Sharma Ajay, Varshney Peeyush, Kasliwal Rajeev, Nagar Anand, Venkatatelikicherla Krishnavardhan, Sarin Shashwat, Choubey R P, Kapoor V K
Department of Surgical Gastroenterology, Mahatma Gandhi Medical College and Hospital, Jaipur, 302022 India.
Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Jodhpur, 342005 India.
Indian J Surg Oncol. 2022 Jun;13(2):403-411. doi: 10.1007/s13193-022-01534-6. Epub 2022 Apr 26.
Insulinoma is the commonest functioning pancreatic neuroendocrine tumor. The only curative treatment is surgical excision after preoperative localization. A retrospective analysis of nine patients (February 2017-June 2020), 2 males and 7 females, was done for clinical presentation, biochemistry, localization methods, intraoperative findings, postoperative outcome, histopathology reports, and follow-up. Techniques for localization of the tumor were pancreatic protocol triple-phase multi-detector computed tomography (MDCT), endoscopic ultrasound (EUS), Ga 68 DOTANOC PET-CT, and Ga 68 NOTA-exendin-4 PET-CT (GLP1R scan). The mean age was 38 (range 20-68) years and mean duration of symptoms 34 (range 8-120) months, and symptoms of Whipple's triad were present in all cases after a supervised 72-h fast. MDCT localized tumor in 8/9 cases. EUS before MDCT in one patient had also localized tumors. Ga 68 DOTANOC PET-CT detected tumor in 2/4 patients. In one patient, MDCT or DOTANOC PET scan could not localize tumor; GLP1R scan localized tumor accurately. Two patients had associated MEN1 syndrome. All 9 patients underwent surgical resection (four open and five laparoscopic) of tumor-enucleation (3), distal pancreatectomy with splenectomy (3), and pancreatoduodenectomy (PD) (3). The last four procedures and all three enucleations were laparoscopic. Five patients developed postoperative pancreatic fistula (POPF), only one grade B which required percutaneous drain placement. One patient, who had initial open enucleation, developed hypoglycemia after 48 h; PD was performed. All patients were cured and all, except one (who died of upper GI bleed), were alive and disease-free during a mean follow-up of 26 (range 2-41) months. Preoperative localization of insulinoma is important and decides the outcome of surgery in terms of cure. MDCT can localize tumors in most patients; the last resort for localization is the GLP1R scan. Laparoscopic procedures are equally effective compared to open surgery. Considering the benign nature of the disease, enucleation is the procedure of choice.
胰岛素瘤是最常见的功能性胰腺神经内分泌肿瘤。唯一的根治性治疗方法是术前定位后进行手术切除。对9例患者（2017年2月至2020年6月）进行了回顾性分析，其中男性2例，女性7例，分析内容包括临床表现、生化指标、定位方法、术中发现、术后结果、组织病理学报告及随访情况。肿瘤定位技术包括胰腺协议三相多排螺旋计算机断层扫描（MDCT）、内镜超声（EUS）、Ga 68 DOTANOC正电子发射断层显像/X线计算机体层成像（PET-CT）以及Ga 68 NOTA-艾塞那肽-4 PET-CT（GLP1R扫描）。平均年龄为38岁（范围20 - 68岁），平均症状持续时间为34个月（范围8 - 120个月），所有病例在72小时禁食监测后均出现了Whipple三联征的症状。MDCT在9例中的8例中定位到了肿瘤。1例患者在MDCT检查前的EUS检查也定位到了肿瘤。Ga 68 DOTANOC PET-CT在4例患者中的2例中检测到了肿瘤。1例患者，MDCT或DOTANOC PET扫描未能定位到肿瘤；GLP1R扫描准确地定位到了肿瘤。2例患者伴有多发性内分泌腺瘤1型（MEN1）综合征。所有9例患者均接受了肿瘤摘除术（3例）、远端胰腺切除术加脾切除术（3例）以及胰十二指肠切除术（PD）（3例）的手术切除（4例开腹手术和5例腹腔镜手术）。最后4例手术及所有3例摘除术均为腹腔镜手术。5例患者发生了术后胰瘘（POPF），仅1例为B级，需要经皮放置引流管。1例最初接受开腹摘除术的患者在48小时后出现低血糖；进行了PD手术。所有患者均治愈，除1例死于上消化道出血外，其余患者在平均26个月（范围2 - 41个月）的随访期间均存活且无疾病复发。胰岛素瘤的术前定位很重要，并且在治愈方面决定了手术的结果。MDCT可在大多数患者中定位肿瘤；最后的定位手段是GLP1R扫描。与开腹手术相比，腹腔镜手术同样有效。考虑到该疾病的良性性质，摘除术是首选的手术方式。
