Grant C S, Charboneau J W, Reading C C, James E M, Galiber A
Department of Surgery, Mayo Clinic, Rochester, Minnesota.
Wien Klin Wochenschr. 1988 May 27;100(11):376-80.
Ideally, surgical exploration for insulinomas would be met with uniform success in both finding and removing the tumor, incurring no postoperative mortality or morbidity. In reality, however, insulinomas remain undetected by even experienced surgeons in 10 to 20% of patients, including present-day series. Additionally, postoperative complications may occur in 10 to 25% of patients, principally related to the pancreatic dissection. Although dispensing with any attempt to preoperatively localize the tumor has been advocated, most authors agree that localization efforts are necessary and helpful. To review the results and surgical implications of current localization techniques, 41 adult patients who were surgically treated for insulinomas at the Mayo Clinic from 1980 through June 1987, were reviewed. Tumor size ranged from 5 mm to 4 cm, and the sensitivity of tumor localization using arteriography, computed tomography, preoperative and intraoperative ultrasonography were 55%, 27%, 59%, and 90%, respectively. Since the introduction of intraoperative ultrasonography into our clinical practice in 1982, all 29 of our adult patients' insulinomas have been identified with a combination of this technique and palpation by an experienced surgeon. There were no false positive interpretations with intraoperative ultrasonography, and tumors were imaged in four patients that were not palpable. In 18 of these 29 (62%) patients, the information gleaned from the images appeared to influence the surgical management. While there is no substitute for exploration by an experienced surgeon, his ability is enhanced by the addition of both preoperative and intraoperative ultrasonography.
理想情况下，对胰岛素瘤进行手术探查应能在发现和切除肿瘤方面取得一致成功，且术后无死亡率或发病率。然而，在现实中，即使是经验丰富的外科医生，在10%至20%的患者（包括当代病例系列）中仍无法检测到胰岛素瘤。此外，10%至25%的患者可能会出现术后并发症，主要与胰腺解剖有关。尽管有人主张放弃术前定位肿瘤的任何尝试，但大多数作者认为定位努力是必要且有帮助的。为了回顾当前定位技术的结果和手术意义，我们对1980年至1987年6月在梅奥诊所接受胰岛素瘤手术治疗的41例成年患者进行了回顾。肿瘤大小从5毫米到4厘米不等，使用动脉造影、计算机断层扫描、术前和术中超声检查对肿瘤定位的敏感性分别为55%、27%、59%和90%。自1982年将术中超声检查引入我们的临床实践以来，我们所有29例成年患者的胰岛素瘤均通过该技术与经验丰富的外科医生触诊相结合得以识别。术中超声检查没有假阳性结果，并且在4例无法触及的患者中对肿瘤进行了成像。在这29例患者中的18例（62%）中，从图像中获得的信息似乎影响了手术管理。虽然经验丰富的外科医生进行探查无可替代，但术前和术中超声检查的加入增强了他（她）的能力。
