Li Wei, Cheng Yali, Ma Qingyong, Wu Zheng, Wang Zheng
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, PR China.
Heliyon. 2025 Jan 10;11(2):e41799. doi: 10.1016/j.heliyon.2025.e41799. eCollection 2025 Jan 30.
Insulinoma is a rare pancreatic neuroendocrine neoplasm caused by pancreatic beta cell tumor or beta cell proliferation resulting in excessive insulin secretion. Due to its rarity, surgical analysis and summary studies on patients with insulinoma are few and the sample size is limited.
In this study, we retrospective the cumulative experiences including demographics, clinical characteristics, detailed surgical reports and postoperative outcome of 76 patients diagnosed with insulinoma from 2010 to 2020 at the First Affiliated Hospital of Xi'an Jiaotong University.
Our cohort consisted of 48 females and 28 males with an average diagnosis age of 52 years. Loss of consciousness (68 %), sweating (59 %), vertigo (56 %) are three most shown symptoms. The average time from symptom onset to diagnosis of insulinoma was 33.4 month. When CT combined with MRI was used, the diagnostic rate was as high as 96.87 %. Of the 76 patients, 48.68 % of preoperative tumors were in the head/neck, and the remaining 51.32 % were in the body/tail. Most of the patients received surgery for enucleation (65.79 %). The duration of surgery was 216 ± 105 min. The incidence of postoperative pancreatic fistula was 53.95 %. Postoperative pancreatic hemorrhage occurred in 6 patients (7.89 %), all of whom were pancreatic head/neck surgery patients. The incidence of pancreatic fistula, bleeding and major complications after the operation of pancreatic head/neck insulinoma was higher than that of pancreatic body/tail insulinoma.
CT combined with MRI can localize insulinoma in most patients. As a parenchyma-sparing pancreatectomy, enucleation is the procedure of choice if possible. The incidence of postoperative hemorrhage should be more vigilant after the surgery of pancreatic head/neck insulinoma. The intraoperative suture of high-risk vessels prone to bleeding should be performed if necessary.
胰岛素瘤是一种罕见的胰腺神经内分泌肿瘤，由胰腺β细胞瘤或β细胞增殖导致胰岛素分泌过多引起。由于其罕见性，关于胰岛素瘤患者的手术分析和总结研究较少，样本量有限。
在本研究中，我们回顾性分析了2010年至2020年在西安交通大学第一附属医院确诊为胰岛素瘤的76例患者的累积经验，包括人口统计学、临床特征、详细的手术报告和术后结果。
我们的队列包括48名女性和28名男性，平均诊断年龄为52岁。意识丧失（68%）、出汗（59%）、眩晕（56%）是最常见的三种症状。从症状出现到诊断胰岛素瘤的平均时间为33.4个月。当CT与MRI联合使用时，诊断率高达96.87%。在76例患者中，术前肿瘤位于胰头/颈部的占48.68%，其余51.32%位于胰体/尾部。大多数患者接受了剜除术（65.79%）。手术时间为216±105分钟。术后胰瘘发生率为53.95%。术后6例（7.89%）发生胰出血，均为胰头/颈部手术患者。胰头/颈部胰岛素瘤手术后胰瘘、出血及主要并发症的发生率高于胰体/尾部胰岛素瘤。
CT联合MRI可使大多数患者的胰岛素瘤定位。作为一种保留实质的胰腺切除术，剜除术在可能的情况下是首选术式。胰头/颈部胰岛素瘤手术后应更警惕术后出血的发生。必要时应对易出血的高危血管进行术中缝合。
