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。

Surgical treatment of pancreatic insulinoma by laparoscopy

Objective To evaluate the safety and outcome of laparoscopic insulinoma resection. Methods Twenty-five patients with insulinoma were admitted and divided into two groups: laparoscopic group(10 patients)and laparotomy group(15 patients). All tumors of two groups were located at the body or tail of pancreas preoperatively by abdominal CT and digital subtraction angiography (DSA). Laparoscopic enucleation was performed for patients in laparoscopic group, open enucleation was performed for patients in laparotomy group. There were no differences in preoperative location and size of tumors between two groups. Statistical method was used to compare the discrepancy from operation time, the volume of blood loss, hospital stay and morbidity of complication between two groups. Results There were no discrepancies from operation time, blood loss, hospital stay after operation between two groups (P>0.05). However, one case of pancreatic leakage developed in laparoscopic group, comparably, 3 cases of pancreatic leakage, 2 cases of celiac sepsis and 5 cases of fluid accumulation in thoracic cavity developed in laparotomy group. There were significant discrepancies in morbidity of complication between two groups. Conclusions Laparoscopic resection of pancreatic insulinoma is safe and feasible for tumors located at the body or tail of the pancreas. Its application for tumors located at the pancreatic head needs further evaluation.