Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection.
Incidence and management of postoperative hyperglycemia in patients undergoing insulinoma resection.
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DOI：
10.1007/s12020-018-1633-1
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发表时间：
2018-09
期刊：
影响因子：
3.7
通讯作者：
Kebebew E
中科院分区：
文献类型：
--
作者：
Nockel P;Tirosh A;El Lakis M;Gaitanidis A;Merkel R;Patel D;Nilubol N;Sadowski SM;Cochran C;Gorden P;Kebebew E
有研究认为，胰岛素瘤切除后出现的反弹性高血糖是一种生化治疗方法。然而，文献中缺乏关于胰岛素瘤切除术患者高血糖发生率和干预需求的客观数据。我们研究的目的是评估术后高血糖的发生率，任何诱发因素，以及在一项前瞻性队列研究中对所有接受常规血糖监测的患者进行干预的必要性。回顾性分析33例胰岛素瘤切除术患者，术后常规血糖监测（前6小时每小时一次，后24小时每4小时一次）。高血糖定义为葡萄糖大于180 mg/dL （10 mmol/l）。12例（36%）患者在24小时（1-16小时）内出现高血糖。在高血糖患者中，平均最高血浆葡萄糖水平为221.5 mg/dL（范围97-325 mg/dL） （12.3 mmol/l）， 4例（33%）患者接受胰岛素治疗。发生高血糖的患者和未发生高血糖的患者在年龄、性别、体重指数（BMI）、肿瘤大小、生化特征、手术方式和胰切除术程度方面没有显著差异。对33例患者中的14例进行手术前和手术后的胰岛素水平评估。术中胰岛素水平的下降百分比在发生高血糖的患者和未发生高血糖的患者之间没有显著差异。所有术后高血糖患者血糖水平均恢复正常，出院时均未使用抗高血糖药物。胰岛素瘤切除术后高血糖是常见的，一部分患者需要短暂的胰岛素治疗。
It has been proposed that rebound hyperglycemia after resection of insulinoma indicates a biochemical cure. However, there is scant objective data in the literature on the rate and need for intervention in hyperglycemia in patients undergoing resection of insulinoma. The goal of our study was to evaluate the rate of postoperative hyperglycemia, any predisposing factors, and the need for intervention in a prospective cohort study of all patients undergoing routine glucose monitoring. A retrospective analysis of 33 patients who had an insulinoma resected and who underwent routine postoperative monitoring of blood glucose (every hour for the first six hours then every four hours for the first 24 h) was performed. Hyperglycemia was defined as glucose greater than 180 mg/dL (10 mmol/l). Twelve patients (36%) developed hyperglycemia within 24 h (range 1–16 h). In patients with hyperglycemia, the mean maximum plasma glucose level was 221.5 mg/dL (range 97–325 mg/dL) (12.3 mmol/l), and four (33%) patients were treated with insulin. There was no significant difference in age, gender, body mass index (BMI), tumor size, biochemical profile, or surgical approach and extent of pancreatectomy between patients who developed hyperglycemia and those who did not. Pre-excision and post-excision intraoperative insulin levels were evaluated in 14 of 33 patients. The percentage decrease of the intraoperative insulin levels was not significantly different between patients who developed hyperglycemia and those who did not. All patients with postoperative hyperglycemia had normalization of their glucose levels, and none were discharged on anti-hyperglycemic agents. Hyperglycemia is common after insulinoma resection, and a subset of patients require transient treatment with insulin.
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