Iihara Masatoshi, Obara Takao
Department of Endocrine Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Biomed Pharmacother. 2002;56 Suppl 1:227s-230s. doi: 10.1016/s0753-3322(02)00238-x.
Pancreatic insulinomas are mostly benign and solitary tumors. Successful management of patients with insulinoma relies on accurate localization of the tumors and the use of appropriate surgical techniques. However, preoperative radiological imaging studies often fail to localize the insulinomas because of the small tumor sizes. Conventional intraoperative ultrasonography combined with palpation has been widely used as the best localization tool. Since contact ultrasonography, a new technique for localizing pancreatic lesions, became available as a laparoscopic study, several surgeons have utilized laparoscopy for not only localization but also resection of insulinomas. Previous reports of laparoscopic ultrasonography for intraoperative identification of insulinomas showed a 100% success rate in cases with insulinoma localized by preoperative imaging studies, but a less satisfactory rate in cases with occult insulinoma. Laparoscopic resection of insulinomas located in the head of the pancreas is often difficult because of its anatomical relationship with important adjacent structures such as pancreatic duct and mesenteric vessels. In contrast, insulinomas located in the body or tail of the pancreas are laparoscopically resectable even when they are in close proximity to the major pancreatic duct. Laparoscopic procedure is a feasible technique with low morbidity for surgical management of insulinomas. Accurate preoperative localization is essential for safe performance of this minimally invasive procedure.
胰腺胰岛素瘤大多为良性孤立性肿瘤。胰岛素瘤患者的成功治疗依赖于肿瘤的精确定位以及适当手术技术的应用。然而，由于肿瘤体积小，术前影像学检查常常无法定位胰岛素瘤。传统的术中超声检查结合触诊已被广泛用作最佳定位工具。自从接触式超声检查这一用于定位胰腺病变的新技术作为一种腹腔镜检查手段出现后，一些外科医生已将腹腔镜用于胰岛素瘤的定位及切除。先前关于腹腔镜超声检查用于术中识别胰岛素瘤的报告显示，术前影像学检查已定位胰岛素瘤的病例成功率为100%，但隐匿性胰岛素瘤病例的成功率则不太令人满意。由于位于胰头的胰岛素瘤与诸如胰管和肠系膜血管等重要相邻结构存在解剖关系，其腹腔镜切除往往很困难。相比之下，位于胰体或胰尾的胰岛素瘤即使紧邻主胰管，也可通过腹腔镜切除。腹腔镜手术是一种可行的技术，用于胰岛素瘤的外科治疗时发病率较低。准确的术前定位对于安全实施这种微创手术至关重要。
