Division of Gastroenterologic and General Surgery, Mayo Clinic, Rochester, MN 55905, USA.
World J Surg. 2011 Apr;35(4):785-9. doi: 10.1007/s00268-011-0970-5.
Laparoscopic insulinoma resection (LIR) for sporadic disease is increasingly supported as a feasible and safe operation in small series of patients. To determine whether LIR is an acceptable alternative to the open operation, it is necessary to compare LIR to historical controls. The purpose of this study was to identify the skills and technology needed for LIR and establish outcome standards.
A database of patients with benign sporadic insulinoma who underwent an open procedure at the Mayo Clinic was reviewed for demographics, imaging, operative/pathology reports, and outcomes. Outcomes were compared to a world-wide meta-analysis of patients who had undergone LIR reported in the English literature between 1996 and 2009.
Two hundred fifteen patients underwent a primary open operation for benign sporadic insulinoma. Solitary tumors were found in 97%. Meta-analysis identified 232 patients who underwent LIR. The open and LIR groups underwent comparable operations that included enucleations (64 vs. 68%) and distal pancreatectomies (28 vs. 35%) (p = 0.06). The mean estimated blood loss, operating time, and length of stay were comparable between the open and LIR groups (p = NS). Pancreatic fistula occurred more often in the LIR group (24 vs. 11%, p < 0.05). A curative operation was performed in 98% of control patients and in 99% of the LIR group (p = NS).
Multiple insulinomas are rare and a focused resection guided by imaging may be performed. LIR is associated with an increased incidence of pancreatic fistula. Success of LIR will depend on accurate multimodality preoperative imaging, skilled use of lap-US to replace palpation for localization, and safe methods to dissect the tumor adjacent to the pancreatic duct.
腹腔镜胰岛素瘤切除术（LIR）治疗散发性疾病在小系列患者中已越来越被认为是一种可行且安全的手术。为了确定 LIR 是否是开放式手术的可接受替代方法，有必要将 LIR 与历史对照进行比较。本研究的目的是确定 LIR 所需的技能和技术，并建立结果标准。
对梅奥诊所接受开放式手术治疗良性散发性胰岛素瘤的患者的数据库进行了回顾，以了解患者的人口统计学、影像学、手术/病理报告和结果。结果与 1996 年至 2009 年期间发表在英文文献中的 LIR 患者的全球荟萃分析进行了比较。
215 例患者接受了原发性开放式手术治疗良性散发性胰岛素瘤。97%的患者发现为单发肿瘤。荟萃分析确定了 232 例接受 LIR 的患者。开放式和 LIR 组接受了类似的手术，包括肿瘤剜除术（64%对 68%）和远端胰腺切除术（28%对 35%）（p = 0.06）。开放式和 LIR 组的平均估计出血量、手术时间和住院时间相似（p = NS）。LIR 组的胰瘘发生率更高（24%对 11%，p < 0.05）。对照组患者中有 98%的患者进行了根治性手术，而 LIR 组有 99%的患者进行了根治性手术（p = NS）。
多发胰岛素瘤很少见，可通过影像学引导进行有针对性的切除术。LIR 与胰瘘的发生率增加有关。LIR 的成功将取决于术前准确的多模态影像学检查、熟练使用腹腔镜超声（lap-US）代替触诊进行定位以及安全地分离与胰管相邻的肿瘤的方法。
