de Carbonnières Anne, Challine Alexandre, Cottereau Anne Ségolène, Coriat Romain, Soyer Philippe, Abou Ali Einas, Prat Frédéric, Terris Benoit, Bertherat Jérôme, Dousset Bertrand, Gaujoux Sébastien
Department of Digestive, Hepato-biliary and Endocrine Surgery, Cochin Hospital, APHP, 75014 Paris, France; Université de Paris, 75006 Paris, France.
Université de Paris, 75006 Paris, France; Department of Nuclear Medicine, Cochin Hospital, APHP, 75014 Paris, France.
HPB (Oxford). 2021 Dec;23(12):1799-1806. doi: 10.1016/j.hpb.2021.04.013. Epub 2021 Apr 27.
This paper reports our experience of the perioperative management of patients with sporadic, non-malignant, pancreatic insulinoma.
A retrospective monocentric cohort study was performed from January 1989 to July 2019, including all the patients who had been operated on for pancreatic insulinoma. The preoperative work-up, surgical management, and postoperative outcome were analyzed.
Eighty patients underwent surgery for sporadic pancreatic insulinoma, 50 of which were female (62%), with a median age of 50 (36-70) years. Preoperatively, the tumors were localized in 76 patients (95%). Computed tomography (CT) and magnetic resonance imaging allowed exact preoperative tumor localization in 76% of the patients (64-85 and 58-88 patients, respectively), increasing to 96% when endoscopic ultrasonography was performed. Forty-one parenchyma-sparing pancreatectomies (PSP) (including enucleation, caudal pancreatectomy, and uncinate process resection) and 39 pancreatic resections were performed. The mortality rate was 6% (n = 5), with a morbidity rate of 72%, including 24 severe complications (30%) and 35 pancreatic fistulas (44%). No differences were found between formal pancreatectomy and PSP in terms of postoperative outcome procedures. The surgery was curative in all the patients.
CT used in combination with endoscopic ultrasonography allows accurate localization of insulinomas in almost all patients. When possible, a parenchyma-sparing pancreatectomy should be proposed as the first-line surgical strategy.
本文报告了我们对散发性、非恶性胰腺胰岛素瘤患者围手术期管理的经验。
进行了一项回顾性单中心队列研究，时间跨度为1989年1月至2019年7月，纳入所有接受胰腺胰岛素瘤手术的患者。分析术前检查、手术管理及术后结果。
80例患者接受散发性胰腺胰岛素瘤手术，其中50例为女性（62%），中位年龄50（36 - 70）岁。术前，76例患者（95%）肿瘤得以定位。计算机断层扫描（CT）和磁共振成像分别使76%的患者（分别为64 - 85例和58 - 88例）术前肿瘤得以精确定位，行内镜超声检查后这一比例增至96%。实施了41例保留实质的胰腺切除术（PSP）（包括摘除术, 胰尾切除术及钩突切除术）和39例胰腺切除术。死亡率为6%（n = 5），发病率为72%，包括24例严重并发症（30%）和35例胰瘘（44%）。在术后结果方面，根治性胰腺切除术和PSP之间未发现差异。所有患者手术均治愈。
CT联合内镜超声检查几乎可使所有患者的胰岛素瘤得到精确定位。如有可能，应将保留实质的胰腺切除术作为一线手术策略。
