Grygiel Katarzyna, Szmidt Jacek, Jeleńska Magdalena, Pawlak Katarzyna
Department of General, Vascular and Transplant Surgery, Warsaw Medical University.
Pol Przegl Chir. 2012 Jan;84(1):31-6. doi: 10.2478/v10035-012-0005-4.
Endogenic hyperinsulinism is mainly caused by neuroendocrine tumors (insulinomas) which autonomously secrete insulin. Because the symptoms are often aspecific, a considerably delay in diagnosis occurs. The treatment consists of operative removal of the tumor from the pancreas, preceded by pre-operative localization. In this article we describe our experience with surgical removal of insulinomas.
We retrospectively analyzed all patients with insulinoma which were treated in our center. Definitive diagnosis was made using a 72-hours glucoses fasting test. We describe the symptoms, localization techniques and the outcomes after surgery.
Between January 2002 and May 2011, 45 patients (35.6% men and 64.4% female) were treated in our center. The most prevalent symptoms were altered consciousness and general malaise. The combination of CT-scan and endoscopic ultrasound had the highest (90%) sensitivity to localize tumors pre-operatively. During surgery, in 40 patients (89%) the tumor could be removed by enucleation. In the other five patients partial pancreas resection was required. In 22 patients (49%) we used intra-operative insulin level measurements to confirm complete tumor resection. Within the first month after surgery, two patients (4.4%) developed acute pancreatitis, four patients (8.8%) developed a pancreatic fistula. One patient died of multi-organ-failure. All patients were free from symptoms of hyperinsulinism after the surgery and after a median follow-up of 4.5 years.
Based on the experience with 45 patients, surgical removal, aided by pre-operative localization with CT and endoscopic ultrasonography, is an effective and safe treatment for insulinomas.
内源性高胰岛素血症主要由自主分泌胰岛素的神经内分泌肿瘤（胰岛素瘤）引起。由于症状通常缺乏特异性，诊断往往会出现相当大的延迟。治疗方法是在术前定位后，通过手术从胰腺中切除肿瘤。在本文中，我们描述了我们手术切除胰岛素瘤的经验。
我们回顾性分析了在本中心接受治疗的所有胰岛素瘤患者。通过72小时葡萄糖禁食试验进行明确诊断。我们描述了症状、定位技术和手术后的结果。
2002年1月至2011年5月，本中心共治疗了45例患者（男性占35.6%，女性占64.4%）。最常见的症状是意识改变和全身不适。CT扫描和内镜超声联合使用在术前定位肿瘤方面具有最高（90%）的敏感性。手术中，40例患者（89%）的肿瘤可以通过剜除术切除。其他5例患者需要进行部分胰腺切除术。22例患者（49%）术中使用胰岛素水平测量来确认肿瘤完全切除。术后第一个月内，2例患者（4.4%）发生急性胰腺炎，4例患者（8.8%）发生胰瘘。1例患者死于多器官功能衰竭。所有患者术后均无高胰岛素血症症状，中位随访4.5年。
基于45例患者的经验，在CT和内镜超声术前定位的辅助下，手术切除是治疗胰岛素瘤的一种有效且安全的方法。
