Mehrabi Arianeb, Fischer Lars, Hafezi Mohammadreza, Dirlewanger Antje, Grenacher Lars, Diener Markus K, Fonouni Hamidreza, Golriz Mohammd, Garoussi Camelia, Fard Nassim, Rahbari Nuh N, Werner Jens, Büchler Markus W
From the Departments of *General, Visceral, and Transplantation Surgery, †Radiology, and ‡Anesthesiology, University of Heidelberg, Heidelberg, Germany.
Pancreas. 2014 Jul;43(5):675-86. doi: 10.1097/MPA.0000000000000110.
Insulinoma with an incidence of 0.4% is a rare pancreatic tumor. Preserving surgery is the treatment of choice. Exact localization is necessary to plan the appropriate approach. This article gives an overview on localization and surgical strategies for treatment of insulinoma.
In this systematic review, 114 articles with 6222 cases of insulinoma were reviewed with emphasis on localization techniques and surgical treatment.
Insulinoma happens mostly in the fifth decade of life, with a higher incidence in men. They occur mostly sporadic (94%), benign (87%), and single (90%). Insulinomas are mostly smaller than 20 mm (84%). The tumors are distributed almost equally in the pancreas.
Computed tomography is routinely used as first choice preoperatively. Intraoperative inspection, palpation, and sonography were applied with high success rate. Intraoperative sonography is considered as the most reliable technique. Enucleation is the most administered type of surgery (56%). Different types of resection include distal pancreatectomy (32%), Whipple procedure (3%), and subtotal pancreatectomy (<3%). Despite the development of laparoscopy, open approach is the favorite method (90%). The most common surgical complication is fistula. The mortality rate of open approach was higher (4 vs 0%). Despite high cure rate, recurrence of insulinoma occurs in 7% after surgery.
胰岛素瘤发病率为0.4%，是一种罕见的胰腺肿瘤。保留性手术是首选治疗方法。精确的定位对于规划合适的手术方式很有必要。本文概述了胰岛素瘤的定位及手术治疗策略。
在这项系统评价中，对114篇包含6222例胰岛素瘤病例的文章进行了综述，重点关注定位技术和手术治疗。
胰岛素瘤多发生于50岁左右，男性发病率较高。它们大多为散发性（94%）、良性（87%）且为单发（90%）。胰岛素瘤大多小于20mm（84%）。肿瘤在胰腺内分布几乎均等。
计算机断层扫描通常作为术前首选。术中检查、触诊及超声检查成功率较高。术中超声被认为是最可靠的技术。摘除术是最常用的手术方式（56%）。不同类型的切除术包括胰体尾切除术（32%）、惠普尔手术（3%）及胰腺次全切除术（<3%）。尽管腹腔镜技术有所发展，但开放手术仍是最常用的方法（90%）。最常见的手术并发症是瘘。开放手术的死亡率较高（4%对0%）。尽管治愈率较高，但胰岛素瘤术后复发率为7%。
