Mcclaran Janet Kovak, Pavia Philippa, Fischetti Anthony J, Donovan Taryn A
From the Animal Medical Center, New York, New York.
J Am Anim Hosp Assoc. 2017 Nov/Dec;53(6):338-345. doi: 10.5326/JAAHA-MS-6417. Epub 2017 Sep 11.
Laparoscopic partial pancreatectomy has been performed in experimental canine studies and has been evaluated in human medicine but has not been reported in a clinical veterinary case. The authors present a 9 yr old field spaniel with weakness and hypoglycemia with insulin levels and Amended Insulin: Glucose Ratio results equivocal for a pancreatic insulinoma. Multiple abdominal ultrasounds did not detect the tumor, yet dual-phase computed tomographic angiography revealed the presence of a focal hypoattenuating nodule in the left lobe of the pancreas. A 3-port laparoscopic approach to the abdomen confirmed a 1.5-cm mass in the mid-left limb of the pancreas, and resection of the mass was performed with a bipolar vessel-sealing device. The surgery was performed without complication, and the dog became normoglycemic within 4 hr following surgery. Final histopathology results revealed pancreatic neuroendocrine carcinoma of the β cells. Recurrence of hypoglycemia was noted 18 mo postoperatively; however, repeat computed tomographic angiography did not reveal pancreatic abnormalities and fine needle aspirates of liver nodules did not suggest metastatic disease. Medical management was elected and the patient was euthanized 28 mo after surgery due to refractory hypoglycemic seizures.
腹腔镜部分胰腺切除术已在实验犬研究中开展，并在人类医学中进行了评估，但尚未见临床兽医病例报告。作者报告了一例9岁的田野猎犬，出现虚弱和低血糖症状，胰岛素水平及修正胰岛素：葡萄糖比值结果对于胰腺胰岛素瘤来说模棱两可。多次腹部超声未检测到肿瘤，但双期计算机断层血管造影显示胰腺左叶存在一个局灶性低密度结节。采用三孔腹腔镜入腹方法证实胰腺左中肢有一个1.5厘米的肿块，使用双极血管封闭装置切除了该肿块。手术顺利，无并发症，术后4小时内犬的血糖恢复正常。最终组织病理学结果显示为β细胞胰腺神经内分泌癌。术后18个月出现低血糖复发；然而，重复计算机断层血管造影未发现胰腺异常，肝脏结节的细针穿刺抽吸未提示转移性疾病。选择了药物治疗，术后28个月患者因难治性低血糖惊厥而实施安乐死。
