断方法和各种手术治疗方法。方法回顾性分析吉林大学第一医院普外科与吉林省肿瘤医院普外科1985年6月至2005年6月期间诊治的38例胰岛素瘤的临床资料,系统评价术前超声、术中超声、术前CT及术前增强CT定位诊断方法。结果术前超声、术前CT、术前增强CT及术中超声检查其确诊率分别为47.4%、51.5%、85.7%及100%。行肿瘤局部摘除术21例,单纯远端胰腺切除术14例,远端胰腺切除术联合脾摘除3例。结论胰岛素瘤的术前定位诊断较困难,术前超声与术前CT在术前定位诊断方面差异无统计学意义,术前增强CT能够明显提高胰岛素瘤的术前诊断率,术中超声是胰岛素瘤最有效的定位诊断方法。行肿瘤摘除术是治疗良性胰岛素瘤的最佳方式,能够降低术后并发症发生率。多发性胰岛素瘤或恶性胰岛素瘤应行胰腺次全切除术以避免复发,必要时可联合脾脏摘除。     

胰岛素瘤10例诊断与治疗体会

目的探讨胰岛素瘤的临床特征、治疗方法。方法回顾性分析我院2001年5月至2009年11月收治的10例胰岛素瘤的临床表现、检查方法和治疗结果。结果经手术切除病理证实胰岛素瘤10例,肿瘤位置:胰头部4例,胰体部5例,胰体尾部1例。手术治疗:肿瘤局部切除术5例,肿瘤摘除术2例,胰体尾切除术2例,胰腺节段性切除+胰肠吻合1例。术后血糖均恢复正常,并发胰瘘4例,腹腔脓肿1例,无手术死亡。结论胰岛素瘤术前定位腹部超声或CT检查简便实用,如不能定位可术中探查;胰岛素瘤一经确诊,须尽快手术治疗。     

胰岛素瘤腹腔镜外科治疗体会

目的 评估腹腔镜胰岛素瘤切除术的可行性和安全性。方法 2002年6月至2004年6月25例胰岛素瘤患者,分别行腹腔镜胰岛素瘤切除术（腹腔镜组,10例）和开腹胰岛素瘤切除术（开腹手术组,15例）,比较2组手术时间、术中出血量、术后住院天数和并发症发生率差异是否有统计学意义。结果 肿瘤发生部位、大小差异无统计学意义,手术时间、术中出血量和术后平均住院天数等差异均无统计学意义（P〉0．05）。并发症发生率方面,腹腔镜手术组仅1例并发胰瘘,开腹手术组3例并发胰瘘、2例并发腹腔感染、5例并发胸腔积液,开腹手术组并发症发生率显著高于腹腔镜手术组（P〈0．01）。结论 位于胰体或尾部的胰岛素瘤行腹腔镜下胰岛素瘤切除术是安全可行的,并且并发症发生率低于经典的开腹手术。     

胰岛素瘤的外科诊断与治疗

目的 探讨胰岛素瘤的外科诊断和治疗.方法 回顾性分析郑州大学第一附属医院普外科2008年6月-2014年10月收治的45例胰岛素瘤患者的临床资料.结果 45例胰岛素瘤患者包括功能性胰岛素瘤41例(91.11％)和无功能性胰岛素瘤4例(8.89％).应用选择性动脉造影、术前超声、术中超声、CT进行定位诊断.45例胰岛素瘤中,其中18例行腹腔镜下单纯肿瘤切除术,6例在腹腔镜下行脾脏切除术并胰尾部切除术;21例开腹,其中8例行胰十二指肠切除术,12例肿瘤位于胰颈部,行胰腺颈部局部切除术并胰尾部-空肠Roux-en-Y吻合术,1例开腹探查未发现占位.结论 胰岛素瘤早期诊断是关键,手术是目前最理想的治疗方法,腹腔镜手术在这一领域具有卓越优势.     

Laparoscopic detection and resection of insulinomas

BACKGROUND: Laparoscopic ultrasonography as a diagnostic tool for the localization of islet cell tumors has been described before, but few reports on laparoscopic resection of insulinomas exist. We retrospectively reviewed the results of our experience with laparoscopic detection and the resection of insulinomas to determine its feasibility. METHODS: Between February 1996 and February 1999, 10 patients underwent operation for organic hyperinsulinism at our institution. Patient and clinical characteristics were studied retrospectively. Laparoscopic ultrasonography was performed to localize the insulinoma and then laparoscopic resection was performed. RESULTS: Eight women and 2 men underwent operation for hyperinsulinism. In 6 patients the insulinoma could be resected laparoscopically, either by enucleation (5 patients) or by resection of the pancreatic tail (1 patient). Four procedures were converted to laparotomy for the proximate location of the insulinoma to the portal vein or pancreatic duct (3 procedures) and failure to identify the insulinoma (1 procedure). The overall success rate of preoperative localization of an insulinoma with the use of various imaging techniques was 60% (6/10 patients). Laparoscopic ultrasonography could identify an insulinoma in 90% of the patients (9/10 patients). The median hospital stay was 7 days. CONCLUSIONS: Laparoscopic ultrasonography followed by laparoscopic removal of the insulinoma in patients with clinically manifested hyperinsulinism is a feasible and safe technique with low morbidity and fast postoperative recovery. Preoperative localization studies appear of limited value.     

全腹腔镜下胰岛素瘤切除术18例单中心经验总结

目的:总结全腹腔镜下胰岛素瘤的诊断和治疗经验。方法:回顾分析2002年6月至2009年10月北京协和医院为18例患者施行全腹腔镜下胰岛素瘤切除术的临床资料,分析全腹腔镜胰岛素瘤切除术的安全性、可行性及主要技术环节。结果:18例中1例胰岛素瘤位于胰颈外,余均位于胰体/尾部,肿瘤直径平均(1.77±0.57)cm;7例行肿瘤切除术,7例行保留脾脏的胰腺远端切除术,4例中转开腹,中转开腹率22.2%。术后平均随访48个月,无低血糖症状复发。结论:全腹腔镜胰岛素瘤切除术安全可行,尤其肿瘤位于胰头表面或胰体尾部,更优于经典的开腹手术。     

Surgical therapy of insulinoma

From 12 Patients surgically explored because of suspected insulinoma, the diagnosis was correct in 11. In 8 patients there was a solitary insulinoma, which was diagnosed in every case by preoperative ultrasonography, computed tomography or angiography. In one patient with three adenomas, only one was diagnosed preoperatively, the second by palpation and the third by intraoperative sonography. One patient had a diffuse hyperplasia. The intraoperative frozen section was correct in 9 from 11 patients. The preoperative localisation of insulinoma assisted in the intraoperative identification. The intraoperative pancreatico sonography is an useful help in localisation of insulinoma. For treatment the enucleation of tumor is preferable.     

Role of intraoperative ultrasonography in the surgical management of insulinomas

The findings in 35 surgically treated patients with insulinoma and 43 tumors of these patients were analyzed to confirm the efficacy of diagnostic modalities and surgical interventions. The rate of accurate preoperative tumor localization was 72% by angiography, 53% by computed tomographic scan, 55% by ultrasonography, and 83% by percutaneous transhepatic portal vein sampling. Extensive operative exposure and palpation detected 81% of the tumors and intraoperative ultrasonography demonstrated 96% of the tumors. Intraoperative ultrasonography was significantly better than any other diagnostic procedure and was able to demonstrate the anatomical relationship of the insulinoma to the essential structures of the pancreas. Intraoperative ultrasonography also helped determine the safest route for enucleating the insulinomas. Five patients (14%) in our series had metastatic diseases; 2 of these patients with metastases beyond the lymph nodes died due to the growth of tumors. The other 33 patients were free of insulinoma syndrome after the removal of the insulinomas. Streptozotocin was used in 1 patient with recurrent malignant insulinoma, with encouraging results.     

胰岛素瘤诊治分析：附72例报告

目的:探讨胰岛素瘤的诊断和外科治疗方法。方法:回顾性分析我院31年余诊治的72例胰岛素瘤的临床资料。结果:84.72%有典型的Whipple三联征表现。80.56%血浆免疫反应性胰岛素/血糖(IRI/G)比值>0.3。术前定位诊断方法的阳性率分别为:腹部超声78.13%,CT(平扫或增强)60.97%,多排螺旋CT胰腺灌注100%,MRI 37.50%,内镜超声(EUS)72.73%,选择性动脉造影(DSA)28.57%。术中超声联合扪诊诊断阳性率92.31%。肿瘤最大直径≤2 cm者占88.75%。37.5%的肿瘤位于胰头颈部,27.50%位于胰体部,35.0%位于胰尾部。81.58%的病例可行胰岛素瘤局部剜除术。病理诊断均为胰岛素瘤,65例(90.28%)为功能性胰岛素瘤,7例(9.72%))为无功能性胰岛素瘤;4例(5.56%)为多发性肿瘤,2例(2.78%)恶性倾向,1例(1.39%)合并多发性内分泌肿瘤1型(MEN-1)。结论:Whipple三联征和IRI/G>0.3可作为胰岛素瘤定性诊断的主要依据。应联合应用超声,CT,多排螺旋CT胰腺灌注,MRI,内镜超声和DSA多种方法进行术前定位。术中超声联合扪诊是简单有效的定位诊断方法。肿瘤的局部剜除术是多数胰岛素瘤的最佳手术治疗方式。     

Síndrome de hipoglucemia por hiperinsulinismo endógeno: tratamiento quirúrgico

Background

The endogenous hyperinsulinemic hypoglicemia syndrome (EHHS) can be caused by an insulinoma, or less frequently, by nesidioblastosis in the pediatric population, also known as non insulinoma pancreatic hypoglycemic syndrome (NIPHS) in adults.The aim of this paper is to show the strategy for the surgical treatment of ehhs.

Material and methods

A total of 19 patients with a final diagnosis of insulinoma or NIPHS who were treated surgically from january 2007 until june 2012 were included. We describe the clinical presentation and preoperative work-up. Emphasis is placed on the surgical technique, complications and long-term follow-up.

Results

All patients had a positive fasting plasma glucose test. Preoperative localization of the lesions was possible in 89.4% of cases. The most frequent surgery was distal pancreatectomy with spleen preservation (9 cases). Three patients with insulinoma presented with synchronous metastases, which were treated with simultaneous surgery. There was no perioperative mortality and morbidity was 52.6%. Histological analysis revealed that 13 patients (68.4%) had benign insulinoma, 3 malignant insulinoma with liver metastases and 3 with a final diagnosis of SHPNI. Median follow-up was 20 months. All patients diagnosed with benign insulinoma or NIPHS had symptom resolution.

Conclusion

The surgical treatment of EHHS achieves excellent long-term results in the control of hypoglucemic symptoms.     

Role of intraoperative insulin monitoring in surgical management of insulinoma

BACKGROUND AND PURPOSE: Precise localization and surgical excision is the therapeutic strategy for insulinomas. However, it is often difficult to localize the insulinomas, because of their small size. Surgeons may not localize and remove all of them together, particularly in patients with multiple insulinomas. We reviewed our experience to confirm the efficacy of blood glucose and intraoperative immunoreactive insulin (IRI) monitoring for surgical management of insulinomas. PATIENTS AND METHODS: Thirty-nine patients with insulinoma were surgically treated in our department. Perioperative blood glucose monitoring was performed in 14 patients, intraoperative quick IRI assay of the peripheral blood in 10 patients, and assay of a portal sample in 4 patients by an IMX analyzer. RESULTS: Rebound response of blood glucose to insulinoma removal was not always noted (8/14; 57%). Seven of ten patients showed a decrease of peripheral serum IRI levels within 15 minutes after removal of the insulinoma. The other two patients showed a rebound response of peripheral blood glucose or portal IRI. All the patients who had intraoperative monitoring of peripheral blood and peripheral and portal IRI had no recurrent insulinoma syndrome after surgical removal of their insulinomas. CONCLUSION: Combined monitoring of peripheral blood glucose and peripheral and portal IRI are helpful in the surgical management of insulinomas, as they can indicate that no insulinoma remains.     

胰岛素瘤的诊断和治疗：附120 例报告

目的:探讨胰岛素瘤的诊断与治疗方法。方法:回顾性分析40 年间收治的120 例胰岛素瘤患者的临床资料。结果:全组患者均有Whipple三联症的临床表现，血糖均<2.75mmol/L；75 例空腹血清胰岛素>25μU/mL，平均(65 ±6.0)μU/mL。术前B 超检查60 例，2 例发现肿瘤；CT 检查50 例，10 例发现肿瘤；术中B 超检查18 例，16 例与术中探查相符，1 例发现了未能扪及的肿瘤。良性肿瘤112例，恶性肿瘤4例，胰岛细胞增生症4例。行单纯肿瘤摘除70 例，行包括肿瘤在内的胰体尾脾切除44 例，单纯胰体尾切除4 例，活检2 例。112 例良性胰岛素瘤术后111 例低血糖症状立即消失，1 例术后仍有低血糖症状发作，通过再次手术时发现钩突部肿瘤，切除后治愈。继发胰瘘20 例，均为肿瘤摘除者，其中14 例经引流自愈，5例经手术治疗痊愈，1 例因腹腔感染死亡。结论:胰岛素瘤术前定位不易，术中探查及术中B 超是发现肿瘤的主要手段；对良性者应力争行肿瘤摘除术，对肿瘤位于胰体尾较大且深或多发肿瘤者应行胰体尾切除术。     

胰腺钩突部功能性胰岛素瘤的定位诊断和治疗

Functional insulinoma accounts for 85% of insulinoma, and it is evenly distributed in the head, body and tail of the pancreas. The main clinical manifestation of patients with functional insulinoma is endocrine disorder, and 92% of them presented with neurological symptoms. Preoperative localization of functional insulinoma is difficult because of the small size of the tumor. A 31-year-old male patient with the chief complaint of paroxysmal dizziness and confusion was admitted to the First Affiliated Hospital of Kunming Medical College on May 3,2010. The patient was preliminarily diagnosed with functional insulinoma by detecting the levels of fasting blood glucose,serum insulin and fasting serum C-peptide, as well as the presence of Whipple's triad. Ultrasonography and enhanced computed tomography demonstrated that a well-defined tumor of 13.0 mm ×13.0 mm in size was located in the pancreatic uncinate process.On May 27, 2010, the patient received surgical resection of the tumor, and histological examination of the resected specimen confirmed insulinoma.     

Diagnosis and surgical treatment of organic hyperinsulinism

From 1982 to 1998 144 patients (males 31.7%, females 68.3%) with organic hyperinsulinism underwent surgery. Mean age of the patients was 44.2 +/- 4.6 years. The causes of the development of this disease were benign insulinoma (82.6%), malignant insulinoma (6.9%), beta-cells hyperplasia and microadenomatosis (4.2%). In 6.3% of the patients the origin of the disease was not established. The location of the insulinoma in the pancreatic head was detected in 33.8%, in the body--in 35.2%, in the tail--31%. The sensitivity of the used methods of topical diagnosis was the following: US--40.3%, CT--28.6%, angiography (selective celiacography and upper mesentericography)--76.9%, blood samples from the right hepatic vein after intraarterial stimulation of different parts of the pancreas by Ca with measurement of immunoreactive insulin level--87.2%, intraoperative palpation--86.5%, intraoperative US examination--100%. Preoperatively, the authors used combined angiographic examination, the sensitivity of which made up 94.9%, this study being a single one which allows to reveal the region of the lesion of the pancreas in beta-cells hyperplasy. Tumor enucleation (59 patients), distal resection of the pancreas (50), the excision of the insulinoma (25), duodenopancreatic resection (1), explorative laparotomy (9) were made. Postoperative complications rate arose in 43.6% of the patients, mortality rate--7.7%. The best results were achieved in enucleation of insulinoma and distal resection of the pancreas. The authors suggest that in preoperative diagnosis of insulinomas the preferable methods should be US-examination and combined angiographic examination. Intraoperative revision should be made with use of US examination. Depending on the intraoperative findings the preference should be given either to enucleation of insulinoma or to distal resection of the pancreas.