The Congenital Hyperinsulinism Center and the Department of Surgery at the Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
J Pediatr Surg. 2013 Dec;48(12):2517-24. doi: 10.1016/j.jpedsurg.2013.04.022.
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 in a cure in all 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.
胰岛素瘤是罕见的儿科肿瘤，其最佳定位研究和管理仍未确定。我们介绍了我们在儿童时期对胰岛素瘤进行手术治疗的经验。
对 1999 年至 2012 年间接受手术治疗的胰岛素瘤患者进行了回顾性研究。
该研究包括 8 名患者。术前定位在仅 20%、28.6%、40%和 50%的患者中分别通过腹部超声、腹部 CT、内镜超声或 MRI 成功定位，奥曲肽扫描在 4 名患者中无诊断价值。对于诊断失败，选择性使用 18-氟-DOPA PET/CT 扫描、动脉刺激/静脉取样或经肝门静脉取样成功定位胰岛素瘤。术中，所有病变均通过触诊或术中超声协助识别。使用保留胰腺技术（剜除术或胰体尾切除术）进行手术切除后，所有患者均治愈。术后并发症包括 2 例胰瘘和 1 例 MEN-1 患者术后漏诊胰岛素瘤，需要再次成功手术。
术前肿瘤定位可能需要多种影像学方法，以避免盲目性胰切除术失败。术中超声辅助触诊提供了一种可靠的方法，可以准确定位胰岛素瘤。完全手术切除可治愈。复发症状需要评估是否有其他病变。
