经脐单切口腹腔镜胰腺大部切除术治疗高胰岛素血症的应用研究

Efficacy of single-incision laparoscopic 90% pancreatectomy for persistent hyperinsulinemic hypoglycemia in infants

目的通过研究经脐单切口腹腔镜胰腺大部切除术治疗持续性婴儿高胰岛素血症性低血糖(persistent hyperinsulinemic hypoglycemia of infancy,PHHI)的技术和效果,探讨该技术的可行性和有效性。方法2011年7月至2015年2月,3例患儿因出生后持续性低血糖于内科诊断为PHHI。所有患儿于香港养和医院行核素扫描,诊断为弥漫性高胰岛素血症。经药物治疗后,低血糖症状未见明显好转,遂接受胰腺部分切除术治疗。术中采用经脐单切口腹腔镜行胰腺部分切除术。首先探查整个胰腺有无局灶性结节,本研究中3例患儿胰腺未见局灶性病变,采用胰腺大部切除术(切除90%左右的胰腺组织)治疗。术后对所有患儿进行跟踪随访,内容包括术后低血糖症状缓解与否,定期复查血胰岛素、血糖浓度等。结果所有患儿均成功接受经脐单切口腹腔镜胰腺大部切除术治疗,无中转开腹者。手术时间120~230min,术中出血量较少,无输血者。术后腹腔引流时间为4~5d。术后住院时间为6d。术后病理诊断为弥漫性胰岛细胞增生症(diffuse nesidioblastosis)。术后空腹血糖浓度较术前升高(术前:0.54~1.8mmol/L,平均1.19mmol/L;术后:4.38~8.9mmol/L,平均6.82mmol/L),术后空腹血胰岛素浓度较术前降低(术前:14~33.3μU/ml,平均25.7μU/ml;术后:2.4~5.5μU/ml,平均3.7μU/ml)。迄今为止随访4~46个月,随访期间3例患儿血糖浓度和血胰岛素浓度恢复正常,未出现复发。术后无胰瘘、胰腺炎等并发症发生者。结论经脐单切口腹腔镜胰腺大部切除术是治疗PHHI安全而有效的治疗方法。

Objective To explore the efficacy and outcomes of single-incision laparoscopic 90% pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy (PHHI).Methods From July 2011 to February 2015,single incision laparoscopic 90% pancreatectomy was performed in three PHHI children.All of them received 18F-DOPA PET/CT preoperatively and diffuse physiologic 18F-DOPA activity was evident in entire pancreas.And the postoperative levels of blood glucose and insulin were recorded.Results Single-incision laparoscopic partial pancreatectomy was successfully performed in all cases.None of them required a conversion into a conventional multi-incision or open procedure.The operative duration was 120 to 230 min.Blood loss was minimal and there was no necessity for blood transfusion.The duration of postoperative abdominal drainage was 4 to 5 days. And the postoperative hospitalization length was 6 days.A definite diagnosis of diffuse nesidioblastosis was established histopathologically.The postoperative level of fasting blood glucose was higher than that of pre-operation (4.38-8.9vs.0.54-1.8mmol/L).And the postoperative level of fasting insulin was lower than that of pre-operation (2.4-5.5vs.14-33.3μU/ml).During a follow-up period of 4 to 46 months,the levels of blood glucose and insulin were restored in three children.There was no postoperative recurrence of hypoglycemia.Conclusions Single incision laparoscopic 90 pancreatectomy is both safe and effective for PHHI children.