Gagner M, Pomp A, Herrera M F
Department of General Surgery, Cleveland Clinic Foundation, OH 44195, USA.
Surgery. 1996 Dec;120(6):1051-4. doi: 10.1016/s0039-6060(96)80054-7.
Diagnostic laparoscopy and laparoscopic ultrasonography have been applied recently for diagnosis and localization of islet-cell tumors. A further step was taken by performing resection of these tumors with laparoscopic techniques.
We studied a retrospective series of 12 patients operated on with laparoscopic techniques since January 1992. The seven female and five male patients had a mean age of 43 years. The mean tumor size was 3 cm. Thirty-six percent of the tumor site could not be identified before operation. Eight patients underwent planned laparoscopic distal pancreatectomy (five insulinomas, two gastrinomas, and one unknown origin), and four underwent planned laparoscopic enucleation (one insulinoma and three unknown origin). Of the eight distal procedures, three had conversions (one inability to localize the tumor and two metastatic gastrinomas). Average operating time was 4.5 hours, with an average hospital stay of 5 days. Of the four explorations for possible enucleation, one was performed and one was converted to a Whipple procedure for nesidioblastoma of the head of the pancreas. The other two had negative explorations. The successful enucleation of an insulinoma of the anterior body of the pancreas was performed in 3 hours, and the hospital stay was 4 days. No recurrence was seen in the enucleated or distal pancreatectomy group in follow-up (15 to 38 months).
Laparoscopic enucleation or resection of benign islet tumors results in a shorter hospital recovery and is a good alternative to open surgery.
诊断性腹腔镜检查及腹腔镜超声检查近来已应用于胰岛细胞瘤的诊断及定位。利用腹腔镜技术对这些肿瘤进行切除是更进一步的举措。
我们回顾性研究了自1992年1月起采用腹腔镜技术手术的12例患者。7例女性和5例男性患者的平均年龄为43岁。肿瘤平均大小为3厘米。术前36%的肿瘤部位无法确定。8例患者接受了计划性腹腔镜远端胰腺切除术（5例胰岛素瘤、2例胃泌素瘤和1例来源不明），4例接受了计划性腹腔镜摘除术（1例胰岛素瘤和3例来源不明）。在8例远端手术中，3例中转开腹（1例无法定位肿瘤，2例为转移性胃泌素瘤）。平均手术时间为4.5小时，平均住院时间为5天。在4例可能进行摘除术的探查中，1例成功进行了摘除，1例因胰腺头部胰岛细胞瘤转变为惠普尔手术。另外2例探查结果为阴性。胰腺体部前部的1例胰岛素瘤成功摘除，用时3小时，住院时间为4天。随访（15至38个月）期间，摘除术组或远端胰腺切除术组均未见复发。
腹腔镜摘除或切除良性胰岛肿瘤可使患者住院恢复时间缩短，是开放性手术的良好替代方案。
