Laparoscopic localization and resection of insulinomas
Laparoscopic localization and resection of insulinomas
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DOI：
10.1001/archsurg.139.3.270
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发表时间：
2004-03-01
影响因子：
--
通讯作者：
Schlinkert, DK
中科院分区：
文献类型：
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作者：
Jaroszewski, DE;Schlinkert, RT;Schlinkert, DK
假设：腹腔镜定位和切除胰岛素瘤是可行的和安全的，并可能减少发病率和住院时间。设计：通过回顾性病历审查确定的病例系列。设置：马约诊所，斯科茨代尔，亚利桑那州和罗切斯特，明尼苏达州，一个单一的机构三级医疗中心。患者：9例患者（6名男性和3名女性;平均年龄54岁），他们在1997年9月至2002年4月期间尝试进行腹腔镜胰岛素瘤切除术。胰腺胰岛素瘤的腹腔镜定位和切除。主要结果测量：术中。结果：术前定位成功5例（56%）。由于无法识别肿瘤（n=3）或由于靠近门静脉（n=1）而无法进行安全的腹腔镜切除术，需要4例转为开放探查。腹腔镜术中超声检查有助于识别5例患者中的4例（80%）的病变（平均肿瘤大小，2.1 cm）; 3例患者成功进行了腹腔镜切除术。腹腔镜切除术后的平均住院时间较短（4.5 vs 7.0天，无并发症病例）。在随访（平均，29个月，范围，3-57个月），1例接受腹腔镜眼球摘除术的患者有复发性低血糖症。结论：腹腔镜定位和切除胰岛素瘤是可行的，安全的。腹腔镜超声辅助胰岛素瘤成功定位和腹腔镜切除。术前定位是不需要的，但以前的肿瘤位置的知识有助于集中术中超声和限制胰腺动员。排除胰漏患者（两组均观察到），使用腹腔镜胰岛素瘤切除术可缩短住院时间和恢复时间。
Hypothesis: Laparoscopic localization and resection of insulinomas are feasible and safe and may decrease morbidity and the length of hospitalization.Design: Case series identified through retrospective medical record review.Setting: Mayo Clinic, Scottsdale, Ariz, and Rochester, Minn, a single-institution tertiary care medical center.Patients: Nine patients (6 men and 3 women; mean age, 54 years) who underwent attempted laparoscopic insulinoma resection between September, 1997, and April, 2002.Interventions: Laparoscopic localization and resection of insulinoma tumors of the pancreas.Main Outcome Measures: Intraoperative. complications, conversion to open laparotomy, and length of hospitalization.Results: Preoperative localization was successful in 5 patients (56%). Four conversions to open exploration were required because of an inability to identify the tumor (n=3) or to perform a safe laparoscopic resection owing to proximity to the portal vein (n=1). Laparoscopic intraoperative ultrasonography facilitated identification of lesions (mean tumor size, 2.1 cm) in 4 (80%) of 5 patients; 3 patients underwent successful laparoscopic resection. Average hospital stay was shorter after laparoscopic resection (4.5 vs 7.0 days in uncomplicated cases). At follow-up (mean, 29 months; range, 3-57 months), 1 patient who underwent laparoscopic enucleation had recurrent hypoglycemia.Conclusions: Laparoscopic localization and resection of insulinomas are feasible and safe. Laparoscopic ultrasound aids successful insulinoma localization and laparoscopic resection. Preoperative localization is not required, but previous knowledge of tumor location helps focus intraoperative ultrasound and limit pancreatic mobilization. Excluding patients with pancreatic leaks (observed in both groups), hospital stay and time to recovery may be shortened by using laparoscopic insulinoma resection.