Nakamura Yoshiharu, Matsushita Akira, Katsuno Akira, Yamahatsu Kazuya, Sumiyoshi Hiroki, Mizuguchi Yoshiaki, Uchida Eiji
Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan.
Asian J Endosc Surg. 2015 Aug;8(3):303-9. doi: 10.1111/ases.12187. Epub 2015 Apr 14.
Insulinoma is a very serious functional tumor. Surgeons should confirm complete resection of insulinomas before completing the operation, even in laparoscopic surgery.
Between August 2007 and September 2014, 15 consecutive patients with biochemical evidence of an insulinoma underwent laparoscopic pancreatectomy. Intraoperatively, a peripheral arterial blood sample was taken, and insulin was measured by quick insulin assay. Insulin levels were determined before anesthesia induction, every 30 min thereafter, and every 30 min for at least 1 h after tumor resection to confirm insulin levels did not increase before surgery was completed.
All 15 patients (3 men and 12 women, average age 57.2 years) successfully underwent laparoscopic resection. One patient had two tumors, and the remaining 14 patients had one tumor each (three in the head, five in the body, and eight in the tail of the pancreas). Preoperative localization and regionalization studies identified the tumor correctly through CT (12/15 [80.0%]), MRI (9/12 [75.0%]), angiography (11/13 [84.6%]), endoscopic ultrasonography (7/10 [70.0%]), and selective arterial calcium injection (14/14 [100%]). Intraoperative ultrasonography detected 13 of 15 tumors (86.7%), and intraoperative blood insulin monitoring confirmed the complete resection of 16 of 16 tumors (100%). All patients were discharged with normal insulin levels and have been followed up for 3-88 months. There has been no recurrence of symptoms in any patients and none has died.
Complete removal of an insulinoma can be reliably predicted by intraoperative blood insulin monitoring even in laparoscopic pancreatectomies.
胰岛素瘤是一种非常严重的功能性肿瘤。即使在腹腔镜手术中，外科医生在完成手术前也应确认胰岛素瘤已被完全切除。
2007年8月至2014年9月期间，15例有胰岛素瘤生化证据的连续患者接受了腹腔镜胰腺切除术。术中采集外周动脉血样本，通过快速胰岛素测定法测量胰岛素。在麻醉诱导前、此后每30分钟以及肿瘤切除后至少1小时内每30分钟测定胰岛素水平，以确认在手术完成前胰岛素水平没有升高。
所有15例患者（3例男性和12例女性，平均年龄57.2岁）均成功接受了腹腔镜切除术。1例患者有两个肿瘤，其余14例患者各有一个肿瘤（胰头3个、胰体5个、胰尾8个）。术前定位和分区研究通过CT（12/15 [80.0%]）、MRI（9/12 [75.0%]）、血管造影（11/13 [84.6%]）、内镜超声检查（7/10 [70.0%]）和选择性动脉钙注射（14/14 [100%]）正确识别了肿瘤。术中超声检查发现了15个肿瘤中的13个（86.7%），术中血胰岛素监测确认16个肿瘤全部被完全切除（100%）。所有患者出院时胰岛素水平正常，已随访3 - 88个月。所有患者均无症状复发，也无死亡病例。
即使在腹腔镜胰腺切除术中，通过术中血胰岛素监测也能可靠地预测胰岛素瘤是否被完全切除。
