Department of Gastroenterological Surgery, Fujita Health University School of Medicine, Bantane Hospital Department of Surgery, 3-6-10 Otobashi, Nakagawa-ku, Aichi Prefecture, 454-8509, Japan.
Clin J Gastroenterol. 2022 Oct;15(5):1012-1017. doi: 10.1007/s12328-022-01679-5. Epub 2022 Aug 15.
A 50-year-old woman was hospitalized for fainting caused by hypoglycemia. Her blood glucose level was low (40 mg/dL), immunoreactive insulin was 16.9 μU/mL, and C-peptide level was high (4.8 ng/mL). Computed tomography and magnetic resonance imaging revealed a 7-mm tumor in the uncinate process of the pancreas. A selective arterial calcium injection test indicated an increase in the superior mesenteric artery. Insulinoma of the uncinate process of the pancreas was diagnosed, and tumor enucleation was planned using an artificial pancreas for intraoperative and postoperative blood glucose control. Hypoglycemia (blood glucose, 38 mg/dL) was observed from the onset of surgery. An artificial pancreas cannot be used if the blood glucose level is ≤ 70 mg/dL; thus, continuous glucose infusion was administered. The sudden rise in blood glucose prompted insulin infusion from the device, causing hypoglycemia. Controlling blood glucose levels is challenging when introducing the artificial pancreas. However, altering the device's blood glucose control algorithm controlled the fluctuating blood glucose level, and, intraoperative average blood glucose was raised to 94.8 ± 21.1 mg/dL, thereby avoiding hypoglycemia, that is, a blood glucose level of ≤ 70 mg/dL. We report a case in which an artificial pancreas was used for glycemic control during surgery for an insulinoma.
一位 50 岁女性因低血糖引起的晕厥住院。她的血糖水平较低（40mg/dL），免疫反应性胰岛素为 16.9μU/mL，C 肽水平较高（4.8ng/mL）。计算机断层扫描和磁共振成像显示胰腺钩突有一个 7 毫米的肿瘤。选择性动脉钙注射试验表明肠系膜上动脉增加。诊断为胰腺钩突胰岛素瘤，并计划使用人工胰腺进行肿瘤剜除术，以控制术中及术后血糖。从手术开始就出现了低血糖（血糖 38mg/dL）。如果血糖水平≤70mg/dL，则不能使用人工胰腺；因此，给予持续葡萄糖输注。血糖突然升高促使设备输注胰岛素，导致低血糖。当引入人工胰腺时，控制血糖水平具有挑战性。然而，改变设备的血糖控制算法控制了血糖波动，术中平均血糖水平升高至 94.8±21.1mg/dL，从而避免了低血糖，即血糖水平≤70mg/dL。我们报告了一例在胰岛素瘤手术中使用人工胰腺进行血糖控制的病例。
