腹腔镜治疗功能性胰岛素瘤的临床应用疗效:附11例报告  

Clinical efficacy of laparoscopic treatment for functional insulinoma:a report of 11 cases

作　　者：崔永义 马洪艳 张国杰 张春晨 CUI Yongyi;MA Hongyan;ZHANG Guojie;ZHANG Chunchen(Department of General Surgery,Hebei Yanda Hospital,Langfang,HeBei 065201,China)

机构地区：[1]河北燕达医院普通外科,河北廊坊065201

出　　处：《中国普通外科杂志》2020年第9期1091-1097,共7页China Journal of General Surgery

摘　　要：背景与目的:胰岛素瘤是最常见的功能性胰岛细胞肿瘤,手术是唯一能治愈的方法。随着技术与设备的发展,腹腔镜下手术已被医患所认可。本研究旨在探讨腹腔镜胰岛素瘤切除术的可行性及疗效。方法:回顾性分析2016年7月—2019年5月笔者所在单位行腹腔镜胰岛素瘤切除术的11例患者的围手术期临床资料及随访资料。结果:11例患者中,男4例,女7例;就诊时年龄21~62岁,平均44.8岁;病程8 d至4年,术前定性、定位诊断均为胰岛素瘤。10例在腹腔镜下成功切除肿瘤,其中行胰岛素瘤切除术8例(胰腺颈部2枚,体部5枚,尾部2枚);2例行胰体尾切除术(胰腺体部1枚,尾部1枚)。11例均行术中腹腔镜超声检查,10例患者发现肿瘤,共11枚,1例腹腔镜超声未探及肿瘤,终止手术。手术时间85.0~380.0 min,术中出血量10.0~530.0 mL。肿瘤切除30 min后,血糖升高1.5~2.3 mmol/L;术后第1天清晨血糖3.9~10.4 mmol/L,出院时血糖2.4~12.8 mmol/L。术后病理均为良性胰岛素瘤。3例术后出现并发症,1例出现胰瘘(A级),2例出现反跳性高血糖。术后住院时间5.0~15.0 d。随访10~43个月,完整切除肿瘤的10例患者,低血糖症状完全消失,无肿瘤复发。结论:胰颈、体尾部表面及适合胰体尾切除的良性胰岛素瘤,腹腔镜下手术切除安全、有效、创伤小,临床可推广应用。Background and Aims:Insulinoma is the most common functional islet-cell tumor of the pancreas,and surgery is the only cure for this condition.With the development of technology and equipment,laparoscopic surgery has been accepted by doctors and patients.This study was conducted to evaluate the feasibility and efficacy of laparoscopic insulinoma enucleation.Methods:The perioperative clinical data and follow-up results of 11 patients who underwent laparoscopic insulinoma resection in the authors’institute from July 2016 to May 2019 were retrospectively analyzed.Results:Among the 11 patients,there were 4 males and 7 females.The patients were aged 21-62 years with an average age of 44.8 years at the time of hospital attendance.The course of disease ranged from 8 d to 4 years,and all patients were diagnosed with insulinoma according to preoperative qualitative and localization examinations.Laparoscopic tumor resection was successfully performed in 10 patients,including tumor enucleation in 8 patients(2 with tumor located in the neck of the pancreas,5 cases in the body,and 2 cases in the tail),and resection of the body and tail of the pancreas in 2 patients(1 case in the body,and 2 cases in the tail).Intraoperative laparoscopic ultrasound examination was performed in all the 11 patients,by which,a total of 11 tumors were detected in 10 cases,and no lesion was found in 1 case,so the operation was aborted.The operative time was 85.0–380.0 min,and intraoperative blood loss was 10.0–530.0 mL.At 30 min after tumor resection,the blood glucose increased by 1.5–2.3 mmol/L;blood glucose was 3.9–10.4 mmol/L on the first postoperative day in the morning,and 2.4–12.8 mmol/L at discharge from hospital.Postoperative pathology reported benign insulinoma for all patients.Postoperative complications occurred in 3 patients,including pancreatic fistula(grade A)in 1 patient and rebound hyperglycemia in 2 patients.The length of postoperative hospital stay was 5.0–15.0 d.Follow-up was conducted for 10 to 43 months,and the hypo

关 键 词：胰岛素瘤 腹腔镜 胰腺切除术 

分 类 号：R735.9[医药卫生—肿瘤]