인슐린종의 임상적 분석
Clinical Analysis of Insulinoma
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Insulinoma is a rare disease for which early diagnosis followed by proper surgical management provides a chance for cure. Analyses of clinicopathological features of patients can help optimize the surgical approach in the treatment of insulinoma. Methods: The records of 13 patients (seven male, six female mean age 44.3 years; age range 17∼62 years) who were diagnosed clinically and pathologically with insulinoma and who underwent surgery between March 1997 and April 2007 at the Department of Surgery, Seoul National University Hospital. Hospital in English please were retrospectively examined. Results: All patients had findings compatible with Whipple’s triad. Mean fasting blood sugar was 40.5 mg/dl, serum insulin level was 33.5μU/ml, and insulin-to-glucose ratio was 0.6. A prolonged starvation test was performed on six patients. Tumors were localized in 10 patients with a computed tomography (CT) scan and in three patients with CT angiography. Five tumors were located in the pancreas head and uncinate process, five in the body, and four at the body-tail border and tail. Patients underwent resection of tumorby enucleation, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy, laparoscopic distal pancreatectomy, and duodenum-preserving resection of pancreas head. Four immediate postoperative complications (fluid collection, pancreatic fistula, delayed gastric emptying) occurred. No symptoms or recurrences were apparent during the median 15 month follow-up. Conclusion: Insulinoma is difficult to diagnose correctly without a prolonged duration of symptoms. Localization of insulinoma can be aided by a CT scan and/or CT angiography. Less aggressive operative procedures such as sim ple enucleation might be a sufficient and feasible procedure for curative resection of benign insulinomas. (Korean J Endocrine Surg 2010;10:99-105)
Abstract
Purpose: Insulinoma is a rare disease for which early diagnosis followed by proper surgical management provides a chance for cure. Analyses of clinicopathological features of patients can help optimize the surgical approach in the treatment of insulinoma. Methods: The records of 13 patients (seven male, six female mean age 44.3 years; age range 17∼62 years) who were diagnosed clinically and pathologically with insulinoma and who underwent surgery between March 1997 and April 2007 at the Department of Surgery, Seoul National University Hospital. Hospital in English please were retrospectively examined. Results: All patients had findings compatible with Whipple’s triad. Mean fasting blood sugar was 40.5 mg/dl, serum insulin level was 33.5μU/ml, and insulin-to-glucose ratio was 0.6. A prolonged starvation test was performed on six patients. Tumors were localized in 10 patients with a computed tomography (CT) scan and in three patients with CT angiography. Five tumors were located in the pancreas head and uncinate process, five in the body, and four at the body-tail border and tail. Patients underwent resection of tumorby enucleation, distal pancreatectomy, pylorus-preserving pancreaticoduodenectomy, laparoscopic distal pancreatectomy, and duodenum-preserving resection of pancreas head. Four immediate postoperative complications (fluid collection, pancreatic fistula, delayed gastric emptying) occurred. No symptoms or recurrences were apparent during the median 15 month follow-up. Conclusion: Insulinoma is difficult to diagnose correctly without a prolonged duration of symptoms. Localization of insulinoma can be aided by a CT scan and/or CT angiography. Less aggressive operative procedures such as sim ple enucleation might be a sufficient and feasible procedure for curative resection of benign insulinomas. (Korean J Endocrine Surg 2010;10:99-105)
참고문헌 (30)
- Abboud B, "Occult sporadic insulinoma: localization and surgical strategy", World J Gastroenterol, 14, pp.657~665 (2008)
- Tucker ON, "Conlon KC. The management of insulinoma", Br J Surg, 93, pp.264~275 (2006)
- Leow MK, "Clinical utility of selective intra-arterial calcium-stimulated hepatic venous sampling in regionalisation of insulinomas--the Singapore experience", Ann Acad Med Singapore, 32, pp.86~91 (2003)
- 안지영, "췌장 인슐린종에 대한 진단과 치료", 대한외과학회지, 67(2), pp.129~134 (2004), 대한외과학회
- Chang HJ, "Insulinoma of the pancreas", J Korean Surg Soc, 47, pp.256~266 (1994)
- Kim JH, "Insulinoma", J Korean Surg Soc, 50, pp.874~883 (1996)
- 이선혁, "단일기관에서 경험한 췌장 인슐린종의 임상특성 및 치료성적", 대한외과학회지, 72(2), pp.128~132 (2007), 대한외과학회
- 유영경, "췌장 인슐린종", 대한외과학회지, 64(6), pp.498~504 (2003), 대한외과학회
- Cryer PE, "Symptoms of hypoglycemia, thresholds for their occurrence, and hypoglycemia unawareness", Endocrinol Metab Clin North Am, 28, pp.495~500 (1999)
- Service FJ, "The prolonged fast", J Clin Endocrinol Metab, 85, pp.3973~3974 (2000)
- Ramage JK, "Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours", Gut, 54(Suppl 4), pp.1~16 (2005)
- Aoki T, "Evaluation of preoperative and intraoperative arterial stimulation and venous sampling for diagnosis and surgical resection of insulinoma", Surgery, 126, pp.968~973 (1999)
- Lo CY, "Role of laparoscopic ultrasonography in intraoperative localization of pancreatic insulinoma", Surg Endosc, 14, pp.1131~1135 (2000)
- Morita S, "Preoperative localization of pancreatic insulinoma by super selective arterial stimulation with venous sampling", Abdom Imaging, 32, pp.126~128 (2007)
- Fidler JL, "Preoperative detection of pancreatic insulinomas on multiphasic helical CT", AJR Am J Roentgenol, 181, pp.775~780 (2003)
- Gouya H, "CT, endoscopic sonography, and a combined protocol for preoperative evaluation of pancreatic insulinomas", AJR Am J Roentgenol, 181, pp.987~992 (2003)
- King AD, "Dual phase spiral CT in the detection of small insulinomas of the pancreas", Br J Radiol, 71, pp.20~23 (1998)
- Rappeport ED, "Multidetector computed tomography and neuroendocrine pancreaticoduodenal tumors", Acta Radiol, 47, pp.248~256 (2006)
- Hiramoto JS, "Intraoperative ultrasound and preoperative localization detects all occult insulinomas; discussion 1025-6", Arch Surg, 136, pp.1020~1025 (2001)
- Huai JC, "Localization and surgical treatment of pancreatic insulinomas guided by intraoperative ultrasound", Am J Surg, 175, pp.18~21 (1998)
- Kalafat H, "Intraoperative doppler ultrasound: a reliable diagnostic method in insulinoma", Hepatogastroenterology, 54, pp.1256~1258 (2007)
- Wong M, "Intraoperative ultrasound with palpation is still superior to intra-arterial calcium stimulation test in localising insulinoma", World J Surg, 31, pp.586~592 (2007)
- Berends FJ, "Laparoscopic detection and resection of insulinomas", Surgery, 12, pp.386~391 (2000)
- Jaroszewski DE, "Laparoscopic localization and resection of insulinomas", Arch Surg, 139, pp.270~274 (2004)
- Doherty GM, "Results of a prospective strategy to diagnose, localize, and resect insulinomas", Surgery, 110, pp.989~996 (1991)
- Soga J, "Insulinoma", hypoglycemic syndrome: a statistical evaluation of 1085 reported cases of a Japanese series, 1998, pp.17, 379~388
- Ayav A, "Laparoscopic approach for solitary insulinoma: a multicentre study", Langenbecks Arch Surg, 390, pp.134~140 (2005)
- Sa Cunha A, "Laparoscopic versus open approach for solitary insulinoma", Surg Endosc, 21, pp.103~108 (2007)
- Iihara M, "Minimally invasive endocrine surgery: laparoscopic resection of insulinomas", Biomed Pharmacother, 56(Suppl 1), pp.227~230 (2002)
- Liu H, "Strategy for the surgical management of insulinomas: analysis of 52 cases", Dig Surg, 24, pp.463~470 (2007)