2nd Surgical Department and Surgical Oncology Unit of "Korgialenio-Benakio", Red Cross Hospital, 11 Mantzarou str., Neo Psychiko, 15451, Athens, Greece.
J Gastrointest Surg. 2009 Oct;13(10):1869. doi: 10.1007/s11605-009-0954-z. Epub 2009 Jul 18.
Insulinomas, benign in the vast majority, are the prevailing pancreatic endocrine tumors amenable to surgical resection which is beneficial in most instances. This study aimed to compare the results of laparoscopic vs. open surgery enucleation of insulinomas.
From October 1999 to June 2008, 12 case series of enucleation for benign insulinoma in the body and tail of the pancreas were identified through retrospective review of medical records. Main outcome measures were recurrent hypoglycemia, conversion to open procedure, complications, and length of hospital stay.
Seven patients were addressed with open and five with laparoscopic procedure. Mean age was 55 years (36-69). Lesions were identified preoperatively (via computed tomography and endoscopic ultrasonography) in 5/7 in the open and 4/5 in the laparoscopic group. Intraoperative ultrasound identified the rest of insulinomas. One conversion to the open approach was mandatory because the insulinoma was resting on the portal vein. The mean operative time and hospital stay was 92 min (66-126)/14 days (11-22) for the open and 121 min (89-187)/11 days (5-18) for the laparoscopic procedure (including conversion) (p < 0.5 in both comparisons). Pancreatic fistula rate was respectively 28.57% (2/7) and 20% (1/5) (p = 0.65). Mortality was nil. Mean follow-up was 54 months (3-109). Recurrent hypoglycemia was documented in one patient of the laparoscopic group (p = 0.46) but blood glucose concentrations remained stable with diazoxide.
Laparoscopic insulinoma enucleation seems to be a feasible and safe approach associated with reduction in hospital stay and comparable rates of pancreatic fistula in relation to open surgery.
胰岛素瘤绝大多数为良性，是可通过手术切除的主要胰腺内分泌肿瘤，大多数情况下手术切除是有益的。本研究旨在比较腹腔镜与开腹胰岛细胞瘤切除术的结果。
通过回顾性病历审查，我们于 1999 年 10 月至 2008 年 6 月期间确定了 12 例胰岛细胞瘤切除术的病例系列。主要的观察指标是低血糖复发、转为开放手术、并发症和住院时间。
7 例患者采用开腹手术，5 例患者采用腹腔镜手术。患者的平均年龄为 55 岁（36-69 岁）。7 例开腹手术中有 5 例（71.43%）和 5 例腹腔镜手术中有 4 例（80%）术前通过计算机断层扫描和内镜超声检查发现病变。术中超声发现了其余的胰岛素瘤。因为胰岛素瘤位于门静脉上，有 1 例必须转为开腹手术。开腹手术的平均手术时间和住院时间分别为 92 分钟（66-126 分钟）和 14 天（11-22 天），腹腔镜手术（包括中转开腹）的平均手术时间和住院时间分别为 121 分钟（89-187 分钟）和 11 天（5-18 天）（两者比较均 P < 0.05）。胰瘘发生率分别为 28.57%（2/7）和 20%（1/5）（P = 0.65）。无死亡病例。平均随访时间为 54 个月（3-109 个月）。腹腔镜组有 1 例患者出现低血糖复发（P = 0.46），但经二氮嗪治疗后血糖浓度稳定。
腹腔镜胰岛细胞瘤切除术是一种可行且安全的方法，与开腹手术相比，它可缩短住院时间，胰瘘发生率相似。
