The surgical management of insulinomas in children.
The surgical management of insulinomas in children.
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DOI：
10.1016/j.jpedsurg.2013.04.022
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发表时间：
2013-12
影响因子：
2.4
通讯作者：
Adzick, N. Scott
中科院分区：
文献类型：
--
作者：
Peranteau, William H.;Palladino, Andrew A.;Bhatti, Tricia R.;Becker, Susan A.;States, Lisa J.;Stanley, Charles A.;Adzick, N. Scott
胰岛素瘤是罕见的儿科肿瘤，其最佳定位研究和治疗尚未确定。我们介绍我们在儿童期胰岛素瘤的手术治疗方面的经验。对 1999 年至 2012 年因胰岛素瘤接受手术治疗的患者进行了回顾性研究。该研究包括 8 名患者。腹部超声、腹部 CT、内窥镜超声或 MRI 术前定位成功的患者分别只有 20%、28.6%、40% 和 50%。 4 名患者的奥曲肽扫描无法诊断。对于诊断失败，选择性利用 18-氟-多巴 PET/CT 扫描、动脉刺激/静脉采样或经肝门静脉采样成功定位胰岛素瘤。术中，通过触诊或术中超声辅助识别所有病变。使用保留胰腺技术（摘除术或远端胰腺切除术）进行手术切除，所有患者均获得治愈。术后并发症包括两名患者出现胰瘘，以及一名需要成功再次手术的 MEN-1 患者漏诊胰岛素瘤。术前肿瘤定位可能需要多种成像方式，以避免盲目胰腺切除术不成功。超声辅助下的术中触诊提供了精确定位胰岛素瘤的可靠方法。完全手术切除可治愈。反复出现的症状需要评估其他病变。
Insulinomas are rare pediatric tumors for which optimal localization studies and management remain undetermined. We present our experience with surgical management of insulinomas during childhood. A retrospective review was performed of patients who underwent surgical management for an insulinoma from 1999 to 2012. The study included eight patients. Preoperative localization was successful with abdominal ultrasound, abdominal CT, endoscopic ultrasound, or MRI in only 20%, 28.6%, 40%, and 50% of patients, respectively. Octreotide scan was non-diagnostic in 4 patients. For diagnostic failure, selective utilization of 18-Fluoro-DOPA PET/CT scanning, arterial stimulation/venous sampling, or transhepatic portal venous sampling were successful in insulinoma localization. Intraoperatively, all lesions were identified by palpation or with the assistance of intraoperative ultrasound. Surgical resection using pancreas sparing techniques (enucleation or distal pancreatectomy) resulted ina cure inall patients. Postoperative complications included a pancreatic fistula in two patients and an additional missed insulinoma in a patient with MEN-1 requiring successful reoperation. Preoperative tumor localization may require many imaging modalities to avoid unsuccessful blind pancreatectomy. Intraoperative palpation with the assistance of ultrasound offers a reliable method to precisely locate the insulinoma. Complete surgical resection results in a cure. Recurrent symptoms warrant evaluation for additional lesions.
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